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Dealing with Panic Attacks

“I can’t exactly describe what I’ve been going through Dr. Rayel. But it’s really weird. I’m overwhelmed and I don’t know what to do. I need help.”

This is a typical statement I’ve heard from individuals suffering from panic disorder. To describe to you the clinical manifestations of this illness, let me tell you a hypothetical case.

Susie sobs as she narrates her experiences for the past several months. One typical day while she’s doing her chores, she suddenly develops an “overwhelming” sensation all over her body. She’s sweaty and tremulous, and feels that her heart is pumping fast. Within a few seconds, she also suffers from chest pain and shortness of breath. This episode has lasted for about 20 minutes but she feels that this was her worst 20 minutes of her life.

Since then, Susie has been experiencing “horrible” anxiety attacks almost daily. When she has this episode, she feels that she’s about to die or suffer from stroke or heart attack.

Overwhelmed by her experience, she stays away from friends and relatives and avoids big crowds. Moreover, Susie can’t anymore do her usual activities. She is afraid to leave the house and go to work.

Susie’s experience is typical of someone with Panic Disorder. A person with this disorder develops anxiety attacks associated with physical changes such as fast heart beat, shortness of breath, chest pain or tightness, fainting episodes, sweating, and tremors. In addition, thoughts that he or she would die or develop a stroke or heart attack are common

An episode is usually sudden, described as coming “out of the blue,” and usually not precipitated by any triggers. It can therefore happen any time and anywhere. An attack can last from a few seconds to several minutes.

One episode can make a person feel scared of having another one. So many people with this condition feel distressed anticipating the occurrence of another attack. As a consequence, they prefer to stay at home and isolate themselves from friends, co-workers, and even relatives. Eventually, they become incapacitated.

If you’re like Susie, is there any treatment that can help?

Yes, there is. Individuals with panic disorder are successfully treated with antidepressants such as the serotonin-reuptake inhibitors. Usually, the dose should be started low, for instance 10 mg/day of citalopram or 25 mg/day of sertraline. After a few weeks, the dose should gradually increase if the person’s clinical status requires it.

Cognitive behavior therapy is likewise effective. This “talk psychotherapy” helps the individual change his or her thinking. Negative thought processes associated with the illness should be addressed in therapy because they create more harm than good.

Behavioral intervention should also help. Gradual exposure to a crowd can make individuals feel comfortable with social situations. Relaxation techniques such as breathing exercises or progressive muscle relaxation should help in dealing with anxiety-provoking triggers.

During treatment, patience is imperative because it takes a while before any treatment intervention works. However, don’t despair. After a few weeks, the medication and talk therapy should start working and should give you a feeling of comfort.

What’s the role of benzodiazepines (for example: lorazepam, diazepam, or clonazepam) in the treatment of panic disorder?

This drug can provide acute relief but should be used only on a short-term basis, perhaps for only three to four weeks, because of its addiction potential. It also causes memory lapses, thus it can potentially put some people at risk when driving or using mechanized equipment.

For long-term treatment, the combination of antidepressant and psychotherapy is still preferable.

by Michael G. Rayel, MD -

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Dr. Michael G. Rayel - author, game inventor, and psychiatrist - has created the Oikos Game Series to promote emotional health and has provided EQ Webinar for parenting, personal, and career success. For more info, visit or