(48) Depression

Panic disorder

Recurring panic attacks can occur with no warning, although they can be linked with specific situations, e.g. an open space, a crowded shop, or heights. There is a sudden intense feeling of fear and apprehension with a variety of bodily sensations that may include palpitations, shortness of breath, sweating, faintness, nausea, chest discomfort and pins and needles in the hands and feet (sometimes around the mouth). This is such an unpleasant experience that, not surprisingly, a so-called ‘anticipatory fear’ develops – a fear of panic occurring and a fear of loss of control.

Approximately one-third of people who experience panic attacks are clearly clinically depressed. For the two-thirds who are not, the response to antidepressant medication is still impressive.

I had a sudden choking feeling for no reason at all at college the other day. I’ve had several since term started. I feel I can’t breathe, my pulse races, and I think that I’m going mad. The doctor said it’s not my heart, but a panic attack. What causes these panic attacks?

Some small, perhaps scarcely noticeable thought or feeling triggers anxiety. The body picks this up and reacts to it in an exaggerated way. Adrenalin is released, which raises your pulse rate and alerts you. You then perceive this and interpret it as something badly wrong, something physical. This in turn causes more anxiety and a vicious cycle results of anxiety, arousal and terror. It tends to happen to people who are highly stressed, and may occur with depressive illness, when your coping reserves are low.

People may get chest pains, dizzy attacks, trembling, sweating, palpitations, choking, or feelings of unreality and detachment. They may breathe extra fast and breathe off too much carbon dioxide from their bloodstream, causing tingling in their arms and face. This experience may be terrifying. One useful trick to stop hyperventilation is to breathe in and out of a big paper bag for five minutes. This restores the normal balance of blood gases, and will stop your hands and face tingling.

Maybe 1 person in 10 has a panic attack at some time – they are quite common. Panic attacks, although very unpleasant, do not cause lasting physical harm.

How can I deal with these panic attacks? What can I do to prevent them?

See your doctor for a physical checkover, to exclude any other physical causes of these symptoms. Panic disorder can be mimicked by some medical problems, such as an overactive thyroid or disturbance of heart rhythm. Your doctor may want to do a blood test and possibly an ECG.

You can help yourself by reducing alcohol, caffeine, and nicotine (all these can increase anxiety). Be particularly careful not to use alcohol as a tranquilliser. Remember it is habit-forming; italso causes rebound anxiety, i.e. later, the anxiety is worse than before you had the drink. Do not avoid places or situations where panic attacks have happened. This could reinforce your anxiety and make it worse.

Some advice for a panic attack

If you have an attack:

Do not rush off or run away (that would increase your adrenaline output and make you more excited), but stay put.
Practise deep, controlled, steady breathing.
Try to concentrate on some outside object rather than thinking about how you feel.
Learning meditation techniques can help distract your mind from its own anxiety.

Cognitive behavioural therapy (CBT) has been shown to be a good treatment. Consider also contacting one of the self-help organizations such as No Panic, or Triumph over Phobia.