When Panic Strikes

When Panic Strikes

On 24 November, Dhananjay Chaturvedi, a 32-year-old entrepreneur, was heading home after a hectic day. It was around 8.30pm and Chaturvedi remembers being very tired. “Suddenly my breathing got laboured, I started perspiring excessively and shaking. By the time I reached home, I was gasping for breath, but somehow I managed to call my brother, who was at home." Chaturvedi was rushed to hospital. There, after a thorough clinical examination and an ECG (electrocardiogram), he was informed that he had not suffered a heart attack as he had feared, but a panic attack. Chaturvedi had been very stressed at work that month and feels this could have been the precipitating factor.

What is a panic attack?

Panic attacks involve sudden fear, anxiety or extreme discomfort. They may occur sporadically or as part of an anxiety disorder, such as panic disorder, social anxiety disorder or phobias. “Complications, which are symptoms that can develop as a result of continued panic attacks, may include specific irrational fears (phobias), especially of leaving home (agoraphobia), avoidance of social situations, depression, work-related problems, suicidal thoughts, financial problems, and alcohol or other substance abuse," says J.M. Wadhawan, chairperson, department of psychiatry, Sir Ganga Ram Hospital, New Delhi.

The tendency for panic attacks often runs in families, and this may mean that genes plays a strong role in determining who will get it, according to Surbhee Soni, clinical psychologist, Fortis La Femme Hospital, Delhi. As was the case with Chaturvedi. Both his father and grandfather suffered on and off from panic attacks.

“However, many people who have no family history of the disorder also develop it," says Soni. “Often stress is a major precipitating factor. In fact, young people especially in the age group of 25-35 years are more prone to panic attacks these days." People today live pressure-cooker lives and are forever grappling with environmental challenges, such as relationship issues or exam stress, and internal adjustment issues as they race to build careers and family. Those who find it difficult to cope and already have an anxious temperament are more susceptible to such attacks.

There is also an association between major life transitions and an increased incidence of panic attacks, be it graduation, starting a career, getting married or having a baby. Soni recalls the case of a 24-year-old woman who walked into the OPD complaining of hyperventilation (trying to breathe very fast), slurring of speech, constant tingling in the body and frequent blackouts—all symptoms of a panic attack. “On examination we found that all her symptoms were purely psychological and she was subconsciously bringing them on to avoid the pressure that her parents were putting on her to get married to someone she didn’t want to," she says.

“Sometimes the cause can be medical too: Mitral valve prolapse (when one of the heart’s valves doesn’t close correctly), hyperthyroidism, hypoglycaemia, stimulant use (amphetamines, cocaine, caffeine) and medication withdrawal," says J.P.S. Sawhney, honorary senior consultant and chairperson, department of cardiology, Sir Ganga Ram Hospital, Delhi.

While the symptoms of such attacks are the same in both men and women, the former are more prone to them. “Panic disorders are twice as common in men compared to women. Also shy, inhibited, cautious, or introverted children or those who had either an over-protected or an excessively difficult childhood may be more prone to a panic attack later in life. Worriers, obsessive thinkers, emotionally sensitive individuals, or those with low self-esteem tend to be prime cases of people who suffer from such attacks," says Soni. Sometimes, perfectionists, or “type A" personalities, who want to be able to control everything, may also be susceptible, she adds.

Mimicking your heart

A panic attack typically lasts for several minutes (usually about 10 minutes) and is one of the most distressing conditions a person can experience. “Its symptoms—suffocation, restlessness, palpitation, a choking feeling, etc.—closely mimic those of a heart attack, making it difficult for a layman to distinguish between the two conditions," says Dr Sawhney. “When we get such a patient, a clinical examination, comprehensive history analysis and an ECG is done. Such patients mostly have temporary high blood pressure (systolic) and a high pulse rate but when heart disease is ruled out, they are usually referred to a psychiatrist or a psychologist for further treatment," he adds.

Treatment at hand

“There is little reason to worry if you’ve had just one panic attack. But if the episodes are frequent and are left untreated, it can lead to panic disorder and other problems such as withdrawal from normal activities. Sometimes anxiety may even worsen to the point where the person’s life is seriously affected by panic attacks," warns Dr Wadhawan.

It is possible to treat the cause of these attacks. Treatment is usually therapeutic, with cognitive behavioural therapy and relaxation methods being applied, and pharmacological, with medication being prescribed. “Which route is followed depends on the underlying cause, symptoms and their severity. Sometimes both treatments may be used simultaneously," says Soni. In the case of the 24-year-old lady patient mentioned earlier, behaviour modification worked wonders—her irrational thoughts were transformed into rational ones through a process of self-realization.

Chaturvedi says he underwent a total lifestyle change. “I consciously worked on my stress levels, began meditation, gave up smoking, started eating meals at regular times (earlier, the only meal I would have sitting down was dinner) and on my doctor’s prescription, started blood pressure medications. Today I am happier and healthier and am sure that panic attack won’t move on to a full-blown panic disorder in my case," he says.

Are you prone to panic attacks?

If you are “forever agitated, restless, take frequent trips to the loo, experience perpetual dryness of mouth, get anxious at small challenges, have a tendency to lose (your) cool and get angry at the smallest of provocations, snap at people, have dull throbbing headaches or shoulder and neck pain—these are signals that our body gives before a panic attack. If you see these signs, schedule a review with a doctor," advises Surbhee Soni, clinical psychologist, Fortis La Femme Hospital, New Delhi.

Mastering IT

Self-help tips to counter attacks

•Avoid cigarettes, coffee and other caffeinated beverages. Also, be careful with medications that contain stimulants, such as diet pills.

•Practise relaxation techniques. When practised regularly, yoga, meditation and progressive muscle relaxation strengthen the body’s relaxation response, which helps fight anxiety and panic.

•Learn about panic. Read up on it, and find out if it runs in the family. The information will help you stay on guard and also teach you how to tackle it right.

•Take quick action. If you feel a panic attack coming up, immediately sit down somewhere, close your eyes and breathe in and out deep from your gut at least five times.

•Deep breathing can relieve the symptoms of panic as this helps people to calm down when they begin to feel anxious.

—Surbhee Soni, clinical psychologist, Fortis La Femme Hospital, New Delhi.

From panic attacks to heart attacks

A comprehensive study of 57,615 adults with a diagnosis of panic attack or panic disorder and 347,000 participants without panic symptoms, done by British researchers (published in the ‘European Heart Journal’, 2008), found that the incidence of heart disease and heart attack was especially high for younger study participants (under the age of 50) with panic symptoms. Based on this study, the researchers suggested that those with panic disorder or a history of panic attacks should be appropriately screened for heart disease. “Today’s panic attack can be tomorrow’s heart attack," warns Upendra Kaul, executive director, cardiology, Escorts Heart Institute and Medical Research Centre, New Delhi.

Psychological strain which is caused as a result of panic attacks has been linked to coronary heart disease. Panic attacks are also associated with other cardiovascular risk factors, such as hypertension. Alternatively, anxiety could contribute to adverse cardiovascular effects, such as coronary artery spasm, tendency towards increased blood clotting or disturbances in heart rhythm", he says

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