Medication and talk therapy may help with panic disorders

Anxiety & mental health

Dear Doctors: Can you please talk about panic attacks? Each time I have one, I can't eat, sleep or socialize. The medication I was given has severe side effects. Are there other treatments or other things I can do? Sometimes just my thoughts trigger an attack, and I'm in it for a month with no relief.

Dear Reader: A panic attack is the sudden onset of a wave of anxiety or fear that is so powerful, it causes physical symptoms. Many people find the combination of emotional and physical distress to be so disturbing that it amplifies the attack. The fact that panic attacks occur out of the blue, without a discernible cause or trigger, makes them all the more upsetting.

These episodes often begin with an intense emotional sensation that jolts the person from the natural flow of daily life. For some, it can be a sense of impending doom or great danger. Others have described a profound sense of detachment or isolation.

These are often accompanied by physical symptoms that can include a racing or pounding heartbeat, difficulty breathing, cold sweat, chills, nausea, vertigo, abdominal distress, uncontrolled trembling or chest pain. Some people experiencing a panic attack fear it signals a permanent loss of control. For others, the symptoms are so intense, they believe they are having a heart attack.

Many of us will experience a panic attack once or twice over the course of our lifetimes. But when they occur repeatedly, they fall into a category known as panic disorder. As you described in your letter, living with a panic disorder can be extremely isolating. That makes it important to seek treatment. A physician or a mental health professional will understand the scope of what you are going through and can provide a source of support.

Unfortunately, there is no single treatment for panic disorder. For many people, a combination of medication and talk therapy can be helpful. Certain antidepressants and anti-anxiety medications have been shown to be effective. Some doctors will prescribe a class of drugs known as benzodiazepines, which can help blunt the force of a panic attack that is in progress.

There is also evidence that the old suggestion of breathing into a paper bag for a short period of time can provide relief. This is based on research linking panic attacks to an imbalance in blood pH, in which too much oxygen has caused the blood to become alkaline. The idea is that breathing in the carbon dioxide that is exhaled into the bag restores optimal blood pH, which may then ease the attack.

We urge you to talk to your doctor about the side effects you experienced when taking the medication that was prescribed. It is possible that a different drug may confer similar benefits without causing distress. And if you haven't already, give talk therapy a try. A therapist can guide you in exploring the potential situations, emotions or events that may be triggers for these attacks. They can also help identify specific coping methods that work for you.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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