Panic attacks are sudden, out of the blue attacks that make you feel anxious and panicky. There are usually physical symptoms associated including shortness of breath, sweating, dizziness, and nausea. The aim of treating panic disorder is to reduces or even get rid of the symptoms.
Like many other illnesses, the treatment of panic attacks will focus on two parts. These parts include the management of the acute attack. The first is the how to survive the attack when it is happening, and the second will be the maintenance treatment to prevent the severity of the attacks. Ultimately, if possible, we want to completely treat panic disorder into remission.
Strategies to manage a panic attack when you are having one or feel one coming on:
• Recognise that you are having a panic attack
Firstly, say to yourself “I am having a panic attack. The symptoms I am experiencing is due to a rush of adrenaline. The adrenaline is trying to save my life, so I am not ill. It was Passover in a few minutes.” Or something like this- choose your own script.
• Focus on your breathing
Slow down your breathing. Count if it helps, e.g. 4 counts in, hold for 7 counts, breath out for 8 counts.
• Try mindfulness
Being mindful is useful to notice that a panic attack is starting. If you are mindful, you will notice subtle changes in your body and thoughts.
• Move
Any movement can be beneficial. Aerobic exercises are good, so is stretching and walking. Choose what you enjoy and do it regularly.
• Try finding something to do which will work for you. E.g. finding a quiet spot and focus on a familiar object.
If you have an object you can carry with you, it can be very helpful. It can be a photo, a snack, a stress ball.
• Lavender
This one is new to me. Lavender came up in most of the articles I read whilst preparing for this article.
• Last resort- take anxiolytic
Many of my patients carry a couple of anti-anxiety pills with them. Sometimes they do not even use it, just the thought that they have something that will make them feel better helps to manage the panic attack.
Maintenance treatment:
1. Medication
Not all people who experience panic attacks need to take medication on a long-term basis. It will be recommended by your doctor if you and the doctor decide your symptoms warrant it. The medication that works best are the antidepressants that cause an increase of serotonin in the brain.
These antidepressants will include names like sertraline, citalopram, fluoxetine, paroxetine, escitalopram, and venlafaxine. The one is not better than the others (although I, like most psychiatrists will have their favourites). The choice of antidepressants sometimes depends on the side-effect profile. This means that people need different effects from their medication, so treatment is individualised.
It is important to start low- half the starting dose/ halve the tablet. And then go slow- slowly increase the dose to reach the effect you want. Also bear in mind that it is often necessary to go to a double dose eventually to treat panic attacks into remission.
2. Psychotherapy
Psychotherapy, or at least psychoeducation is crucial in the management of panic attacks. At the very least you should know what a panic attack is and how to manage it (psychoeducation). Psychotherapy can include a variety of modalities. CBT (Cognitive Behaviour Therapy) is the technique that is still supported by the most evidence.
In my practice I try to determine what is the underlying issue (s) with each patient. Some patients need treatment for PTSD (Post Traumatic Stress Disorder) or depression to recover.
3. Other maintenance tips:
Give up coffee. And look out for “hidden” caffeine in other drinks like tea.
Learn to be mindful.
Get enough sleep.
Exercise.
What happens after I overcome panic disorder?
Panic disorder is seen as a chronic problem. There is probably a genetic component for most patients with sever panic disorder. This means that it will not be easy (or even possible) to change into a carefree, chilled type of person if you have been anxious for a long time.
However, I have many patients who improved so much that they do not need medication anymore. There is single route to recovery. As with anything in life, some people are “lucky” and get results quicker.
Anyone can learn how to cope better with panic attacks. There is a sense of losing control when we get panic attacks, but we can take back control.
To read more about The Brain and Panic Attacks click on the following link.