| Panic Attacks - what they are and how
to cope with them. by Hal Brown, LICSW Revised June 25, 2000
Just as they are not immune to depression, farmers who like to see themselves as strong and self-reliant are as susceptible to panic disorder as the general population. That's one reason discovering one has a panic disorder can be so embarrassing. It isn't unheard of for farmers having been rushed to the hospital for a possible heart attack, only to find out it was a panic attack, to claim it was something "respectable" like food poisoning. If you don't believe me, next time you're in the emergency room, ask a nurse how many patients come in with symptoms of a heart attack, have their EKG and blood work, and leave two hours later with nothing more than a prescription for Valium. While the causes of panic disorder are not fully understood, this much has become clear in the past few years. Like with depression, panic disorder seems to be a physiological condition caused by a glitch in the way the neurotransmitters in the brain handle certain chemicals, most notably serotonin. Although the medical jury is still out on exactly why it is so, there is no doubt that the medications, like Prozac, that work so successfully to lessen or eliminate depression, also lessen or eliminate panic attacks. Tranquilizers like Valium, Xanax or Klonopin taken every day will also work, and will lessen the severity and duration of a panic attack if taken right at the start of one, but their mechanism of action is different than the antidepressants. There are few other non-life threatening physical experiences as frightening as a person's first panic attack. While most panic disorders emerge in the late teens or early twenties it is not uncommon for people to have their first panic attack at any age. Panic disorder can come on when you anticipate a stressful situation, during one, or for no apparent reason. Most people find the last kind the most disturbing because it seems to come from nowhere and have no cause except a life-threatening physical one. The symptoms of a panic attack are virtually all physical, and often mimic real life threatening disorders like heart attacks, pulmonary embolism or stroke. Anyone with any sense should call 911 or go to the emergency room if they have these symptoms.
Secondary symptoms which are experienced as physical, but almost immediately are interpreted in the worst possible way include:
All of these symptoms are perceived as indicative that something terrible and out of one's control is happening. Instead of flowing with the experience and letting it pass (as it almost always does in about an hour when people learn not to be afraid of their panic attacks), most people initially escalate and prolong their first panic attacks by their belief they are in dire jeopardy of dying. Treatment of Panic Attacks Panic attacks are usually easy to treat with a combination of medication and educative psychotherapy (sometimes called cognitive-behavioral therapy). Relaxation techniques have been used in the past but recent research shows they aren't as effective as previously thought. There are two approaches to medication. One is the every day regimen of an antidepressant or anti-anxiety drug. Antidepressants are the first choice rather than anti-anxiety drugs. In addition to being more effective for most people, they are easier to get off of than the anti-anxiety drugs which tend to have an anxiety-rebound effect. The second way to use medication is for people with less severe and less frequent panic attacks. They can use rapid acting anti-anxiety drugs when they feel a panic attack coming on. Sometimes a patient is started on both antidepressants and anti-anxiety medication for a few weeks until the antidepressants start to work, and then withdrawn from the anti-anxiety drugs. If you take a panic attack blocking medication that eliminates the attacks altogether there's no way you can learn to cope with them without medication, since you won't have them anymore if they are effective. In order to find out if you still are going to have panic attacks you have to taper off the medication. Then it takes a few weeks for the medication to fully be effective if you need to start again. If you rely on taking an anti-anxiety drug when a panic attack starts, you are probably getting the primary benefit from a placebo effect on the secondary psychological symptoms. This is because by the time the medication is in your bloodstream and gets to your brain to begin to work, you are already on the down side of the panic attack anyway. This is not necessarily a bad approach, because the medication will help you to relax and sometimes just knowing you have it available will help you ward off panic attacks when you get the initial sensation that one is coming on. Psychotherapy for panic attacks always includes learning about panic disorder, and learning how to differentiate a panic attack from life threatening disorders like heart attacks. People with panic disorders can have heart attacks, but these won't be brought on by the panic attack. Once you learn to recognize your own symptoms of panic attack, and are reassured by your doctor after taking an EKG, that you didn't have a heart attack, if you still worry that you are having one when you have a panic attack, insist on a referral for a stress EKG. It never hurts to have a second opinion from a specialist. Generally insurance will pay for this, especially if you are over 40. If after reassurances from your physician, and psychotherapy, you can't stop worrying about a stroke, you should try to get your insurance company to pay for a CAT scan at the least, or preferably an MRI, just to reassure yourself. If they won't pay it may be worth it to pay yourself. The same goes for any medical condition you find you can't stop worrying about when you have a panic attack. Some therapists may disagree with me on this, but I believe factual medical understanding of these things does not promote hypochondria but lessens it. No matter what, everyone should remind themselves as a panic attack seems to be starting that the worst than can happen is that they will experience the same symptoms they've had many times before, for about the same length of time, and then it will be over. If they aren't at home they should make their way to the safest feeling close-by place they can find and wait out the attack. When out in public, people who suffer from anxiety attacks tend to be so embarrassed that they wrongly assume that all passers by can see their distress. In fact, most panic attack symptoms are internal, and nobody notices. Another approach some people find effective is desensitization. While medical researchers can bring on the symptoms of a panic attack with certain drugs, you can do it yourself to some extent through physical exertion. That way you can become more comfortable with the sensations of a racing, pounding heart, profuse sweating. You can make yourself feel nauseous and light headed by spinning around. What makes panic attacks so frightening isn't that the physical sensations are so unusual, it's that they come on without warning, suddenly, and often all at once. Then if you interpret these feelings to mean you're about to die, it adds fear to the panic and obviously, the overall effect is that much more dreadful. If you are worried that you may have a panic attack when you are driving and get into an accident, rest assured that neither I or any therapists I know have ever heard of this happening. In fact, that's a difference between a stroke or heart attack and a panic attack. The former can cause a fatal car accident. With a panic attack while driving you can always manage to get to the side of the road, and generally can even drive home or to a safe place. In your profession, most accidents occur from sleep deprivation, and that is something you can do something about. What can happen if you don't get treatment for a panic disorder Sometimes panic disorders just go away. Some people have one and never have another. Other's have them for years, move or change jobs, and they disappear. However, a panic disorder can lead to a person avoiding doing things and going places which seem to bring them on. These are often situations that bring them in contact with people. They can develop agoraphobia which at it's worst makes people so afraid they can't leave home. People have to quit their jobs, drop out of school, and even have others do their shopping for them. More likely, without treatment, people just lead unhappy lives never knowing when a good time, or work, will be interrupted by a panic attack. They are overly attentive to bodily sensations and become hypochondriacs. They see their physicians and leave feeling foolish when told "it's all in your head". This is a shame because, like depression, panic attacks is one of the most treatable disorders of psycho-neurologic disorders. |
Panic disorder and the less severe anxiety disorders rank about equal with
depression in terms of numbers afflicted. There is ample information on the subject:
books, magazine articles, cyberpsychology web sites and periodic television specials.
However much information there is, it doesn't help those farmers who tend not to pay
attention to mental health issues until something happens to personally effect them.