Panic/Anxiety Disorders
What are Panic/Anxiety Disorders?
Generalized Anxiety Disorder (GAD) is chronic, excessive anxiety and worry about simple day-to-day events. The patient feels worried and tense even when there is no real cause. People with symptoms of GAD can’t stop worrying about health, money, family, work or school so much that it interferes with daily activities and relationships. Generalized Anxiety Disorder usually begins at an earlier age and symptoms may manifest themselves slowly over time. Social function and quality of life are adversely affected to a large extent.
Panic attacks may be a result of an anxiety disorder. These attacks are a serious health problem for people in the age group of15 to 19 years. Once someone has had a panic attack – for example, while driving, while in a shopping mall or elevator, the person would develop phobias (irrational fears) about these situations and they may avoid shopping or driving altogether. A panic attack is different from GAD in that it is unexpected and temporarily disabling; whereas GAD is constant and chronic.
Symptoms of Panic/Anxiety Disorders
GAD is chronic and the symptoms last for at least six months. They vary from case to case but some common symptoms are:
01) Excessive and continuous worry,
02) Restlessness,
03) Problems seem larger than they really are,
04) Headaches and muscle tension,
05) Irritability,
06) Excessive sweating,
07) Lack of concentration,
08) Nausea and frequent urination,
09) Bouts of trembling,
10) Exhaustion,
11) Edginess (being startled easily),
12) Sleeplessness.
A panic attack is a sudden, unjustifiable, short period of fear. It would typically last for several minutes. The attack is very distressing for the person and its symptoms are very close to those of a heart attack (there are other symptoms in the case of heart attack). They are:
01) Palpitations (racing or pounding heartbeat),
02) Profuse perspiration,
03) Trembling,
04) Breathlessness,
05) Choking sensation,
06) Chest pain
07) Nausea, stomach upset,
08) Dizziness or lightheadedness,
09) Tingling sensation in the hands,
10) Hot flushes or chills.
Diagnosis of Panic/Anxiety Disorders
Generalized Anxiety Disorder and Panic attacks both require specialized psychiatric attention. There are no specific laboratory tests for diagnosis, but the psychiatrist may conduct some tests to check for other physical ailments which could be the cause of the mental disorders.
Although the doctor diagnoses the severity of each case on reports of the duration of symptoms and degree of dysfunction, making a thorough study of the person’s medical history, family history, habits, diet, environmental influences, etc is essential to formulate accurate remedial measures. GAD is diagnosed only if the symptoms are constant and interfere with daily life. If the symptoms are sudden, short bursts of fear then they are considered panic attacks.
Causes of Panic/Anxiety Disorders
In a Panic attack, the alarm system of the person responds to an imaginary threat and is triggered even when there is no danger. Even today, psychiatrists do not know exactly why some people are more susceptible to the problem than others. The common causes of panic attacks are:
1) Genetic framework,
2) Post traumatic stress disorder after surgery, extreme emotional stress, etc,
3) Schizophrenia (personality disorder),
4) Medications like antidepressants, anticonvulsants taken over long periods of time,
5) Chronic alcoholism,
6) Smoking,
7) Pregnancy in some cases,
Drug abuse,
9) Panic attack as a withdrawal symptom from alcohol/drugs.
It is not clear why more women than men suffer from GAD (anxiety). Research on women’s responses to stress suggests that women experience a wider range of stressful life events as compared to men. Anxiety disorders are so heterogeneous that the factors causing GAD differ from case to case. But some common causes are:
1) Family history: Heredity shows a predisposition towards GAD.
2) Brain chemistry: There are special neurotransmitters or chemical messengers in the brain that move information between nerve cells. Abnormal levels of certain types of neurotransmitters can cause GAD as this can alter the way the brain reacts to certain situations.
3) Trauma: Stressful events like physical abuse, death of a loved one, divorce, change of environment, etc can be a cause too.
4) Substance abuse: Alcoholism or drug abuse can be a factor,
5) Addictives: Excessive smoking or coffee can also trigger symptoms of anxiety in some cases.
Types of Panic/Anxiety Disorders
Agoraphobia: The ancient term ‘agoraphobia’ is translated from Greek as ‘fear of an open marketplace’. This is a Generalized Anxiety Disorder (GAD) and can affect a person when he or she is awake. This has a disabling effect on the patients, as they develop unjustifiable fear of carrying out some routine tasks like being alone outside one’s home, traveling in a car, bus, or airplane, or being in a crowded place like a mall. This interferes with their daily life.
Nocturnal GAD: Panic attacks can manifest in the day as well as at night. The nocturnal panic attacks resulting from GAD cause the patient to wake up in sudden panic. These usually do not last for more than 10 minutes at a time, but to calm down such a person would take much longer than in the case of a daytime panic attack.
Treatment of Panic/Anxiety Disorders
For both GAD and panic attacks, the treatment is carried out on various fronts. Some methods are:
Cognitive Behavioral Therapy: GAD and panic disorders are responsive to counseling and psychotherapy. During the past several decades, time-limited therapies that teach the patient to better cope with anxiety have worked wonders.
Behavioral and relaxation techniques are used to help the patient better cope with the root cause of the symptoms. These methods include stress management techniques, aerobics for muscle relaxation, yoga and breathing exercises, curing alcoholism or substance abuse through counseling, etc.
Pharmacotherapy: The medications typically used to treat patients with anxiety disorders benzodiazepines, tri-cyclic antidepressants (TCAs), beta-blockers to cure physical symptoms, Selective Serotonin Reuptake Inhibitor (SSRI), etc are used for the treatment of GAD or panic.
However, dependency on anti-anxiety medications, sleepiness and sexual problems are some potential complications of pharmacotherapy. Hence, it is important that pharmacotherapy is closely monitored, as it might in some cases be life-threatening, especially in pregnant women or those who have suicidal tendencies.
Combination Treatment: Some patients may respond better to a combination or a sequential use of psychotherapy and pharmacotherapy treatment. This method has proved to be more cost-effective in severe cases.
Living with Panic/Anxiety Disorders
Generalized Anxiety Disorder (GAD) and Panic Disorder are common, emotionally disabling, serious ailments. But they are not organ or life threatening. At the same time, they are not to be taken lightly as they adversely affect the quality of the patient’s life. If detected in the early stages, the patient may respond well to treatment.
GAD may continue for years. Complications can develop like more frequent panic attacks; specific irrational phobias like fear of leaving home (Agoraphobia); avoidance of social functions; depression; work or school problems, suicidal thoughts or actions; financial problems, alcoholism or substance abuse, etc. Panic disorders are one of the risk factors of heart disease.
Medical personnel have to be very careful while handling patients with GAD or panic attacks. The patients may mistakenly assume that they do not have any ailments and treatment is not necessary if the doctor says, “There’s nothing to worry about. It’s all in your head.”
Prevention of Panic/Anxiety Disorders
GAD and Panic Disorder cannot really be prevented. But once diagnosed, subsequent incidences can be prevented in some cases:
1) Diet: The most crucial of all is changing over to a more balanced food diet.
2) Exercise: Focusing on fitness with the help of gym or aerobics can also help.
3) Caffeine/Colas: Avoid consuming coffee, tea, colas and chocolates, which perk you up for a while and then cause depression.
4) Change medication: If you are on medication for some other physical ailment, replace it with an herbal substitute which has no side-effects, after consulting your doctor.
5) Counseling: After a traumatic or distressing experience like divorce, death of a loved one, etc, if the event is adversely affecting your daily life, seeking counseling and psychological help in time would prevent the onset of these disorders.
The World Mental Health statistics say that in America alone 6.8 million adults suffer from GAD or panic disorder. The risk is highest between childhood and middle age. About 80% of the GAD patients have frequent panic attacks, but appropriate treatment and lifestyle changes have substantially reduced the severity and frequency and given relief to about 70% of people with panic disorder cases.
