Panic disorders are no fun.
Not only do you actually get terrifying panic attacks that leave you hyperventilated and incredibly anxious, but you have to live with the overarching fear that something might trigger your next attack.
Fortunately, panic disorders are treatable.
Tackling a panic disorder takes time, understanding, and a lot of diagnostic work. There is no simple way to overcome a panic disorder, as every individual has their own set of unique circumstance and triggers.
You need to approach treatment with patience and care.
Today, I want to explore what a panic disorder is and ways you might approach coping with it.
What is Panic?
A panic attack, or anxiety attack, is different from pure hyperventilation or a life-threatening heart attack, but similar enough to pose a concern for many. While heart attacks are typically physically-based and involve a problem with the heart as a functioning muscle, and hyperventilation is a symptom or physical response often accompanying a full-blown panic attack, panic attacks themselves are psychological and can best be described as an overreaction of your adrenal system, reacting to what may sometimes amount to nothing.
That’s right – the hallmark of a real panic attack, and what makes them so originally terrifying, is the fact that you basically can slip into one without a moment’s notice.
The way “panic” usually functions is that our body enters a state of emergency at such a rapid rate that we “freak out”, cutting out rational thought and instead becoming creatures of impulse in a fight-or-flight response, sometimes to our detriment.
Panic is usually a relevant response to certain extreme situations, even though it’s never recommended. In some cases, panic can give us the physical strength needed to fend off an attacker or escape from a dangerous situation as quickly as possible. In other cases, panic can kill us. But in any case, a normal instance of panic is usually a response to something actually terrifying. But panic disorders frame this response in a highly abnormal way.
How a Panic Disorder Works
When you’re suffering from a panic disorder, just an overarching sense of stress can be enough to prime a panic attack. If you have trouble at work or at school or are in a rough patch with your significant other, that pressure can mount on and eventually explode.
In a sense, there is a sort of “danger” – your mind and body are preoccupied with these overarching stressors, but the panic attacks themselves may occur without any active provocation, danger or trigger. In summary, panic disorders or anxiety disorders are characterized by:
- Repeated panic attacks, sometimes triggered but often without warning.
- An overarching fear of not just another attack, but actual danger and even death.
- Hyperventilation, heartburn, dizziness and nausea.
- An increasing avoidance of situations, people and places where panic attacks have occurred.
It’s important to understand that this does not mean you’re prone to “overreacting” – a panic disorder has nothing to do with your disposition or mental fragility. Panic disorders, like many other mental illnesses, are typically the cause of a mixture of genetics and family history of anxiety, environmental factors, and trauma/highly stressful life situations.
You can be a mentally resilient character, courageous even, and one day find yourself getting a panic attack in the middle of some grocery shopping, and a day later get diagnosed with a mental disorder.
What is usually guaranteed, however, is that a panic disorder will slowly erode your sense of control and destroy your self-confidence. You may not start out as an emotional wreck, but that can change.
Panic disorders then become fodder for the growth of accompanying mental conditions and even agoraphobia, a fear of leaving your comfort zone to go to open public places. Coming back from that isn’t a doomed road, as many are inclined to believe – a panic disorder is actually very treatable and the mental influence of oncoming panic attacks can be overcome, reversed and ignored with time and proper treatment. Which, of course, brings us to the all-important question of how panic disorders are treated.
Treating a Panic Disorder
Panic disorders are part of a larger group of mentally debilitating diagnoses: anxiety disorders. As a form of anxiety disorder, a panic disorder will typically share a similar treatment plan – one composed of optional medications, psychotherapy/talk therapy, and possible alternative therapies depending on a client’s circumstances, needs, and other individual factors.
As per usual, there’s no straight-up answer for a treatment plan – but there are individual treatment tools that apply in most cases of panic disorder treatment. These include:
- Lifestyle changes
- Self-care instructions and exercises
Prescribing the right medication is typically the first step to combating a panic disorder. This is because the medication has an immediate effect on a client’s quality of life, and lets them reduce the symptoms of their disorder from debilitating to troubling in a short amount of time.
At first glance, it would be easy to assume that antidepressants don’t necessarily affect the frequency of panic attacks, but help reduce their effect on your psyche – after all, they’re meant to make up for the natural loss or lack of neurotransmitters in cases of major depression.
But recent research has shown that antidepressants have proven usability in several mood disorders and anxiety issues. The effect they have on your neurotransmitters not only fends off the symptoms of depression but works to soothe anxiety and reduce the frequency of panic attacks by keeping you calmer.
Typically, these antidepressants either come in the form of commonly prescribed SSRIs, or the older TCAs and MAOIs. SSRIs are serotonin reuptake inhibitors, which basically balance your serotonin levels by preventing the excessive absorption of the neurotransmitter into your brain cells, a neurological dysfunction that often causes depression to harbor symptoms like insomnia and oversleeping. Their effect on panic attacks is well-documented, especially with drugs like Prozac and Zoloft.
TCAs (tricyclic antidepressants), on the other hand, are considered less tolerable than SSRIs and are thus rarer, but were once the most common serotonin regulators on the market. They’re still offered today, just not in the same amount. MAOIs (monoamine oxidase inhibitors) are even less common, but also serve their proper purpose in select cases. These drugs stabilize not just serotonin and norepinephrine like TCAs do, but also stabilize dopamine, another very common neurotransmitter related to energy and motivation. Like their cousin, they’ve been largely supplanted by SSRIs due to improved safety and tolerance – but because of the nature of medication and the need for more than a single line of options for people with specific tolerance issues, there are cases where you might be prescribed a MAOI or a TCA rather than a SSRI.
Antidepressants aren’t your only drug option for fighting the symptoms of a panic disorder. Another common form of medication is the beta blocker. Beta-blockers affect epinephrine, a previously-mentioned neurotransmitter that specifically deals with the release of adrenaline. Basically, the idea is that beta blockers keep you from entering a state of flight-or-fight, effectively reducing the effect and occurrence of panic attacks while opening your blood vessels to decrease blood pressure. There are some issues with beta blockers – specifically, they can cause fatigue and shouldn’t be used in cases where clients also suffer from respiratory and circulatory issues.
The thing about medication is that it works pretty damn quickly – but it’s not a necessity or even a guaranteed solution. Antidepressants have had a controversial history of sometimes causing suicide rather than preventing it. It’s important to note that there are many different drugs out there, and some work far better than others.
Over the long-term, however, lifestyle changes, therapy, and alternative treatments are far more important.
Moving Away from Medication
While there’s quite a lot out there when it comes to counteracting panic attacks through medication, the truth is that this isn’t ideal. Medication is a short-term solution with amazing promise and the capacity to very rapidly and very clearly change your life, especially if you’ve been plagued with panic attacks and fear of more attacks for quite some time.
But that solution doesn’t last for very long. In the long-term, medication carries with it the risk of side effects, dependencies, and other issues. Moving away from panic disorder medication is not just a possibility, but a goal. The most commonly-prescribed long-term treatment solution is psychotherapy.
Psychotherapy, a form of talk therapy, is a session-by-session treatment plan that involves conversation between you and your therapist to delve deeper into the possible causes and triggers for your panic disorder. Part of talk therapy is dedicated to better helping you understand your own psyche, and your condition, and the way it affects you. The other part involves arming you with exercises, self-care tips, and healthy coping mechanisms to help you reduce the incidence of panic attacks, end self-destructive or doubting behavior, and help you create a stable support system with your family.
Lifestyle changes are also integral for a long-term transition away from medication. While SSRIs and other assorted drugs help inhibit the brain’s excessive reuptake of serotonin and other neurotransmitters, better food, more exercise and increased exposure to fresh air and sunlight can also help you improve the amount of serotonin and dopamine in your system, and further boost your psyche through improved self-esteem and confidence.
Other habits, like cutting out social media use, limiting internet use and incorporating more frequent walking, reading, and cooking overtaking the elevator or escalator, watching TV and eating takeout can further boost your physical health and improve your ability to focus, think, and be mindful – qualities that can make a real difference when tackling the symptoms of a panic disorder.
Alternative treatments can also help, depending on your circumstances and how well you react to them. If therapy isn’t doing the trick for you, then perhaps cutting-edge solutions like EMDR and brainspotting, or more esoteric practices like acupuncture can help. Modern mindfulness training and meditation can also help you sharpen up your focus and fight against the unnatural urge to worry and stress out.
There are a lot of options to choose from when looking to skip out on medication as quickly as possible.
It’s a Long Road
Or at the very least, it can be. That’s why it’s really, really important not to be disheartened or discouraged by what might look like a lack of progress. Trust me – so long as you keep at it, you’ll find that looking back the difference made by your treatment option will become more apparent.
It’s not that therapy won’t seemingly help at first – it absolutely will. And that’s why it can be a little hard to press on with treatment – because in cases where you’re struggling with the symptoms of a panic disorder for months or years at a time, that initial progress will slow down, and you’ll often slog your way through to unnoticeable milestones.
Your panic disorder might be temporary and gone in a few months – or it may take years to get rid of its effects. It’s different from case to case, but if you’re looking at the long haul then remember that it does get easier so long as you keep at it every day.
Do your exercises, focus on your mindfulness, be careful to find healthy ways to relieve your stress and work on better habits and hobbies. Yeah, it’s a long road ahead – but compared to what it’s like to spend the rest of your life free from the agonizing fear of a panic attack, every second spent getting better is worth it.