Friday, June 5, 2009

When Panic Attacks: The Symptoms

"All of a sudden, I felt a tremendous wave of fear for no reason at all. My heart was pounding, my chest hurt, and it was getting harder to breathe. I thought I was going to die."

Panic attacks usually occur suddenly and without any cause. The symptoms of panic attacks can be quite scary and can mimic many serious health issues, such as heart attacks. I can't count the number of times I rushed to the emergency room, worried that I was having a heart attack, only to find out that it was yet another panic attack.

(If you are experiencing panic attacks for the first time, I'd highly recommend getting checked out by your doctor, just to rule out anything more serious. Also, if your usual symptoms are changing, it's good to get rechecked. And obviously, if you are in serious pain or distress, call 9-1-1. Better safe than sorry!)

Here are some of the most common symptoms of Panic Attacks. I've experienced all of these (and more!) at one time or another!

Racing or rapid heart beat
Palpitations or heart fluttering
Chest pains
Feeling of not getting enough air or being smothered
Stomach pain or upset
Dizziness, lightheadedness, nausea
Tingling or numbness in the face, hands, or extremities
Dry mouth, eyes
Hot flashes, sweating, chills
Feeling of unreality or dreamlike sensations
Feeling of terror or impending doom
Fear that one is dying or losing control
Shaking, trembling
Choking sensation, lump in throat, difficulty swallowing
Unsteadiness, balance difficulties
Blushing or blotches on the skin
Turning pale
Urgent need to urinate or defecate
Muscle pain
Inappropriate or disturbing thoughts

There are many more symptoms that have been attributed to panic attacks, but these are some of the most common.

What Happens in The Body During a Panic Attack ?

A panic attack occurs when the body's fight or flight response is triggered. The fight or flight response is the body's primitive, inborn, automatic response that prepares the body to either fight or flee from an attack.

In our early days as cave men and women, this fight or flight response would kick in when we'd see, for example, a saber toothed tiger crouching nearby and need to escape quickly. We didn't understand then the hows and whys, we just knew that when we became afraid we were able to run more quickly to (hopefully) escape the threat. Our very lives depended on this response.

Nowadays we don't have many saber toothed tigers to worry about, but we do have modern day stressors such as a fight with our spouse, trouble at work, sick children, traffic, money problems, etc. Unfortunately, our body cannot differentiate between a true threat to our physical survival (the saber tooth tiger) or a stressor such as an argument with a spouse, so it reacts the same way, by activating the fight or flight response.

Once activated, our fight or flight response causes a surge of chemicals (adrenaline, cortisol, etc.) to be released into our bloodstream. These chemicals cause changes in our body to prepare us to either fight or to flee. Our heart rate increases to circulate blood more quickly to vital organs, respiration increases to provide increased oxygen to the rapidly circulating blood, the muscles tense in the arms and legs in order to move quickly and precisely. Our blood sugar levels increase, our eyes dilate, we begin to perspire, and our mouths become dry. Blood is diverted from such places as the stomach (where it may have been helping to digest food) and begins to pool in other areas, such as the head.

These physiological changes make us stronger and faster and oftentimes we can do things we otherwise would not have been able to do. (Ever heard the story of a mother who was able to lift a car off her child by herself?) If we have to run or fight our body uses up these chemicals in the activity. Problem is, if the threat we are fighting is rush hour traffic, there is no way for us to "burn off" these chemicals, and we experience a variety of troubling symptoms, such as a racing heart or shortness of breath.

When the symptoms begin we may become even more afraid, not knowing or understanding what is happening to us and fearing that we are having a heart attack or going insane. This fear causes the body to release even more chemicals, compounding the situation and making the symptoms last much longer than they need to.

Thursday, June 4, 2009

Panic Attack or Anxiety Attack ?

Some people use the terms "anxiety attack" and "panic attack" interchangeably. Though similar in some ways, they are actually quite different.

We've all experienced anxiety attacks at one time or another. You're walking down the street alone at night. You begin to hear sounds and fear that someone is following you. Your heart starts racing and you pick up your step. Or you are driving down the road when all of the sudden another car runs a red light, nearly broadsiding you. Your heart starts beating rapidly, you may feel weak or dizzy and you may experience shortness of breath. These are some of the same symptoms that can occur during a panic attack, but the difference is that they are brought on by something real that has just happened to you. There is a reason for your body to have reacted as it did. This is called the body's fight or flight response.

In contrast, a panic attack is something that comes from out of the blue. One minute you are in line at the grocery store, smiling at the cute, little baby making faces at you in the cart ahead, the next minute your heart starts racing, you feel faint and short of breath, and you are convinced that you are having some sort of medical emergency. There is no real threat here to cause these symptoms. (That baby isn't going to jump out of the cart and start attacking you!) Your body and mind are causing these symptoms, and they have nothing to do with any real threat.

Sometimes the lines between anxiety attacks or panic attacks are not that clear. People who have a form of anxiety called Generalized Anxiety Disorder, a constant state of worry and anxiety, can start having panic attacks out of the blue. Those with Panic Disorder can start having what is called anticipatory anxiety, which is when you begin worrying that you will have another anxiety or a panic attack if you go someplace where you have experienced an attack before. Giving into this fear is what causes Agoraphobia to develop, and soon you begin fearing and avoiding more and more places, until your world becomes quite small.

Tuesday, June 2, 2009

First Experiences...

I experienced my first full blown panic attack in 1986 when I was 24 years old. I had been married for a little over two years and was working full time, supporting my husband who had recently decided to go back to college. My husband and I had just gotten into a fight the night before, when I came home with $40 of groceries after a long day of work. In his mind, $40 was an excessive amount to spend for a week of food, and he made sure I was aware of it!

I was tired the next day and had a bit of a cold, so I decided not to bother making a lunch and to grab something at Taco Bell instead. I ate a bean burrito, drank a Coke, and popped a Tylenol to help with the cold symptoms. I started back to work, when all of a sudden I began experiencing chest pains and shortness of breath. I thought I was having a heart attack.

Somehow I white-knuckled it back to work, and asked the receptionist for help. The office where I worked had an emergency team of three people who were "trained" to respond to health emergencies. Rather than call 911, they threw me into a car and rushed me to the hospital. On the way, somebody asked me if I had taken any medications. I told them about the Tylenol and they looked at each other and then started wondering aloud whether I had been poisoned. (This was just after the cyanide Tylenol tampering happened in 1986.) I became even more panicked, and by the time I reached the emergency room my blood pressure was 200/90. I can't remember much after that, until the doctor came in with my test results several hours later and told me it was "just anxiety".

I stayed home from work for a couple of days, nursing my cold and trying to relax a little, but then I ran out of sick time and had to go back to work. I was ok for a week or so, a little shaky, but I was making it through the day. Then one day I had to work a couple hours overtime. Driving home that evening, in the middle of my 45 minute commute, I started feeling a little strange. I tried to ignore the feeling, continuing to inch along on the freeway, stopping and starting in the rush hour traffic on 101.

Suddenly, out of the blue, I had another attack. This one was even worse than the first, if that is possible. My chest felt as if it would explode and I didn't think I was getting any air. My hands were sweaty, my legs felt like jello. I wanted to jump out of the car and run screaming but I knew I couldn't just leave my car in the middle of the freeway. I began making my way over to the right and was finally able to exit the freeway. Somehow I made it to a pay phone and got hold of my husband, who came and picked me up and took me to the hospital emergency room. I was given the same diagnosis: "just anxiety", and again sent home.

I tried going back to work the next day but couldn't make it. When I got to the freeway I started having another attack and had to turn back home. I tried several more times, but was unable to make it. Finally I didn't have to try anymore because I was fired from my job.

I went to the doctor several times and the emergency room a few more times as well. I became so agoraphobic that for a period of several weeks I was unable to walk out my front door to get the mail. Eventually I was referred to a Psychiatrist, who diagnosed me with Panic Disorder With Agoraphobia. I was hospitalized for a couple of days here and there but that was useless. The only relief I ever obtained was when I was prescribed large doses of Xanax (2 mg. 3 times a day). On those high levels of Xanax, my body was physically incapable of having a full blown panic attack, but I was basically a zombie.

I continued on with the Xanax for almost three years. Eventually my doctor took me off Xanax cold turkey (long story, I will share sometime...) and the panic attacks came back. I also suffered from severe withdrawal symptoms and had the added pain of a doctor who did not believe that Xanax was even addicting, and so dismissed my symptoms as "all in my head".

I stopped seeing my psychiatrist and just saw my regular internist when I was having particularly severe symptoms. Other than that, I just toughed it out. Then one day my doctor recommended a book to me. It was called Feeling Good, by Dr. David Burns, and it was my first introduction to Cognitive Behavioral Therapy, which in my opinion is the only treatment that can give you the skills you need to overcome panic attacks and agoraphobia once and for all.

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