Panic Disorder

WHAT IS A PANIC ATTACK?

Panic attacks are episodes of intense distress and fear that begin suddenly, build up and reach their peak within 10 minutes. They usually last 10–30 minutes, rarely up to 1 hour, and then pass on their own.

WHAT ARE THE SYMPTOMS OF A PANIC ATTACK?

At least 4 of the following symptoms are present during a panic attack

• Chest pain or tightness in the chest
• Palpitations, a pounding or racing heart
• Sweating,
• Shortness of breath or a choking sensation,
• Feeling unable to catch one's breath
• Dizziness, lightheadedness, feeling unsteady or faint
• Numbness or tingling
• Chills, shivering or hot flashes
• Nausea or abdominal pain
• Trembling or shaking
• Feeling that oneself or one's surroundings have changed or seem strange and different
• Fear of losing control or going crazy
• Fear of dying

Panic attacks can occur in many psychiatric illnesses, above all panic disorder, and in some medical conditions (thyroid disease, anemia, heart disease, vitamin deficiencies, alcohol and substance use disorders, excessive caffeine intake…). Medical conditions must be ruled out before panic disorder can be diagnosed.

WHAT IS PANIC DISORDER?

• Recurrent, unexpected panic attacks,
• Between attacks, persistent worry about having further panic attacks or about their possible consequences ("having a heart attack and dying," "losing control and going crazy," "having a stroke"),
• Certain changes in behavior as a precaution against the attacks and their possible harmful consequences (such as not going to work, avoiding exercise or housework, not eating or drinking certain foods or beverages, or carrying medication, water, alcohol or various foods)

Panic disorder is the mental disorder characterized by the features above.

Our bodies are programmed to protect themselves and survive. Fear is an emotion we need in order to stay alive in dangerous situations. For example, we feel afraid when we come across a dangerous animal. Along with fear, a system kicks in that sounds the alarm in dangerous situations and allows us to fight the problem or flee from the situation.

Then:
1. We start breathing rapidly: This can make us feel short of breath, as if we are choking or cannot catch our breath, and can cause chest pain or a feeling of tightness in the chest.
2. Our heart rate speeds up: We may feel palpitations or become aware of our heartbeat.
3. Our blood pressure rises and our heart pumps plenty of blood, especially to our muscles: We feel sweating, trembling or shaking, and hot flashes.
4. Less blood is pumped to our skin: This can cause numbness or tingling.
5. Less blood is pumped to our digestive system: We may feel nausea or abdominal pain.
6. The oxygen in our blood increases, carbon dioxide decreases and blood circulation in the brain changes: This can make us feel that we or our surroundings have changed or seem strange and different, and can lead to a fear of losing control.

In panic disorder, there is a "false alarm." The body perceives a situation as frightening when there is nothing to fear, flee from or fight. The symptoms caused by the system activated along with fear (rapid breathing, faster heartbeat, numbness, tingling, dizziness…) appear. With this "false alarm," bodily symptoms such as palpitations, sweating, tightness of breath or dizziness, which are entirely "natural and harmless," are interpreted by the patient as signs of a serious illness and are therefore misread as "I'm having a heart attack, I'm going to die," "I'm going crazy," "I'm going to have a stroke."

The patient goes to the emergency department in great fear and anxiety.

WHO GETS PANIC DISORDER?

The lifetime prevalence of panic disorder has been found to be 1.5–3.5%.

It can begin at any stage of life, most often in a person's 20s.

It is more common in women than in men.

CAN PANIC DISORDER BE TREATED?

Panic disorder is a treatable illness. Today there are two types of treatment whose effectiveness has been proven by scientific research. These are: 1. Medication 2. Cognitive behavioral therapy

1. Medication:

In the treatment of panic disorder, medications are used that prevent panic attacks by correcting the disrupted chemical activity in the brain's nerve cells. Today, there are quite a number of medications available in Türkiye that are effective for this condition.

2. Cognitive behavioral therapy:

This treatment method has two goals:

1. The aim is to correct the patient's mistaken knowledge and beliefs about the symptoms of panic attacks, which are in fact completely "harmless" and to teach the patient to cope with these symptoms without fear.
2. The aim is to help the patient overcome their fears by gradually and repeatedly exposing them to the places and situations they avoid being in alone for fear of having a panic attack, enabling them to "face" their fears.

The best results are achieved when these two types of treatment are used together.