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Expert Q&A

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How can I control my panic attacks?

Asked by Stephanie, via e-mail

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I've been having a lot of panic attacks, almost every day; sometimes when I'm working, dealing with the kids or just nothing at all. I'll get shortness of breath, chest hurts on both sides or just one side, and a lot of my heart skipping a beat. And it scares me. I'm 29 years old and in good health. How can I control this?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Stephanie,

I don't need to tell you that panic attacks are among the most hideous experiences a human being can have. They are such strange occurrences. While being in no physical danger at all, you feel as if you are in mortal peril. In the midst of perfectly good health, you feel as if you are on the edge of sudden death. And telling yourself that there is no real danger is of almost no help whatsoever.

My strongest piece of advice is that you make an appointment to see your doctor immediately. Many primary care doctors feel comfortable treating panic disorder or will know a clinician who does.

Like everything else in psychiatry, treatment options come in two general flavors: medications and psychotherapy.

The best proven psychotherapy for panic attacks is similar in many ways to the type of therapy that I've described several times before for obsessive-compulsive disorder. It has two main components, neither of which is pleasant, but which are in the aggregate often highly effective. First, the therapist would work with you to gradually expose yourself to situations that cause panic. Then, once you are in these situations, he or she would teach you to tolerate the terrible panic feelings when they arose.

I suspect that just thinking about doing this might have you breaking out in a cold sweat, which is why it is so important to get professional help.

Among psychotropic medications, two classes are particularly effective for panic, and they are very different from each other. Benzodiazepines, like Valium, Ativan or Klonopin, have powerful anti-anxiety effects that happen very rapidly after they are ingested. If you have long panic attacks, or attacks that come in prolonged volleys, these medications work quickly enough that they can interrupt things in mid-attack.

Most antidepressants also treat panic attacks, but unlike benzodiazepines, they require several weeks of being taken daily before their effects are usually seen. For this reason, many clinicians will start patients on an antidepressant and a benzodiazepine. Once the antidepressant has been on board for several weeks, the benzodiazepine can often be discontinued.

Let me alert you to a few challenges in these treatments. Psychotherapy is great, but depending where you live and the state of your finances, it can be hard to find and expensive. Benzodiazepines work extremely well but have addictive potential when taken long term. If you elect treatment with an antidepressant, make sure that your clinician starts you on the lowest dose possible, because -- paradoxically -- antidepressants can cause panic attacks when they are first taken and can certainly worsen them in people already afflicted.

The good news is that all these treatment options are effective, so it is very likely you will be able to gain control of your symptoms, find relief and continue with your life.

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