FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

TREATING "PANIC ATTACK" MAY REQUIRE ANTIDEPRESSION MEDICATION

Question: My 29-year-old granddaughter is a supervisor in a large plant, and obviously, she is under considerable stress. About 10 years ago when she was also attending college, she started having panic attacks. When she is having an attack, she says, "My life isn't worth all this." I'm worried about her. What can be done for her panic attacks?

Answer: A significant number of people perhaps as many as 5 percent of the population are afflicted with an emotional condition that produces what is known as "panic attacks." Typically, a panic attack develops as a sudden episode of fast heartbeat and shortness of breath, which may be accompanied by chest pain, nausea, abdominal pain, trembling or shaking. The person experiencing a panic attack is very anxious and often fears that a heart attack or stroke is imminent. These feelings may last for minutes or they may take hours before abating.

Panic attacks are two to three times more frequent in women than men, and a family history of the disorder increases the risk that a person will develop it. The first attack usually occurs in the late teens or early 20s just as in your granddaughter's case.

It isn't easy to diagnose a panic attack since many other conditions can cause the same symptoms. Frequently, it requires several visits to the doctor before establishing the correct diagnosis. As an example, even if the doctor has a strong notion that the underlying cause of an episode of chest pain is panic attack, tests to assure that heart disease isn't also present are necessary.

Those with panic attacks are also likely to simultaneously have depression and/or agoraphobia. As you probably know, a depressed person is overcome with feelings of extreme sadness, dejection and hopelessness. A person suffering from agoraphobia has an unrealistic fear of going out in public, which usually develops from his or her asociation of prior panic attacks with previous public outings.

Your granddaughter's statement, "My life isn't worth all this," makes me think she may have panic attacks and depression. Fortunately, there is effective treatment for people with these conditions.

The first line of treatment for panic attack sufferers is education about the nature of their disorder, reassurance and counseling. About one-third of panic attack sufferers improve dramatically with these measures alone. The remaining two-thirds, however, also require medication. Those which have proven successful include: antidepressants in the tricyclic family, such as imipramine, and those in the selective serotonin re-uptake inhibitor class, such as sertraline, as well as other medications in the benzodiazepine family, such as alprazolam or clonazepam.

So, I agree with you. I'm concerned about your granddaughter. But don't feel helpless. Her family doctor, in conjunction with a psychologist or psychiatrst, can help her return to good health.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.