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Anxiety and Panic Attacks: Treatment by Dr. Glaser Anxiety means to feel stressed, worried, concerned. A person should not be stressed or worried more days than not. To live in a constant state of fear is not acceptable. Adults, with anxiety problems, frequently have difficulty in social settings. They may also have problems at work especially with presentations. They can feel like all eyes are on them, judging how they act or look. Children can be afraid to go to school and may outright refuse to go, or ride a bus. Children can be afraid to talk to others especially when in an unfamiliar environment. Adults and teens can abuse alcohol or benzodiazapines (valume, zanax, ativan) in order to be able to function in social settings or at work. When a person is stressed, they feel tired and have difficulty sleeping. Often times their memory is poor and can not concentrate. Depression often follows chronic anxiety. People with severe anxiety are extremely shy and often appear aloof and not interested in socializing to others Panic attacks are acute episodes of severe anxiety. When a person first has a panic attack, they usually think they are having a heart attack and go to an emergency room. Symptoms of a Panic Attack are: shortness of breath, sweating, chest pain or racing heart, intense fear and worry, light headed, feeling like you are going to pass out (fall out). Panic attacks are highly physiologic. That means the body and brain cause this to occur. It may be due to a problem in the sympathetic nervous system but it has not been proven yet. I have seen many patients who lived normal lives then all of a sudden, in their 50's, people without a history of anxiety, all of a sudden start getting panic attacks. It can be baffling as to why it is occurring seemingly out of no where. Post traumatic stress disorder (PTSD) is another form of anxiety that occurs after a specific traumatic event. This requires exposure to a severe trauma then some recollection of that trauma plaguing that person for several months or years. Treatment of anxiety, PTSD, and panic attacks requires talk therapy and probably medication. Some patients can get relief of their symptoms from talk therapy alone. Others require medication plus talk therapy. The more episodes of anxiety and the more family members with anxiety or depression indicates greater need for medication in my opinion. If you want to avoid medication, then you should give yourself 3 months of talk therapy. If after 3 months, you do not have significant improvement, then you should add medication to your regimen. The medications to treat anxiety fall into 2 main categories. First are the antidepressants and second are the benzodiazapines. The antidepressants are also used to treat anxiety and are first line treatment. The benzodiazepines are back up medications and should not be used as the primary treatment. There are a few other medications that are less often used for anxiety: Neurontin, Seroquel, propanolol and clonidine. The antidepressants are discussed in detail under "depression treatment". You can refer to that section for details on these meds. The SSRIs such as prozac, lexapro, zoloft, paxil, celexa have the most evidence supporting their use for anxiety and PTSD and panic attacks. Benzodiazepines (benzos) are well liked by patients with anxiety. They are so well liked, some patients get addicted to them. Patients do not get addicted to antidepressants but they can get addicted to benzos. Benzos are used for emergency rescue. For example, lets say a person is about to give a presentation at work but all of a sudden, they get hot, short of breath, and frightened. That person can take a benzo, in 10 minutes feel totally calm, cool, and collected. The problem with benzos is that if they are taken every day, or nearly every day, the body can develop a tolerance to the medication and they know longer work. In addition to that tolerance, the body can become dependent on them and have heroine type withdrawal symptoms that can be life threatening. If one makes sure to take them only on occasion, then they will continue to work when needed and no addiction will develop. Some people with panic attacks cary benzos with them, and merely holding on to the bottle can calm the panic attack because they know, if they really need it, the med is there to help stop the panic. A sign that you may be taking to many benzos, too often, is a need for higher doses and more pills over time. Too high a dose of benzos can cause a person to fall asleep and stop breathing then die. Benzodiazepines are serious drugs but they work if used correctly. Neurontin, generic name is gabapentin, is a very mild anti-seizure medication. As far as anti-seizure medication go, it has the least side effects. There are studies that show it helps a little. Some patients get significant improvement in their anxiety from neurontin. The side effects are minimal and usually do not occur. All meds have serious risks, however. Seroquel is a med for bipolar, schizophrenia, and depression. It probably also helps anxiety and I prescribe it to patients for anxiety when other medications have failed. It is discussed in detail under the "bipolar treatment section". Propanolol is an old med to treat high blood pressure. It is a "beta blocker'. That means it decreases the "fight or flight" arousal or adrenalin system in your body. Some patients find this helpful in making them more calm. I have found the data supporting its use to treat panic or anxiety to be weak but it is generally safe. There are risks of heart problems with this med and low blood pressure. It is a reasonable alternative if other meds have been tried but failed. All forms of anxiety have a strong genetic component. That means, it runs in families. Anxiety is not a healthy state of mind. It leads to nerve cell death and shrinks the size of the brain. The longer you have anxiety, the harder it is to treat. So I recommend to treat anxiety early. The longer you wait, the less good treatment will do for you, but it is never too late to get help. Mitchell L. Glaser, MD. Chicago Il. |
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