Panic Attacks - what they are and how to cope with them.

The police stress comes mostly from the embarrassment of having a panic disorder.
by Hal Brown, LICSW

I haven't written about this most common (ranking about equal with depression in terms of numbers afflicted) of the unfortunate manifestations of the human psychic mechanism until now because it seemed there was ample information available. And there certainly is: books, magazine articles, cyberpsychology web sites and periodic television specials. However much information there is, it doesn't help police officers who tend not to pay attention to mental health issues until something happens to personally effect them. I wrote about depression early-on because it can lead to suicide, whereas panic disorder rarely does. Now is the time to address panic disorder on Police Stress line.

Just as they are not immune to depression, police officers who like to see themselves as strong and self-reliant are as susceptible to panic disorder as the general population. That's one reason discovering one has a panic disorder can be so embarrassing. It isn't unheard of for police officers having been rushed to the hospital for a possible heart attack, only to find out it was a panic attack, to claim it was something "respectable" like food poisoning. If you don't believe me, next time you're in the emergency room, ask a nurse how many patients come in with symptoms of a heart attack, have their EKG and blood work, and leave two hours later with nothing more than a prescription for Valium.

While the causes of panic disorder are not fully understood, this much has become clear in the past few years. Like with depression, panic disorder seems to be a physiological condition caused by a glitch in the way the neurotransmitters in the brain handle certain chemicals, most notably serotonin.  Although the medical jury is still out on exactly why it is so, there is no doubt that the medications, like Prozac, that work so successfully to lessen or eliminate depression, also lessen or eliminate panic attacks. Tranquilizers like Valium, Xanax or Klonopin taken every day will also work, and will lessen the severity and duration of a panic attack if taken right at the start of one, but their mechanism of action is different than the antidepressants.

There are few other non-life threatening physical experiences as frightening as a person's first panic attack. While most panic disorders emerge in the late teens or early twenties it is not uncommon for people to have their first panic attack at any age. Panic disorder can come on when you anticipate a stressful situation, during one, or for no apparent reason. Most people find the last kind the most disturbing because it seems to come from nowhere and have no cause except a life-threatening physical one.

The symptoms of a panic attack are virtually all physical, and often mimic real life threatening disorders like heart attacks, pulmonary embolism or stroke. Anyone with any sense should call 911 or go to the emergency room if they have these symptoms.

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  •     chest pain
  •     difficulty breathing
  •     rapid or irregular heart beat
  •     dizziness or vertigo
  •     blurred vision
  •     distorted vision
  •     feeling faint
  •     sudden profuse sweating or clamminess
  •     hot flashes or chills
  •     sudden feeling of nausea

Secondary symptoms which are experienced as physical, but almost immediately are interpreted in the worst possible way include:

  •     physical sensation of impending death
  •     feeling of danger without knowing why
  •     overwhelming anxiety

All of these symptoms are perceived as indicative that something terrible and out of one's control is happening. Instead of flowing with the experience and letting it pass (as it almost always does in about an hour when people learn not to be afraid of their panic attacks), most people initially escalate and prolong  their first panic attacks by their belief they are in dire jeopardy of dying.

Treatment of Panic Attacks

Panic attacks are usually easy to treat with a combination of medication, educative psychotherapy and relaxation techniques. There are two approaches to medication. One is the every day regimen of an antidepressant or anti-anxiety drug. Antidepressants are the first choice rather than an anti-anxiety drugs since the former are easier to get off of than the anti-anxiety drugs which tend to have an anxiety-rebound effect. The second is using a rapid acting anti-anxiety drug when one feels a panic attack coming on. Often the decision is left to the patient. Each has its drawbacks. Sometimes a patient is started on both antidepressants and anti-anxiety medication for a few weeks until the antidepressants start to work, and then withdrawn from the anti-anxiety drugs.

If you take a panic attack blocking medication that eliminates the attacks altogether there's no way you can learn to cope with them without medication, since you won't have them anymore if they are effective. In order to find out if you still are going to have panic attacks you have to taper off the medication. Then it takes a few weeks for the medication to fully be effective if you need to start again.

If you rely on taking an anti-anxiety drug when a panic attack starts, you are probably getting the primary benefit from a placebo effect on the secondary psychological symptoms. This is because by the time the medication is in your bloodstream and gets to your brain to begin to work, you are already on the down side of the panic attack anyway. This is not necessarily a bad approach, because the medication will help you to relax and sometimes just knowing you have it available will help you ward off panic attacks when you get the initial sensation that one is coming on.

Psychotherapy for panic attacks always includes learning about panic disorder, and learning how to differentiate a panic attack from life threatening disorders like heart attacks. People with panic disorders can have heart attacks, but these won't be brought on by the panic attack. Once you learn to recognize your own symptoms of panic attack, and are reassured by your doctor after taking an EKG, that you didn't have a heart attack, if you still worry that you are having one when you have a panic attack, insist on a referral for a stress EKG. It never hurts to have a second opinion from a specialist. Generally insurance will pay for this, especially if you are over 40.

If after reassurances from your physician, and psychotherapy, you can't stop worrying about a stroke, you should try to get your insurance company to pay for a CAT scan at the least, or preferably an MRI, just to reassure yourself. If they won't pay it may be worth it to pay yourself. The same goes for any medical condition you find you can't stop worrying about when you have a panic attack. Some therapists may disagree with me on this, but I believe factual medical understanding of these things does not promote hypochondria but lessens it.

The other aspect of using psychotherapy to stop panic attacks is to   change the very brain chemistry that causes them by learning to use relaxation techniques at the first sign one is starting. There are more relaxation techniques than I can enumerate here, from tapes to self-hypnosis. Some work better than others for some people, so be willing to see what is most effective for you. All some people need to do is remind themselves as a panic attack seems to be starting is that the worst than can happen is that they will be miserable for about an hour, and then go to a place they feel secure.

Another approach some people find effective is desensitization. While medical researchers can bring on the symptoms of a panic attack with certain drugs, you can do it yourself to some extent through physical exertion. That way you can become more comfortable with the sensations of a racing, pounding heart, profuse sweating and even feeling nauseous. Of course, don't get into a rigorous exercise routine if your doctor says you shouldn't. If you're generally out of shape, it can't hurt and may help if you do some aerobic exercise a few times a week.

If you are worried that you may have a panic attack when you are driving an get into an accident, rest assured that neither I or any therapists I know have ever heard of this happening. In fact, that's a difference between a stroke or heart attack and a panic attack. The former can cause a fatal car accident. With a panic attack while driving you can always manage to get to the side of the road, and generally can even drive home or to a safe place. In your profession, most accidents occur from sleep deprivation, and that is something you can do something about.

What can happen if you don't get treatment for a panic disorder

Sometimes panic disorders just go away. Some people have one and never have another. Other's have them for years, move or change jobs, and they disappear. However, a panic disorder can lead to a person avoiding doing things and going places which seem to bring them on. These are often situations that bring them in contact with people.  They can develop agoraphobia which at it's worst makes people so afraid they can't leave home. People have to quit their jobs, drop out of school, and even have others do their shopping for them.

More likely, without treatment, people just lead unhappy lives never knowing when a good time, or work,  will be interrupted by a panic attack. They are overly attentive to bodily sensations and become hypochondriacs. They see their physicians and leave feeling foolish when told "it's all in your head". This is a shame because, like depression, panic attacks is one of the most treatable disorders of psycho-neurologic disorders.