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.

 



Printable View