Panic disorder, which affects 3.7 per cent of Canadians, is “fear gone wrong.” But through appropriate therapy and medication, people with panic disorder can keep symptoms in check.
When her younger brother was diagnosed with terminal cancer at age 43, Annette’s reaction was to stay strong. “The family was devastated but ‘we have to stay positive,’” she recalls thinking.
Despite putting on a brave face, Annette began to wake up in the middle of the night, her heart racing and pounding in her chest. “I thought I was having a heart attack,” she says. “I was convinced I was going to die.”
What Annette was experiencing was panic attacks: sudden, intense and terrifying bouts of anxiety that can feel like a heart attack. Panic attacks can be accompanied by a racing heart, sweating, chest pain and shortness of breath – and a fear of imminent death.
“A panic attack is defined by a very sudden peak of terror, usually peaking within ten minutes and then slowly resolving,” says Dr. Diane McIntosh, psychiatrist, founder and CEO of RAPIDS Health. “However, the impact of a panic attack can definitely linger, sometimes for days, sometimes much longer.”
As the attacks intensified, Annette started to, as she put it, “break down mentally.” She recalls, “It reached the point where I was so exhausted that even taking a shower became this huge thing — I had no energy whatsoever in my body. Other times it would be like my whole body was vibrating.”
Despite her alarming symptoms, Annette did not initially seek help. “When you experience anxiety and depression, your cognitive abilities are also compromised,” she says. “I thought that if I ignored things, and if I just got up every day and powered through, I would get to the other side, and this would all go away.”
But that didn’t happen. Instead, she reached what she called ‘a breaking point’–at work. “I couldn’t figure out how to turn on my laptop, and I just sat there,” she says. “I just broke down.”
Anxiety is pretty ubiquitous. We’ve all experienced it, but sometimes it’s hard to figure out what’s normal worry and what is pathological anxiety.
With panic disorder, the brain behaves as if it were under attack. “Typically, when a person is frightened, the fear center of our brain, the amygdala, recognizes there’s an emergency and kicks into action, starting a series of brain events that helps us to react quickly and effectively to the danger,” says Dr. Mcintosh. This is known as the fight or flight response and leads to an increase in heart rate and blood pressure, hyper-alert senses, and more blood is delivered to the muscles to facilitate escape, if necessary.
“The brain also releases cortisol, the most important stress-response hormone, during frightening situations, which helps the brain and body to get back to normal as quickly as possible,” she says.
“Panic attacks are an example of pathological anxiety,” says Dr. McIntosh. “It’s fear that is non-specific, irrational, excessive, or unwarranted. It’s caused by all the same brain structures and brain chemicals as normal fear, but for people diagnosed with panic disorder, the attacks often come completely out of the blue, without any provocation that should elicit a fear response.” When panic becomes chronic, she says, the amygdala is repeatedly sending the message that there is an emergency.
Panic attacks affect up to a third of Canadians annually. Often, they occur if a person is suffering from depression, post-traumatic stress disorder or substance abuse disorder. “Panic attacks can also happen in association with physical disorders, especially ones that affect your breathing, heart rate or balance,” says Dr. McIntosh.
“Panic disorder is an anxiety disorder that includes panic attacks, but the attacks must be recurrent and unexpected. That means that they come completely out of the blue,” she says, and can occur during times of relaxation, sleep, or even while watching TV.
Panic disorder can lead people to live in fear of the next attack, says Dr. McIntosh. Many begin avoiding places where they’ve had panic attacks, a pattern that can negatively impact their quality of life.
“They avoid this, they avoid that, until their world becomes very small,” says Dr. Randy Mackoff, a Vancouver-based clinical psychologist.
Dr. Mackoff says that many of his patients come into his office needlessly embarrassed about their disorder. Many have experienced one or more attacks and think they’re going crazy. They’ve gone to the ER, had tests done and been dismissed by doctors once they were diagnosed with panic disorder.
“The first thing I do is I say, ‘Hey, this is a panic attack and it has a biological component to it — you’re not just making this up,” he says.
Dr. Mackoff then recommends that the patient check in with their doctor to rule out anything physical that could be causing the attacks. He says that “99.99 per cent of the time, there’s nothing medical that’s contributing to this,” such as a thyroid or heart issue.
Psychological counselling can help. Dr. McIntosh says that cognitive behavioural therapy (CBT) can be very effective, as it can help the person to cope in locations where they’ve experienced a panic attack. “CBT helps the person to be able to go back into those environments that were so terrifying,” she says.
People can learn to control their symptoms through a variety of strategies, says Dr. Mackoff. “If your heart starts to pound and you feel like you’re choking, you can actually start to slow down your breathing, focus on other senses, and start to take control of your thoughts,” he says. In this way, someone having a panic attack can learn to determine that there is no emergency and settle themselves.
“That really can have a huge amount of benefit,” he says, as it increases the amount of oxygen entering the body and can help the person to calm their nervous system.
Another technique that works is visualizing a frightening situation and applying various techniques to calm the body and mind. Visualization can prepare a person to handle a stressful situation effectively.
Dr. McIntosh says there are also medications which can help manage panic disorder symptoms, especially antidepressants. Not uncommonly, patients have underlying depression that is triggering panic attacks, so antidepressants treat the depression and the anxiety simultaneously, she says.
Treatment can also take some time, says Dr. McIntosh. “Go slow, but aim for all those symptoms to resolve,” she says. Dr. Mackoff agrees. “Once the medication starts to work, we can then start approaching this in a psychological way,” he says.
Annette took this approach. After months of suffering, “I finally said, ‘I’m not strong: I’m broken and I need help,’ and at the urging of her husband, she saw a psychiatrist who diagnosed her with panic disorder and started her on medication. After some trial and error, she found a medication that controlled her symptoms. She also underwent psychological counselling – before and after her brother’s death.
“I am doing great,” she said. But she credits that to several years of putting in the work and the tools she relies on to get her to this place.
“There was a huge part of me that did not ask for help until I had to, because I did not want anyone to see me as anything but strong, which of course, I came to realize you are strong if you ask for help, you are strong if you let people in.” I have to keep doing the work, doing the things that keep me healthy. My relationships with people have become so much brighter, and these connections have been tighter than they ever were before.”
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This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness.
Panic disorder, which affects 3.7% Canadians, is “fear gone wrong.” With appropriate therapy and medication, people with panic disorder can keep symptoms in check. Summary of “This is Panic Disorder”, Episode 6 of PSYCHEDUP Podcast.
Post-traumatic stress disorder doesn’t just affect soldiers; it can affect anyone who has experienced trauma. But treatment can help. Chelan shares her story. Summary of “This is PTSD”, Episode 5 of the PSYCHEDUP Podcast.
Bipolar disorder often hides behind depression, making diagnosis a challenge. Pauline navigated years of highs and lows before finding stability. Hear how finally receiving an accurate diagnosis and effective treatment can transform lives for people like Pauline. Summary of “This is Bipolar”, Episode 4 of the PSYCHEDUP Podcast.
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