where to get help with panic disorder

The most important step is to consult a professional for an accurate diagnosis. Help is available and in most cases is effective in relieving symptoms. Both medication and psychotherapy is used, although a combination of these two treatment methods is often recommended. Self-help cognitive-behavioural techniques are also of value.

Medications for treating panic disorder include those thatwork immediately but have the limitation that they cause dependence (benzodiazepines), and those that work slowly but that can readily be discontinued (antidepressants). In general, it is suggested that the slow but sure path is the best in panic disorder. The term "antidepressant" is a poor one, as many of these agents are excellent antipanic medications. The most widely used antidepressant agents for treatment of panic disorder are the selective serotonin reuptake inhibitors (SSRIs), which are safe and easy to use.

Nevertheless, there are a number of important principles to bear in mind when using antidepressants for panic disorder. Most importantly, people with panic disorder often experience an increase in anxiety or other side effects if started on regular doses of antidepressants. It is therefore crucial to begin with as low a dose as possible and then to increase the dose only gradually. Several weeks of treatment, and relatively high doses of medication, may ultimately be necessary in order to bring an end to the panic attacks.

However, many people with panic disorder do find it useful to take benzodiazepines for a limited period of time. These agents are certainly useful if prescribed for a short period only. It is important to remember that benzodiazepines can subtly impair motor co-ordination, and therefore to be cautious when driving or operating machinery on these agents.

Perhaps the key element of the psychotherapy for panic disorder is "exposure" to feared stimuli. Many people with panic attacks begin to avoid places where they experienced panic; a vicious cycle then develops of more and more restrictions. Learning not to avoid is a crucial aspect of treatment. By continually practicing feeling anxious, and at the same time experiencing that this does not in fact lead to catastrophic results, one may ultimately overcome panic attacks.

As in the cognitive-behavioural treatment of other anxiety disorders, this approach is difficult insofar as it initially involves increased anxiety levels. There are, however, several ways to help decrease such feelings of anxiety. First, practice "accepting" anxiety. Don't feel under pressure to relax; it's OK to feel anxious, and to simply practice facing these symptoms. Indeed, therapists may suggest ways of increasing "interoceptive exposure", that is teaching people to increase anxiety levels, and then encouraging them to simply accept this feeling of anxiety. Second, take it slow. It may be useful to make a list from 1 (least anxiety provoking) to 10 (most anxiety provoking) that describes different situations that are being avoided. Gradually face each of the different kinds of situation labelled from 1 through to 10. Third, relaxation exercise cans be useful when anxiety levels mount during exposure to internal cues (e.g. feeling dizzy after rapid breathing) or external cues (e.g. moving up on the hierarchy of avoided situations). Visualizing a relaxing scene or a supportive person using all your senses and slow steady abdominal breathing may be useful.

For more information about panic disorder or any other mental health issue contact the Mental HealthInformation Centre of South Africa Tel +27 21 938-9229. You can also ask your GP for a copy of the panic disorder chapter in the False Alarm! How to Conquer the Anxiety Disorders patient guide.

Further resources / references
Anxiety Disorders Association of America, Inc.
11900 Parklawn Drive, Suite 100, Rockville, MD 20852-2624
Tel: 240 485 1001 / Fax: 240 485 1035 / Internet: http://www.adaa.org

Depression & Anxiety Support Group of SA
PO Box 652548, Benmore, 2010
Tel: 011 783 1474/6 / Fax: 011 884 7074

Books about Panic Disorder / Agoraphobia
Don’t Panic: Taking Control of Anxiety Attacks (revised edition). Reid R. Wilson. New York, HarperCollins, 1996.
Embracing the Fear: Learning to Manage Anxiety & Panic Attacks. J. Bemis and A.M.R. Barrada. Minnesota, Hazelden, 1994.
How to Help Your Loved One Recover from Agoraphobia. K.P. Williams. New Jersey, New Horizon Press, 1993.
Living with it: A survivor’s Guide to Panic Attacks. B. Aisbett. Sydney, HarperCollins, 1993.
Overcoming Panic Attacks: Strategies to Free Yourself from the Anxiety Trap. S. Babior and C. Goldman. Minnesota, Pfeifer-Hamilton Publishers, 1996.
Triumph over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks, and Phobias. R. Ross. New York, Toronto, Bantam Books, 1994.