Anxiety and Panic Disorder – A Tormenting Presence
“Am I going to die? I feel like I’m dying…”
“No, you’re going to get through this. You’re having a panic attack. Just keep looking in my eyes and holding my hand. These feelings are going to pass in a few minutes. Hold on…” The emergency department nurse reassured the shaken young man.
He looked to be in his mid-twenties, a handsome, dark-haired guy with a 5 o’clock shadow getting ahead of itself.
“What’s happening to me? Am I dying …?”
“No. This is fear. It’s a real feeling…but it’s not an accurate assessment of what’s happening. You’re doing fine. This feeling is going to pass. Hold my hand…”
“How do you know I’m not dying…? It feels like I’m dying…”
The nurse ached for him. “I’ve seen this before. This is a feeling you’re experiencing. It’s a panic attack. Do you have a pet at home?”
“Yes, I have a dog.”
“What’s his name…?”
“Barkley. Do you think I’m dying now? Just tell me the truth.”
“No…you aren’t dying. Your pulse is a little faster than usual but it’s regular and your blood pressure is sta-“
He cut her off…
“Are you sure…?? Why am I sweating? Because I feel like I’m dying…”
“I know you do. It’s hard to feel like this. But you’re ok. This feeling is going to pass. Do you have any children?”
“Yes, I have a little boy. Will you please tell him I always loved him very much?”
Panic Attacks Can Take Many Forms
Sometimes you may scream and cry; sometimes you may feel frozen and unable to move, sometimes you might just talk about the feelings of imminent death or impending doom like our friend Tom in the Emergency Department.
If you’ve never had one, here’s how to imagine it:
Think how you’d feel if you came upon a grizzly bear in the woods. You might be frozen with fear or feel overwhelmed with your imminent death… or you might just break into a sweat — or a scream…
“Tom, you’re going to be able to tell him that yourself in just a little while. What grade is he in…?”
“He’s in second grade. Are you sure this is a feeling? Because…it feels like it’s real. I wish I had spent more time just playing with him. He doesn’t deserve this.”
“Tom, just make the decision now that you’ll spend more time with him. You’ll have plenty of opportunities. What would you like to do more with him…?
“Oh anything. Basketball, soccer, playing at the park… He deserves more… I might be feeling a little better…. Is that possible?”
The nurse sighs in relief. “That’s great to hear. I gave you some medicine to help you relax. I’m glad you’re feeling better…it’s going to get better and better now… “
“Oh, I hope you’re right. I thought I was dying…”
Tom has never seen a psychiatrist. No one in his family has. But there’s high blood pressure, heart problems, an uncle with diabetes.
He checks again. “You’re sure I’m not going to die…?”
Anxiety is a bear, but panic attacks are dragons.
Panic attacks come when you least expect them, and in full force. If this happens to you often … even regularly … you may have panic disorder.
Traditionally, anxiety and panic attacks have been treated with anxiolytics, or medicines that cause symptoms of anxiety to diminish.
And also antidepressants – both SRI (serotonin reuptake Inhibitors) and SNRI (serotonin norepinephrine reuptake inhibitors) varieties. And when they work, well…they’re a Godsend.
But far too often they don’t help. Even after trying 2 or 3 different prescriptions, increasing the doses, adding augmentation agents like buspirone.
Sometimes the side effects of the medicines are just too much. Maybe they’ve made you tired all the time, or interrupted your sleep. Maybe you’ve gained weight. Developed chronic GI side effects. Found that your libido is non-existant or that you’ve developed other sexual side effects.
Some people are able to get the panic under control with a combination of SRI or SNRI antidepressants combined with Cognitive Behavioral Therapy (CBT).
If your doctor has tried antidepressants, anxiolytics, and even mood stabilizers in an attempt to help you get better, but no combination has worked… then it may be time to consider more novel advanced treatments.
Things like Transcranial Magnetic Stimulation (TMS) or ketamine treatment.
Novel Advanced Treatments To Consider for Anxiety and Panic Disorder
These treatments aren’t weird…they’re very 21st century.
Transcranial Magnetic Stimulation (TMS)
TMS uses a magnetic coil placed over your head, that sends pulses deep into the brain. These pulses stimulate your brain cells to become healthier and function properly.
As a result, you begin to feel better and better during the 3rd or 4th week. It doesn’t work fast…but it works well in about 70-75% of people. TMS requires appointments five days a week for roughly 4-6 weeks. And there are treatment protocols for anxiety disorders that are quite effective.
Ketamine Treatment for Anxiety and Panic Disorder…?
Ketamine was developed in a laboratory in the 1960’s as an anesthetic. And it’s been used in the operating room for over 50 years. It’s effective and has proven itself as a safe medicine when used for that purpose.
Then, several years ago, ketamine began to be tested for depression. And it’s made a huge difference for many of those who received it. There have been some bumps along the way, as we’ve learned about how to help its benefits last, and which routes allow the most wonderful outcomes.
Now, in 2018, ketamine is receiving increasing respect as the most extraordinary antidepressant neuroscience has seen in the last 50 years.
What’s more, it’s being tested in laboratories and clinical practices, and we’re finding ketamine’s benefits are widely experienced by people who suffer with a host of different psychiatric disorders.
This medicine is life changing.
But let’s talk about panic disorder and a case study from 2016 that indicates that ketamine might be useful for it. Because right now, panic disorder lacks extensive studies using ketamine. More studies are needed to validate the results some doctors are seeing regularly in the office.
For far too long, she’d been unable to leave the house or use public transportation, and felt unable to learn to drive because of her anxiety. Panic attacks at least every week caused her to believe that she’d never be able to manage the anxiety that ruled her life.
Her psychiatrist prescribed substantial doses of escitalopram and an intense regimen of electroconvulsive therapy treatments. Then she added 400mg of lamotrigine combined with 30 intensive sessions of CBT. In other words, Ms. A was receiving aggressive treatment. And…
All of this helped to reduce her suicidal thinking and mood improved.
But her anxiety didn’t improve. She remained home-bound because of her fear of leaving and having a panic attack.
Then, 6 or 7 months later, she was seen in the emergency department of her local hospital for severe pain in her neck. An MRI showed she had 2 herniated discs in her spine, so in the ER, she got IV ketamine to treat the pain.
One infusion. For pain.
Symptoms of Panic Disorder, Agoraphobia, and Major Depression IMPROVED
And in the weeks following her ER visit, her anxiety symptoms improved. (This is really pretty cool.)
She felt like shopping at the department store, started a business with a friend, volunteered at a market in her community. Her mood was positive and “normal” for at least 10 weeks. Her doctors attributed it to ketamine — although of course there are a dozen other possible factors.
We see patients who present to us with all kinds of complex symptoms and often panic disorder is just one of the many that bring them to our office. And we see the pit in their stomachs go away. The anxiety lift. The worry diminish. In each case, one at a time. The stories are too complex and too varied to see them as anything more than case reports right now.
So we need to see researchers conduct more studies. When we treat a patient for another disorder, or when a patient is treated with ketamine for severe pain, and their anxiety and panic disorder symptoms fade away at the same time, we’re the first to smile with them. Then they keep smiling all the way home … and all the way back into their day to day lives.
But we need researchers to do their gold standard, double-blind, placebo controlled studies to rule out variables that may enter into the mix in the office, and to verify ketamine is demonstrating effectiveness for this disorder.
There are backup studies for ketamine and social anxiety … another anxiety disorder. We see extensive positive outcomes in treating PTSD with ketamine, an anxiety disorder that often includes panic attacks.
We need to see more studies for ketamine and panic disorder.
At Innovative Psychiatry, we’re seeing patients with anxiety and panic disorder getting better every week and every month. We want to see you get better, too. If you suffer from panic attacks, anxiety, and any other disorders, call us.You can feel so much better. And we want that for you.
To the healing of your best self,
Lori Calabrese, M.D.