What Is A Panic Attack
A panic attack causes sudden, brief feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations. When youre having a panic attack, you may sweat a lot, have difficulty breathing and feel like your heart is racing. It may feel as if youre having a heart attack.
Panic disorder can develop when you worry too much about having another panic attack or change behaviors to avoid having a panic attack.
How Anxiety Medication Works
Controlled medications for anxiety, such as benzodiazepines, work by binding to the brains GABA receptors. This action makes you feel calm and helps reduce nervousness and muscle spasms.
Benzodiazepines are considered controlled substances because the brain and body quickly build up a tolerance, requiring larger doses to get the same effect. When you use these medications regularly, it teaches your body to depend on outside means to relax. So when you dont take the drug, you may become restless, tense, and irritable.
Non-controlled medications affect the brain in a different way. For instance, SSRIs act slowly on the serotonin system while SRNIs act on both serotonin and norepinephrine. These medications are safer for long-term use, whereas benzodiazepines become less effective over time.
How Do Bipolar & Anxiety Affect Each Other
One of the most challenging symptoms associated with bipolar disorder is emotional lability, more commonly known as mood swings. Though mood swings may be predictable over time, there are many occasions in which they are not. Being unsure of how one will function individually or socially in front of others is often met with worry, increasing anxiety incidents. Understanding this connection requires some insight into the physiological processes that lead both disorders to affect each other.
Bipolar disorder affects the thinner cortical gray matter in the frontal, temporal, and parietal regions of both brain hemispheres and the hippocampus, with the most considerable effect seen in blank areas, such as:3, 4, 5
- The left pars opercularis
- The left fusiform gyrus
- The left rostral middle frontal cortex
Given the significant impact of bipolar disorder on the brain, it makes sense that those impacts may also lead to anxiety.
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When Should I Call The Doctor
Some panic attacks have signs that can be confused with a physical problem like a heart attack. If you have chest pain or trouble breathing or lose consciousness, seek emergency medical care.
You should call your healthcare provider if you have panic attacks and experience:
- Chronic anxiety that interferes with daily life.
- Difficulty concentrating.
What Are Ssris And Snris
Selective serotonin reuptake inhibitors like Zoloft and Prozac, and serotonin and norepinephrine reuptake inhibitors like Effexor and Pristiq are antidepressant medications, but they can help with anxiety symptoms as well. For this reason, many providers will prescribe an SSRI or SNRI if you have a combination of depression and anxiety.
SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief, Alonzo said. They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.
Some patients may respond better to one of these medications than others. If after taking the medication for two weeks and symptoms have not improved, talk to your provider to have your medication regimen adjusted. Treatment trials with more than one medication are not uncommon.
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E Social Anxieties And Phobias
For those with social anxieties, medications can help to reduce the tensions associated with entering the fearful situation, to bring a racing heart and sweaty palms under control, and to reduce some shyness.
Physicians use several classes of medications that are beneficial, individually or in combination. These include the beta-blockers, benzodiazepines, venlafaxine, the SSRIs and trazodone.
The drugs with the longest history of use with social anxiety are the beta adrenergic blocking agents, also known as beta blockers. The most commonly used are propranolol and atenolol . The patient can take propranolol as needed or in dosages of 10 to 20 mg three to four times a day, or atenolol in dosages of 25 to 100 mg once daily. Surprisingly, controlled research studies have not supported the widespread anecdotal reports of success with beta blockers. Its possible that their best use is for occasional mild social anxieties associated with performance.
The high potency benzodiazepines clonazepam and alprazolam may also be effective. A combination of a beta blocker and low dosages of clonazepam or alprazolam could be best for some individuals.
If the social anxiety is more general, unpredictable and widespread, then patients may need to take venlafaxine, an MAOI such as phenelzine, or an SSRI such as sertraline. Keep in mind that these medications take several weeks to work.
Bupropion does not have enough evidence yet to verify its effectiveness for social anxiety disorder.
Ssri Antidepressants For Anxiety
Many medications originally approved for the treatment of depression are also prescribed for anxiety. In comparison to benzodiazepines, the risk for dependency and abuse is smaller. However, antidepressants take up to 4 to 6 weeks to begin relieving anxiety symptoms, so they cant be taken as needed. Their use is limited to chronic anxiety problems that require ongoing treatment.
The antidepressants most widely prescribed for anxiety are SSRIs such as Prozac, Zoloft, Paxil, Lexapro, and Celexa. SSRIs have been used to treat generalized anxiety disorder , obsessive-compulsive disorder , panic disorder, social anxiety disorder, and post-traumatic stress disorder.
Common side effects of SSRIs include:
- Increased sweating
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Which Treatment For Anxiety Is The Best
Melisse Prusinkski, Clinical Manager of Morningstar Womens Program at Integrative Life Center, said a mix of individual and group therapy is the best option for treating social anxiety.
Social anxiety can be triggered in a safe environment. With support, you can figure out how to heal the underlying reasons that the social anxiety became pervasive, she said. You will feel the connection of the group.
She said treatment for social anxiety is the scariest thing a person can do because treatment triggers the anxiety to help conquer it.
Unfortunately for those with social anxiety, healing cant happen in isolation. Thats why individual therapy alone probably wont work, she said. Most maladaptive behaviors take over when a person was alone.
Integrative Life Center offers a combination of individual and group therapy for Social Anxiety Disorder and holistic and non-traditional healing practices such as yoga, acupuncture, and equestrian therapy.
Do I Have An Anxiety Disorder
Common signs and symptoms of anxiety include nervousness, restlessness or tenseness, a sense of impending danger or doom, increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, trouble concentrating or sleeping, stomach aches and headaches and the urge to avoid things that trigger anxiety.
Anxiety disorders often develop from a complex set of risk factors. The risk factors may include exposure to trauma, certain medical problems like thyroid disease or heart disease, stress due to a severe illness and other mental health disorders like depression. The use or misuse of drugs and alcohol can worsen symptoms of anxiety.
Anxiety disorders are best treated with a combination of therapy and medication, Alonzo said. It takes time to find the perfect combination for your symptoms. Your primary care provider is the best place to start that journey.
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What Is The Best Non
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision , there are several types of anxiety, including generalized anxiety, separation anxiety, social anxiety, panic disorder, specific phobias, and others.
While they are all treated differently, SSRIs and SNRIs are among the first-line options for almost all anxiety types.
Other non-controlled medications include the following:
reported that imipramine and clomipramine two common tricyclics may be as effective as newer antidepressants in treating anxiety disorders. However, they carry a higher risk for side effects and toxicity.
Typically, SSRIs and SNRIs are tried first before tricyclics are prescribed.
Foods That Help Or Hurt Anxiety
There are several types of medications used to treat anxiety disorders.
Within each of these categories, there are subgroups of drugs that work differently and have their own benefits, risks, and possible side effects.
Theyre supereffective in treating anxiety disorders, says Beth Salcedo, MD, the medical director of the Ross Center for Anxiety & Related Disorders and a past board president of the Anxiety and Depression Association of America. Its not known exactly how SSRIs work on serotonin to alleviate anxiety, says Dr. Salcedo, but what is known is that theyre not addictive like benzodiazepines are .
Its important to follow your doctors instructions when taking any prescription drug. Talk to your doctor if youre concerned about the side effects of a medication, or if the drug youre taking doesn’t seem to be alleviating your symptoms.
Other antidepressants that may be prescribed for anxiety include:
- Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban
- Tricyclic antidepressants, such as Amitid, Amitril, Elavil, or Endep Aventyl, Pamelor or Tofranil
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What Are Anxiety Medications And How Do They Work
Anxiety is a normal and useful response to potentially stressful or dangerous situations. It increases our awareness of what’s going on around us. For most people, anxiety is short-lived and normally goes away once the situation has passed. This is not the case for an estimated 40 million adults in the United States who have some type of anxiety disorder and experience ongoing and unwarranted psychological distress. That distress may also manifest itself in physical symptoms such as muscle tension, headaches, or chest pain.
Anxiety medications include multiple types of drugs that are used to treat the symptoms of anxiety disorders. The three most commonly prescribed types of anxiety medication are
- anti-anxiety medications , and
Antidepressants and anxiolytic medications work primarily by affecting the balance of certain chemicals in the brain known as neurotransmitters. Beta-blockers and other types of drugs are used to address the physical symptoms that may accompany an anxiety attack. First-generation antihistamines are also used to help with anxiety symptoms because they have a sedating effect.
Anxiety disorders are associated with certain chemical imbalances in the brain involving neurotransmitters such as
- norepinephrine, and
- gamma-aminobutyric acid or GABA.
These chemicals are associated with an individual’s sense of well-being or with the ability to relax.
Psychological Therapies For Gad
If you have been diagnosed with GAD, you’ll usually be advised to try psychological treatment before you’re prescribed medication.
You can get psychological therapies like cognitive behavioural therapy and applied relaxation on the NHS.
You can refer yourself directly to an NHS psychological therapies service without a referral from a GP.
Or your GP can refer you if you prefer.
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Treating Children And Adolescents
Whereas specific phobias, SAD, and separation anxiety disorder are common in younger people, PDA and GAD are relatively rare. There are some randomized, placebo-controlled studies of pharmacotherapy for anxiety disorders in children and adolescents showing efficacy of sertraline, fluoxetine, and duloxetine in young patients with GAD, of venlafaxine and paroxetine in SAD, and of sertraline, fluvoxamine, and fluoxetine in mixed samples, including patients with separation anxiety disorder, GAD, and SAD.88 However, little is known about the value of long-term treatment.89 The combination of CBT and sertraline was found to be more effective than both treatment modalities alone.90
For children and youths with separation anxiety disorder, several treatment studies exist.95 However, no controlled studies on the treatment of adults with this disorder could be traced.
There is also a paucity of treatment studies for children with selective mutism. Small studies have shown that psychotherapeutic approaches were at least better than waitlist controls.96,97 One review indicated that only two very small placebo-controlled drug studies showed efficacy of the SSRIs fluoxetine and sertraline.98
Controlled Substances Vs Non
When we talk about non-controlled medications, were referring to medications that do not carry the risk of dependence or addiction according to the U.S. Drug Enforcement Administration .
Benzodiazepines, such as Xanax and Valium, are the oldest and most well-known controlled substances for anxiety. While they have the advantage of working very quickly, they carry the risk of dependence, sedation, and tolerance buildup.
Because of this, its important for people with anxiety to have alternatives to benzodiazepines.
Today, the first-line medications for anxiety are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors .
One of the core differences between SSRIs and SNRIs compared to Benzodiazepines is that the former substances actually treat the source of the anxiety, whereas the latter substance only treats the symptoms.
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When To Get Help
See a GP if you’ve been experiencing symptoms of panic disorder.
They’ll ask you to describe your symptoms, how often you get them, and how long you have had them.
They may also carry out a physical examination to rule out other conditions that could be causing your symptoms.
It can sometimes be difficult to talk about your feelings, emotions and personal life, but try not to feel anxious or embarrassed.
You may be diagnosed with panic disorder if you have regular and unexpected panic attacks followed by at least a month of continuous worry or concern about having further attacks.
Cannabidiol & Medical Marijuana
Lets address the skeptics here first, but also look at the big picture in an unbiased way. We clearly need more research on this topic. Marijuana can clearly be addictive for some. Our society has had a puritanical basis against marijauna research in the past. Its clearly safer on average than alcohol and benzos in terms of overdose and fatality. Typically, overdose on these products has not ever been described as fatal. Only very recently has a coroner said there may have been a fatal overdose on marijuana. Even if this is not an accurate report, with the legalization of marijuana and development of higher potency strains, it would not surprise me that this does occur in time. But for now, in the big picture, the #1 drug that kills in our society is nicotine, and alcohol is #2.
The mechanism of action here concerns the endocannabinoid system in the human body. Like the other classes of medicines discussed, the exact mechanism is not completely understood. This can have various different effects including reducing seizures, anxiety, and gastrointestinal symptoms. The first ever CBD product was approved last year for severe seizure disorders.
I tend to refer my patients to someone who specializes in medical marijuana and CBD when other classes of medications like antidepressants have failed them.
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How Is Panic Disorder Diagnosed
Medical or mental health providers can diagnose panic disorder. Your provider may diagnose panic disorder when you have repeated panic attacks and you:
- Persistently worry about having more panic attacks or their consequences.
- Obsess about losing control during a panic attack.
- Change your behaviors to avoid situations that may trigger a panic attack.
What Are The Complications Of Panic Attacks
Panic attacks are highly treatable. Unfortunately, many people put off seeking help because theyre embarrassed. Untreated panic attacks or panic disorder can interfere with your ability to enjoy life. You may develop:
- Anticipatory anxiety: The possibility of having a panic attack triggers extreme anxiety.
- Phobias: A phobia is an extreme, unreasonable fear of something specific. For instance, acrophobia is a fear of heights, while claustrophobia is a fear of enclosed spaces.
- Agoraphobia: Approximately two-thirds of people with panic disorder develop agoraphobia. This anxiety disorder makes you afraid to be in places or situations where a panic attack might happen. The fear can become so extreme that you become too afraid to leave your house.
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Questions To Ask Yourself And A Mental Health Professional
- Is medication the best option for my anxiety problem?
- Am I willing to put up with unpleasant side effects in return for anxiety relief?
- What non-drug treatments for anxiety might help?
- Do I have the time and am I willing to pursue non-drug treatments such as cognitive-behavioral therapy?
- What self-help strategies might help me get my anxiety under control?
- If I decide to take anxiety medication, should I pursue other therapy as well?
- Is anxiety really my problem? Or is something else going on, such as an underlying health condition or pain, for example?
Getting The Help You Need
If youre battling anxiety and panic disorders, youre not alone. At Mango Clinic, were here to help you live and function normally. Contact us today to start your mental health and wellness journey or click the banner below to book your appointment.
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Michael
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Unresponsiveness To Standard Treatments
Before considering a patient to be treatment unresponsive, it should be ascertained that the diagnosis was correct, adherence to the treatment plan was sufficient, the dose prescribed had covered the full range, and there had been a trial period of adequate duration. When patients report previous treatment failures, it often turns out that a drug was only prescribed in the lowest dose or was stopped within the first 2 weeks due to side effects that occurred in the initial phase before the patient could experience improvement.
Elderly patients may take longer to show a response. Table III contains options in case of drug inefficacy or intolerance. In patients who are unresponsive to psychotropic drugs, the addition of CBT is generally recommended.85
A combination of antidepressants and benzodiazepines is sometimes used in treatment-refractory cases.
When all standard treatments have failed, the off-label use of drugs may be considered, for example, drugs licensed for another anxiety disorder or that are not licensed but have shown efficacy in clinical studies. Such drugs include quetiapine and agomelatine.