Coping with Panic Disorder: Strategies for Managing Symptoms and Travel Anxiety

Q: Coping with Panic Disorder: Strategies for Managing Symptoms and Travel Anxiety

Hello, Mr. <br>Lightning： The primary cause of panic disorder is actually anxiety issues. <br>From physiological, psychological, and social perspectives, factors that may contribute to anxiety include inherent temperamental traits (such as perfectionism), accumulated experiences

Panic disorder prevents individuals from traveling far?

Hello, I have been suffering from panic disorder for 19 years and have been seeing Dr.
Zhao at the New Taipei City Hospital.
I have taken medications including Lyrica and Xanax 0.5mg, but for the past several years, I have only been taking Xanax without any issues.
However, I was sent to the emergency room at En Chu Kong Hospital once in 2015, and again in April of this year at the New Taipei City Hospital and Fu Jen Catholic University Hospital, as my symptoms have increased in frequency.
Recently, my medication was changed to Clonazepam, while I continue to take Xanax 0.5mg as usual.
I have been taking four Xanax pills daily for nearly 10 years.
Each time I go to the emergency room, I experience shortness of breath, abdominal cramps, and high blood pressure (systolic pressure ranging from 160-205 and diastolic pressure from 103-130) with a heart rate of about 130-150.
This is an uncontrollable state that leads me to the emergency room.
Upon examination, the doctors have found my EKG and blood tests to be normal (I also have regular health check-ups, and my blood pressure and heart health are normal).
In the emergency room, I am routinely given 2ml of Ativan, which alleviates my symptoms within about half an hour, allowing me to be discharged.
I feel that the medications have not helped me; for the past several years, only Xanax or Clonazepam have provided relief.
My situation is quite unique; I can predict when I will feel unwell, and my blood pressure tends to rise during those times.
I understand that this condition cannot be completely cured, only managed to alleviate symptoms.
I have seen many doctors and undergone individual therapy, but the results have been limited.
No one in my family has epilepsy or similar conditions.
Due to the increased frequency of my episodes in recent months, my doctor has advised me not to travel far for six months.
However, I still have business to attend to.
Currently, when I am on the highway and see traffic congestion, I can predict that I will have an episode.
If I am lucky, I can endure it or take Xanax to help alleviate the symptoms.
I feel even more anxious when I am not driving and take the subway (claustrophobia).
I even feel nervous about getting a CT scan.
I would like to ask how I should manage my current situation.
Sometimes, when I drive long distances, I have to plan my route to ensure I am near a hospital, which is very distressing for me.
Additionally, I have been experiencing tinnitus for almost six months; sometimes it is present, and sometimes it is not.
I have seen an ENT specialist, and my hearing tests were normal, so it has been attributed to autonomic nervous system dysregulation.
Because of this, I do not exercise much and have not engaged in vigorous exercise for several years.
I really do not want to feel this way.
Sometimes, when I am driving and feel uncomfortable, I get very frustrated.
I have been on Western medication for over a decade without improvement, and I have changed medications several times.
On average, I have an episode about every three days, and medication can relieve it.
However, when I cannot control it, such as after consuming strong tea or coffee, my heart rate accelerates, and I can only go to the emergency room when I feel restless (so I am aware to avoid stimulants).
I believe my condition is psychologically driven.
Doctors always suggest coexisting peacefully with it.
I have spent a considerable amount of money on this, seen many specialists, and still experience recurring issues.
The more I focus on feeling unwell, the more I actually feel unwell.
I try to take my medication on time and ignore it, hoping it will not bother me, but I still have to plan routes near hospitals when I go out.
As I age, I worry about whether this will affect other organs.
I have hypertension, but it is well-controlled with medication, usually averaging below 140/90.
I categorize it as normal, but when I have an episode, it is not the same.
I would like to ask the doctor how I should respond if I experience an episode while on the highway (the doctor suggested I take Xanax first).
Previously, a doctor at Yadong Hospital prescribed me sublingual nitroglycerin, but my family doctor strongly advised against using it, as it can cause dizziness and is primarily used to lower blood pressure.
I can manage my symptoms with Xanax due to emotional triggers.
So, if I feel really unwell, is it only Xanax that I can take? (I feel the effects of Xanax within about 15 minutes, and it can stabilize my blood pressure for about 4-6 hours).
Additionally, I would like to ask the doctor if my elevated blood pressure and heart rate of 130-150 during panic attacks could cause fluctuations in my cardiac troponin I levels.
Do you have any recommendations on how I should face these current issues?

Shan Dian, 30~39 year old female. Ask Date: 2020/07/11

Dr. Wang Yazhen reply Psychiatry

Hello, Mr.
Lightning: The primary cause of panic disorder is actually anxiety issues.
From physiological, psychological, and social perspectives, factors that may contribute to anxiety include inherent temperamental traits (such as perfectionism), accumulated experiences and feelings during the developmental process (such as being harshly criticized for not performing well), and actual environmental stressors, which ultimately lead to significant anxiety; panic is essentially a severe anxiety attack.
Anxiety can also affect the body, including your current hypertension and the tachycardia that occurs during panic attacks; your current tinnitus is also a common symptom associated with anxiety.
Other common physiological issues related to anxiety include gastrointestinal problems (such as constipation or diarrhea), muscle stiffness and tension, and immune system issues, demonstrating the broad impact of anxiety on the body.
Pharmacological treatment intervenes at the physiological level through medication and can certainly be helpful, but medication alone is insufficient.
As mentioned earlier, anxiety arises from the cumulative effect of various factors, including your approach to handling situations, your attitude towards problems, and your perceptions of the world and environment over time, all of which can influence you.
Therefore, I recommend engaging in in-depth and ongoing psychotherapy to better understand yourself and confront your issues.
Cardiac troponin I is typically detectable only in cases of acute myocardial injury; however, for clinical significance, it is advisable to consult a cardiologist for further guidance.
Wishing you all the best!

Reply Date: 2020/07/11

More Info

Coping with panic disorder, especially when it has persisted for many years, can be incredibly challenging. Your experience highlights the complexity of managing symptoms, particularly when they are intertwined with anxiety about travel and other stressors. Here are some strategies and insights that may help you manage your panic disorder and travel anxiety more effectively.

Understanding Panic Disorder
Panic disorder is characterized by recurrent, unexpected panic attacks—sudden periods of intense fear or discomfort that peak within minutes. Symptoms can include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes. The fear of having another attack can lead to avoidance behaviors, which can significantly impact your daily life and activities, including travel.

Medication Management
You mentioned taking medications like Xanax (alprazolam) and Ambien (zolpidem), which are commonly prescribed for anxiety and sleep issues. While these medications can provide temporary relief, they may not address the underlying issues of panic disorder. Long-term reliance on benzodiazepines like Xanax can lead to tolerance and dependence, making it essential to work closely with your healthcare provider to explore other options.

Consider discussing with your doctor the possibility of incorporating selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), which are often effective for anxiety disorders and may help reduce the frequency and intensity of panic attacks over time. Additionally, cognitive-behavioral therapy (CBT) is a highly effective treatment for panic disorder, focusing on changing negative thought patterns and behaviors associated with panic attacks.

Coping Strategies for Panic Attacks
1. Breathing Techniques: During a panic attack, focus on your breathing. Try deep, slow breaths—inhale for a count of four, hold for four, and exhale for four. This can help calm your nervous system and reduce the intensity of the attack.

2. Grounding Techniques: Use grounding techniques to bring your focus back to the present moment. For example, identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

3. Plan Ahead: Since you mentioned feeling anxious about travel, plan your routes in advance, including identifying nearby hospitals. This can provide a sense of security and control over your environment.

4. Gradual Exposure: Gradually expose yourself to situations that trigger your anxiety in a controlled manner. Start with less intimidating scenarios and gradually work your way up to more challenging situations, such as driving on the highway.

5. Mindfulness and Relaxation: Incorporate mindfulness practices, such as meditation or yoga, into your daily routine. These practices can help reduce overall anxiety and improve your ability to cope with panic attacks when they occur.

Managing Physical Symptoms
You expressed concerns about elevated blood pressure and heart rate during panic attacks. It's essential to communicate these symptoms to your healthcare provider, as they can help determine if any additional interventions are necessary. Panic attacks can indeed cause temporary spikes in blood pressure and heart rate, but consistent monitoring and management are crucial.

Seeking Professional Support
Given the complexity of your symptoms and the duration of your panic disorder, consider seeking a comprehensive evaluation from a mental health professional who specializes in anxiety disorders. They can provide tailored treatment options, including therapy, medication adjustments, and lifestyle modifications.

Conclusion
Coping with panic disorder and travel anxiety requires a multifaceted approach that includes medication management, therapeutic interventions, and self-care strategies. While it may feel overwhelming at times, remember that recovery is possible, and many individuals successfully manage their symptoms with the right support and resources. Stay proactive in your treatment, and don't hesitate to reach out for help when needed.

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