Anxiety, Panic Attacks, and Autonomic Nervous System Disorders

Anxiety, panic, or autonomic nervous system dysregulation?

Hello, doctor.
From April to June, I experienced four episodes of shortness of breath, chest tightness, and rapid heartbeat, which led me to the emergency room.
After examination, the doctor concluded that these symptoms were caused by anxiety and were close to panic symptoms.
After some psychological adjustment and without the use of medication, I have not had any episodes for about two months.
However, due to some stress recently, I experienced a slight increase in heart rate and mild chest tightness last night, although my breathing was relatively smooth.
To be safe, I went to the emergency room again, and the doctor prescribed me sedatives and medications to lower my heart rate.
Does this count as a panic attack? Is being close to a panic attack considered panic disorder? During these episodes, I also have a strong urge to use the restroom and experience diarrhea; is this one of the symptoms? I am not very fond of using medication for treatment.
I often feel worse after visiting a psychiatrist, which increases my stress.
I have a general idea of what my stressors are...
Is it feasible to improve my situation through counseling? Are panic attacks and autonomic nervous system disorders different conditions? I have hyperthyroidism and am currently on medication to manage it; could this also make me more prone to anxiety? Thank you for your response, doctor.

Niming, 40~49 year old female. Ask Date: 2021/09/03

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
From your letter, it is clear that you are experiencing discomfort and distress due to the pressures of both anxiety and panic disorders.

1.
Facing an uncertain future, anxiety disorders are common in modern society.
This is a chronic condition that requires long-term treatment for recovery.

2.
The emergency department can only address acute issues; ongoing medical care will be beneficial for your condition.
However, due to individual differences in physiology, it will take time to identify the appropriate medication, so please be patient and cooperate with your physician.

3.
Regarding medication treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
I recommend that if you experience any discomfort, you should note the duration and frequency of these symptoms.
For any physiological issues, please discuss them thoroughly with your physician during your follow-up appointment, as some symptoms may be related to the original condition, while others could be side effects of the medication.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I suggest you consider visiting the clinic for a personal evaluation of your symptoms, so we can collaboratively determine the best course of action for you.
Wishing you good mental and physical health.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2021/09/03

More Info

Understanding anxiety, panic attacks, and autonomic nervous system disorders is crucial for managing your symptoms effectively. Based on your description, it seems you have experienced episodes that align closely with panic attacks, characterized by symptoms such as rapid heartbeat, chest tightness, and difficulty breathing. These episodes can be quite distressing and often lead individuals to seek emergency care, as you did.
Panic attacks are sudden periods of intense fear or discomfort that peak within minutes and can include a range of physical and emotional symptoms. Common symptoms include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes, and a fear of losing control or dying. The fact that you have experienced these symptoms multiple times, particularly in stressful situations, suggests that you may be dealing with panic disorder, especially if these episodes have occurred unexpectedly and without an obvious trigger.

Your mention of feeling pressure to use the restroom or experiencing diarrhea during these episodes is also not uncommon. The autonomic nervous system, which regulates bodily functions such as heart rate and digestion, can react strongly during periods of anxiety or panic. This can lead to gastrointestinal symptoms, including the urge to use the bathroom.

Regarding your question about whether "near panic" counts as a panic attack, it’s important to note that panic attacks can vary in intensity. If you experience significant anxiety and physical symptoms that disrupt your daily life, it may be classified as a panic disorder, even if the episodes are not as severe as others you have experienced.

You also raised an important point about your preference for non-pharmacological treatments. While medications such as benzodiazepines can provide quick relief from acute anxiety symptoms, they are not always the best long-term solution due to potential side effects and dependency issues. Cognitive-behavioral therapy (CBT) and other forms of counseling can be effective in managing anxiety and panic disorders. These therapies focus on identifying and changing negative thought patterns and behaviors that contribute to anxiety, helping you develop coping strategies for stressful situations.

Your underlying condition of hyperthyroidism (overactive thyroid) can indeed exacerbate anxiety symptoms. The thyroid gland produces hormones that regulate metabolism, and an overactive thyroid can lead to symptoms such as increased heart rate, anxiety, and nervousness. It’s crucial to ensure that your thyroid condition is well-managed, as fluctuations in hormone levels can significantly impact your mental health.

In summary, it is advisable to continue working with healthcare professionals to monitor both your anxiety symptoms and thyroid condition. If you prefer to avoid medication, discussing alternative treatments such as therapy with your healthcare provider can be beneficial. Additionally, practicing relaxation techniques, mindfulness, and regular physical activity can help manage anxiety symptoms. Remember, you are not alone in this, and seeking help is a positive step toward feeling better.

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