Panic Disorder: Symptoms, Diagnosis, and Treatment Options

Am I suffering from panic disorder?

I used to work continuously, but about two years ago, due to work-related exhaustion, I stayed home to rest and take care of my child.
For a while, I suddenly experienced palpitations, shortness of breath, stomach pain, and even numbness in my hands and feet.
When I went to the emergency room, the doctor said it was hyperventilation and suggested that during an episode, I could breathe into a plastic bag.
Later, it became a frequent occurrence.
During my illness, I lost about ten kilograms due to a lack of appetite.
The doctor prescribed Xanax and Inderal for treatment, so whenever I felt anxious and my heart started to race, I would take the medication immediately to control or alleviate the symptoms.
My condition improved slightly until two weeks ago when I had another episode, which was more severe.
In addition to the previously mentioned symptoms, I also experienced dizziness, headaches, and elevated blood pressure.
Finally, I consulted a psychiatrist, and one doctor diagnosed me with panic disorder, another with depression, and yet another with neurosis.
Could you please tell me what my actual condition is? Currently, my prescription has been supplemented with Prozac (fluoxetine).
Should I continue taking it? Note: I have a history of thalassemia and gastroesophageal reflux disease.

Ying Ying, 30~39 year old female. Ask Date: 2000/12/03

Dr. Li Junren reply Psychiatry

Your situation exhibits typical symptoms of panic disorder.
Panic disorder is a type of anxiety disorder, distinct from depression, though these two conditions often co-occur.
The medication you are currently using is a good combination (Prozac + Xanax + Inderal), but there may be some misunderstanding regarding its usage.
"Taking medication immediately when a panic attack is imminent to alleviate symptoms" only provides symptomatic relief.
The correct approach is to take the medication regularly for about three to four months (Prozac once daily, Xanax three to four times daily, Inderal two to three times daily), and then gradually taper the dosage under your physician's guidance.
If the frequency of panic attacks increases during the tapering process, extend the duration of medication use.
If no further attacks occur, you may consider discontinuing the medication.
Panic disorder has a high likelihood of recurrence; if a relapse occurs, do not panic, and simply follow the previous steps to regain control.

Reply Date: 2000/12/03

More Info

Panic disorder is a type of anxiety disorder characterized by recurrent and unexpected panic attacks, which are 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, numbness or tingling sensations, feelings of unreality or detachment, and fear of losing control or "going crazy."
Based on your description, it seems you have experienced many of these symptoms, particularly the heart palpitations, shortness of breath, and feelings of anxiety. The fact that these episodes have become more frequent and severe, along with the additional symptoms of dizziness, headaches, and elevated blood pressure, suggests that you may indeed be dealing with panic disorder.
Diagnosis of panic disorder typically involves a thorough evaluation by a mental health professional, who will assess your symptoms, medical history, and any potential triggers for your panic attacks. It’s important to rule out other medical conditions that could mimic panic symptoms, such as heart problems or hyperthyroidism. Given your history of Mediterranean anemia and gastroesophageal reflux disease (GERD), it’s crucial to ensure that these conditions are managed appropriately, as they could contribute to your overall sense of well-being and anxiety levels.

In terms of treatment, panic disorder is often effectively managed with a combination of medication and psychotherapy. The medications you mentioned, Xanax (a benzodiazepine) and Inderal (a beta-blocker), are commonly used to help alleviate symptoms of anxiety and panic. Xanax can provide quick relief during acute episodes, while Inderal can help with physical symptoms like rapid heart rate. However, it’s important to use these medications as prescribed and to discuss any concerns about their use with your healthcare provider.

Prozac (fluoxetine), which has been added to your treatment regimen, is a selective serotonin reuptake inhibitor (SSRI) that is often used to treat anxiety disorders, including panic disorder. SSRIs can help reduce the frequency and intensity of panic attacks over time. It’s generally recommended to continue taking Prozac as prescribed, as it may take several weeks to notice its full benefits. However, if you experience any adverse effects or have concerns about the medication, you should discuss these with your doctor.

Cognitive-behavioral therapy (CBT) is another effective treatment for panic disorder. CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. It can help you develop coping strategies for managing panic attacks and reducing avoidance behaviors that may arise from fear of future attacks.

In summary, it appears that you may be experiencing panic disorder, given the symptoms you’ve described. It’s essential to work closely with your healthcare provider to ensure that you receive a comprehensive evaluation and appropriate treatment. This may include continuing your current medications, exploring psychotherapy options, and addressing any underlying medical conditions that could be contributing to your anxiety. Remember, you are not alone in this, and with the right support and treatment, it is possible to manage and reduce the impact of panic disorder on your life.

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