Managing Panic Disorder: Symptoms and Treatment Options

Anxiety Panic Disorder

Hello, Dr.
Wu.
I often experience chest tightness and difficulty breathing.
In the mornings, about ten minutes after I wake up, I start to feel dizzy and nauseous, along with bloating.
Every day, I have a sensation of tightness in my shoulders and neck, and no matter how I position my neck, it feels uncomfortable.
I also struggle with concentration and often feel unmotivated about many things.
Two years ago, I had a panic attack and took fluoxetine for over a year.
I felt more stable, but I easily become anxious and panicked due to even minor physical discomfort (a bit of a fear of dying).
I have worked hard to gradually taper off the medication as prescribed by my doctor, and the process has been very challenging.
Now, I am experiencing these physical discomforts again, and I really don’t want to go back on SSRIs because tapering off was truly painful.
Recently, due to some palpitations, my cardiologist prescribed me a medication called Yongkangxu to take once a day.
Will this help me? What kind of medication is this? Additionally, I would like to ask if anxiety disorders can improve.
What can I do or eat to help myself? Thank you, and take care.

nick, 20~29 year old female. Ask Date: 2023/02/22

Dr. Wu Enliang reply Psychiatry

Netizens are unsure why some people stop using Paxil (Paroxetine).
Is it due to side effects? After the first-generation SSRI Paxil, many medications with fewer side effects and potentially better efficacy have been introduced.
Xanax (Alprazolam) is a medication that provides temporary relief for anxiety.
There are also non-pharmacological treatment options for anxiety disorders, such as psychotherapy, relaxation training, and transcranial microcurrent stimulation.
Dr.
Wu Enliang.

Reply Date: 2023/02/22

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. Understanding the symptoms and treatment options for panic disorder is crucial for effective management.

Symptoms of Panic Disorder
Panic attacks can manifest both psychologically and physiologically. Common psychological symptoms include:
1. Intense Fear: A sudden feeling of impending doom or fear of losing control.

2. Derealization or Depersonalization: Feeling detached from reality or oneself.

3. Fear of Dying: A strong fear that one is having a heart attack or is about to die.

Physiological symptoms often include:
1. Chest Pain: This can feel like a heart attack.

2. Shortness of Breath: A feeling of being unable to breathe or choking.

3. Palpitations: Noticeably rapid or irregular heartbeats.

4. Sweating: Excessive sweating, often accompanied by chills or hot flashes.

5. Nausea or Abdominal Distress: Feelings of nausea or discomfort in the stomach.

6. Dizziness or Lightheadedness: A sensation of fainting or losing balance.

7. Trembling or Shaking: Physical manifestations of anxiety.

Treatment Options
Managing panic disorder typically involves a combination of medication and psychotherapy.
1. Medications:
- Selective Serotonin Reuptake Inhibitors (SSRIs): These are commonly prescribed for anxiety disorders. They can help regulate mood and reduce anxiety over time. However, as you mentioned, tapering off SSRIs can be challenging and may lead to withdrawal symptoms.

- Benzodiazepines: These medications can provide quick relief from acute anxiety symptoms but are generally not recommended for long-term use due to the risk of dependence.

- Beta-Blockers: Medications like the one you mentioned, Yongkangxu (likely a beta-blocker), can help manage physical symptoms such as palpitations and tremors during panic attacks.

2. Psychotherapy:
- Cognitive Behavioral Therapy (CBT): This is one of the most effective treatments for panic disorder. CBT helps individuals identify and change negative thought patterns and behaviors that contribute to anxiety.

- Exposure Therapy: Gradual exposure to the situations that trigger panic attacks can help desensitize individuals to their fears.

3. Lifestyle Modifications:
- Regular Exercise: Physical activity can help reduce anxiety and improve mood.

- Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, and yoga can help manage anxiety symptoms.

- Healthy Diet: Eating a balanced diet rich in whole foods can support overall mental health. Avoiding excessive caffeine and sugar can also help reduce anxiety symptoms.

Prognosis and Self-Help Strategies
Panic disorder is treatable, and many individuals experience significant improvement with appropriate treatment. It's essential to maintain open communication with your healthcare provider about your symptoms and treatment preferences.
In addition to medication and therapy, consider the following self-help strategies:
- Journaling: Keeping a journal can help you track your symptoms and identify triggers.

- Support Groups: Connecting with others who experience similar challenges can provide emotional support and practical coping strategies.

- Education: Learning more about panic disorder can empower you and reduce feelings of helplessness.

Conclusion
While the journey of managing panic disorder can be challenging, it is important to remember that recovery is possible. If you are hesitant about resuming SSRIs, discuss alternative options with your healthcare provider, including the potential benefits of the medication you are currently taking. Additionally, consider incorporating lifestyle changes and therapeutic practices that can enhance your overall well-being. Remember, you are not alone in this journey, and seeking help is a sign of strength.

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