Friday, October 05, 2007

Panic attacks: False biological alarms

Panic, which is the most dramatic form of acute anxiety, is the cry for life.
---Eric Griez, University of Maastricht, the Netherlands

If you've never had one, you cannot imagine how compelling and physical they are. The feeling is not a 'Hoo-boy am I anxious' one, but rather a 'Dear heaven I am not getting enough oxygen and I may pass out or die' sort of experience. Until I experienced one myself, I put some patients with panic attacks through pulmonary, cardiac, or GI work-ups. Now I often spot them coming based on their chief complaints of 'trouble breathing' as listed on my daily schedule.

I was instantly drawn, then, to an article in an October issue of PLoS One* regarding altered sensitivity to carbon dioxide as the basis of panic attacks. Scientists previously noted that individuals prone to panic have panic-attackish sorts of episodes if exposed to inhaled gases heavy on the carbon dioxide. The panic response to rising levels of carbon dioxide makes evolutionary sense, but an overactive, internal suffocation monitor can lead to unwarranted alarm.

Dr. Griez et al invited 64 panic-free volunteers down to the lab to suck a little air with varying concentrations of carbon dioxide. As carbon dioxide content rose, so did the volunteers' feelings of fear, depersonalization, and a loss of sense of reality. The authors are hopeful that this laboratory model of induced panic attacks may lead to better opportunities to study drug therapy for patients with panic disorder as well as for chronic pulmonary patients dealing with behavorial panic resulting from their high body levels of CO2.

My situational panic disorder developed after I was in a car accident. Although I was not injured, in the moments before the impact my best guess assessment was that I would die. I subsequently became scarcely able to breathe while driving and assumed (what internist wouldn't?) that I had a mid-chest tumor pressing on my trachea. Once I identified my difficulties as panic, the road back to carefree driving was a long strange trip through various medications and behavioral therapy.

If you suffer from panic attacks after in intense experience such as mine where you perceive your life is in danger, check out Crash Course. Dr. Heller's techniques were the most helpful to me in my recovery.
*Griez EJ, Colasanti A, van Diest R, Salamon E, Schruers K (2007) Carbon Dioxide Inhalation Induces Dose-Dependent and Age-Related Negative Affectivity. PLoS ONE 2(10): e987.


Mauigirl said...

My half-siser had a panic attack once when she and my brother-in-law were traveling, and she went to an ER thinking she was having a heart attack - luckily it was just a panic attack. It must be very scary.

seventeen_at_heart said...

that's helpful, I often feel I'm not getting enough oxygen through, especially in the last 6 months or so (I'm 48).
I thought it might be my weight, but it can come even when I'm resting sometimes.

Anonymous said...

I remember living in the downtown area in about 1972 when Denver had a panic attack making bad smog day. The air was a brownish yellow and had a greasy feeling. I began to wonder if we would ever be able to breath air again. I still have 'mild' going to past out, chest too tight to breathe attacks.
I usually have the attacks when I'm driving and have to be behind a 'classic' Pickup truck. And I can forget about waiting for a RTD bus.

Femail doc said...

MG: I'll bet the ERs are very used to that sort of visit. I hope they handled it with grace.

17@heart: Perimenopause is one of the most common times in a woman's life for the onset of panic attacks. Be warned, however, I just read a report that menpausal women with panic attacks are at higher risk for heart disease. The connection seems significant, but the researchers are clueless what the meaning of it all is.

Anonymous: I also have noticed that strong odors such as perfume in a small space like my exam room, or exhaust fumes make me feel short of breath, thankfully short of panic.