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.
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*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.