Health and Wellness

By Ranu Boppana, MD

Coping with Panic Attacks

Reshma, a successful executive, came to see me because of the intense, paralyzing fear she sometimes felt. The episodes would come without warning and caused her heart to race, her palms to sweat and her head to spin. Reshma also had trouble breathing during these attacks and had a painful sensation in her chest. The first time this happened, Reshma went to her local emergency room fearing she was having a heart attack. All the tests showed that she was medically healthy, so her doctor urged her to have a diagnostic evaluation with a psychiatrist.

When Reshma related her life story to me, I learned that she had recently been promoted to vice president at a large multinational firm because of her intelligence and hard work at the company. With the promotion came the task of speaking to large audiences and fear of public speaking filled her with dread. Meeting new people had always been hard for Reshma. She began to have frequent panic attacks and couldn’t sleep before or after a presentation. Reshma began to worry that she was going crazy. She feared that others saw her distress and began to avoid situations where she would have to speak with people. She even had thoughts of quitting the job she had worked so hard to secure.

Reshma also told me that her mother was someone who couldn’t handle stress and she feared that she was becoming like her. Reshma’s mother often got depressed, didn’t interact much with friends or family, feared going places where she might be trapped if she felt ill and rarely left home if she could manage it. Reshma’s husband encouraged Reshma to seek help despite her belief that she was someone who always handled things on her own and didn’t need to see a “shrink”.

But Reshma was right to eventually seek help. She is one of 7 million people in the United States who suffers from Panic Disorder, an anxiety disorder that can severely hamper one’s ability to live a full, productive and enjoyable life. Untreated, anxiety disorders progress and become increasingly disabling, the same way medical disorders cause complications when they are untreated. Individuals with untreated Panic Disorder, like Reshma’s mother, often develop depressive symptoms and agoraphobia, a fear of crowded places or situations from which escape might be difficult.

The causes of Panic Disorder are multifactorial and include a genetic history, breathing disorders, chemical imbalances in the brain and emotional or cognitive conditions. But Panic Disorder is a highly treatable condition—a combination of psychotherapy and medication can be highly effective in helping an individual get back on track. The risk of not treating an anxiety disorder lies in leading an increasingly restricted life.

Reshma made good use of short-term psychotherapy and psychotropic medication. She has experienced no further panic attacks and has grown increasingly confident in her public speaking and social skills, and no longer fears these activities. Her relationship with her husband has also grown closer and they are now parents of two young children. Reshma is saddened that her mother still refuses to get help but is glad that she got timely help for herself.

Reshma was lucky that she had the support and resources to seek help because there are many barriers to mental health treatment. Immigrants in particular experience higher rates of mental distress and anxiety in the United States due to the stress of acculturation. They are also more likely not to seek help because of the perceived stigma of needing or seeing a psychiatrist or having some type of mental illness. Although some people feel that mental disorders are due to character flaws, most mental disorders are highly biological and are as much a person’s fault as having diabetes, hypertension or cancer. Just like with diabetes or hypertension, treatment for mental illness is more effective when the disorder is caught early. Another barrier to effective treatment that immigrants face is finding culturally sensitive treatment. An individual is more likely to regain good mental health when a clinician understands emotions and symptoms in the context of his or her culture.

Finally, a formidable barrier to treatment is the expense. Many insurance companies do not pay for mental health treatment on parity with medical treatment. Because mental healthcare is labor intensive, it can be expensive, and an individual may be left with the agonizing decision of whether or not they can afford treatment. Individuals who need treatment should begin by asking their insurance companies detailed questions about their coverage. Many communities also have sliding scale clinics for those unable to pay for treatment privately. The Anxiety Disorders Association of America, on the web at www.adaa.org, offers some suggestions on where to begin seeking help.

Ranu Boppana, MD is an Adult and Child Psychiatrist in private practice in New York, NY and a Clinical Instructor at the NYU School of Medicine.

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