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Hi – Here is the third article about Panic Disorder and Agoraphobia. Since I am an M.D., I cannot express my point of view without being concerned about liability. So please note this disclaimer before reading further: Any medical information in this article is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.
I hope you will find this helpful since that is the purpose of making this available to you. (Enjoyable at times is O.K. too.)
When a group of people who have Panic Disorder is compared to a group of people who do not, various physical differences can be identified. Not everyone in the Panic Disorder group has those physical differences, but far more people in that group have the differences than do persons in the non-Panic Disorder group. Here are some of those differences:
A chemical called Lactate has been noted to frequently cause panic attacks in persons with Panic Disorder. Sodium Lactate is very commonly used as the basic solution in intravenous fluids given in hospitals. It is important to tell your doctor that you have Panic Disorder and cannot take it. (It is included in the letter for physicians at the end of this chapter.)
Mitral Valve Prolapse Syndrome is seen in more than 50 percent of agoraphobics. This is a condition in which the leaflets of the mitral valve in the heart allow some blood to go backwards. This occurs in almost everyone to some extent. In most agoraphobics, MVPS (also called “Barlow’s Syndrome”) is a benign condition requiring no treatment. However, it may cause you to have various sensations that may be very uncomfortable when you do not know what they mean. Some people experience a "floppy" feeling in their chests. Others experience the sensation of their hearts beating in their throats. Many times people go to their doctors because of these feelings but are told that there is nothing wrong. If this happens to you, don’t think you are imagining things. The condition is there and it is causing the feelings you are having. It’s just that they are not dangerous for you no matter how uncomfortable they may be and they do not need treatment. The condition can be diagnosed by an echocardiogram. This is a painless test that will tell you exactly how your mitral valve is performing. If you or your doctor is concerned that you may be one of the rare individuals who has a case of MVPS requiring treatment, she can order an echocardiogram for you.
Here are some more anomalies (differences - not abnormalities) seen in agoraphobics: First, there is a great sensitivity to hormone changes. Thus, hysterectomy, PMS, thyroid hormone, and adrenal hormones such as cortisone can all make panic attacks more likely. Also, agoraphobics are more sensitive to bright lights, especially the fluorescent lights found in large stores. Testing agoraphobics exposed to these lights has confirmed this by using the electroencephalogram or "brain wave" test. A way to enhance the EEG is to do it after a person has been deprived of sleep. When especially sensitive electrodes (wires) are placed in the nose (called "nasopharyngeal leads"), clear differences between agoraphobics and non-agoraphobics have been identified. More such differences will doubtless be discovered in the near future because of the new brain-imaging technologies that have recently been developed such as P.E.T and S.P.E.C.T. scans.
The list of physical differences goes on and on. It will certainly continue to increase as more research is done. (Lucky you.) A few of the more important ones affecting how you feel are as follows:
Galvanic Skin Response or GSR measures skin resistance to a tiny current. As people relax, the skin resistance goes down. In fact, just repeating the measurements shows a decrease as time goes by. Not so for agoraphobics. Perhaps this reflects the continued high startle response seen in agoraphobics even after repeated stimuli.
Panic Disorder and Agoraphobic patients have a much higher sensitivity to medications than other people. Thus, when medications are prescribed for the treatment of Panic Disorder, they need to be used in far smaller doses than when they are prescribed for people with other conditions (such as depression). I have commonly observed the development of many side effects in agoraphobics at normal doses of antidepressant medications. To be helpful, these must be started “lower and slower” than usual. Then, if need be, they can gradually be increased.
Lastly, it is clear that being simultaneously exposed to a number of confusing stimuli such as lights, sounds, conversations, heat and bodily sensations all together create disorientation and the release of adrenaline in agoraphobics far more easily than in other people. You can see why agoraphobics have trouble in such places as crowded grocery stores. And you can see that there is a physiological reason for why you may prefer to go after hours when the store is quiet and few people are there.
The various anomalies or physical differences lead to panic attacks in an indirect as well as a direct way. For example, agoraphobics not only have an adrenaline reaction to multiple stimuli all coming in at once, but there is a reaction to this reaction. You might wonder: “What’s wrong with me that I feel so weird in situations that pose no problem for other people? Am I crazy? Am I seriously ill and no one has found the problem? What if I have cancer and no one knows?” I’m sure you can see how this can work itself into a panic attack.
What’s the answer? Read this chapter!
When you do, you will realize that there are many physical differences that you have. And the medical profession may not yet recognize many more of them. So you are not crazy. There are real processes going on in your body causing many of your unusual sensations. But just because they are there does not mean that you are having symptoms of something serious. In fact, you are in the same boat as everyone else:
Current medicine is able to identify most serious illnesses. If it has not found one in you, you probably do not have one. Just like everybody else. If medicine has not found a serious illness in a non-agoraphobic, she probably does not have one. No guarantees, but she probably does not. And if medicine has not found a serious illness in you, you probably do not have one. In other words, your unusual physical sensations and reactions make you no more likely to have a serious illness than any non-agoraphobic who has likewise had nothing serious diagnosed.
Read that again. It will rid you of a number of panic attacks. Just bear it strongly in mind the next time you find yourself “what if‘ing” about some strange sensation you are having. You can truthfully tell yourself: “Oh, yeah. Here it is – an unusual sensation and me worrying about what it means. But now I know that it is normal for agoraphobics to have strange sensations. And now I also know that I am no more likely to have anything seriously wrong with me than people who do not have these sensations. If I have had it checked out and my doctor found nothing serious, there is every chance that this is just one of those annoying Agoraphobic sensations.”
Conditions Causing Panic Attacks
As was discussed in the first assignment for Chapter 1, there are physical conditions that can cause the symptoms of a panic attack. Thyroid and adrenal hormones can be released in increased amounts as a result of various disorders of these glands. Thus, hyperthyroidism and hypothyroidism can both cause panic attacks. Also, adrenal disorders such as Cushing's disease can do this. Hypoglycemia is a non-hormone condition that gives people panic attacks. A Glucose Tolerance Test can diagnose it. In this test, you are given a drink of glucose (a sugar) after which the blood levels of glucose are measured at various times. If you are having this test, it is a good idea to keep notes as to what you felt at different times during the test. That way, you can correlate how you felt at different times with the blood glucose levels you had at those times. If your panic attacks resulted from low levels, then you would have correlated the symptoms with the particular blood levels that caused them.
After a Panic Attack
The way most of us are built, our bodies cannot keep releasing and reacting to adrenalin for very long. Just as we become emotionally desensitized to emotional stimuli when they keep being repeated, we also become physically desensitized to repetitive physical stimuli. If the creature from the black lagoon were to stay on screen long enough for us to really examine it, it would stop being scary. Likewise, we might love cherries but, if we were to eat them day after day, our taste buds would get desensitized and the cherries wouldn’t remain so enjoyable.
Our bodies react to adrenalin. But they can’t keep reacting to it all that long. Usually, 20 to 30 minutes and the body stops reacting. An hour is the outside amount for most people. On the other hand, I have often heard from patients that they have had panic attacks that lasted all day. If they really pay attention, however, they find that their hearts did not keep pounding at a high rate all that time. And they certainly did not keep hyperventilating or they would have passed out and the body would have returned to its normal, resting state. Instead, if they time it, those “all-dayers” come to realize that their panic symptoms do not last very long. Their bodies take a break. After a while of recovery, they may have worked themselves into another panic attack, but again, the symptoms lasted a fairly short time. It just seems like hours and hours because it’s so unpleasant at the time. If you keep track of how long panic symptoms are actually lasting, you are likely to be in for a surprise.
After a panic attack, it seems as though there is less anxiety and less adrenalin floating around than usual. People often describe a feeling of being drained and completely relaxed after a panic attack.
You know that hard rubber pressure release valve on the lid of your pressure cooker? The one that blows out if the pressure is allowed to get too high, putting spaghetti sauce all over the ceiling? Well, for many people, a panic attack is like that pressure valve blowing out: All the pressure is released and there is peace. (Usually, they do not mess up the ceiling.) I have known agoraphobics who have times of wishing they had a panic attack, just to kind of “get it all out already” and be able to really relax. So, for many people, after the storm of the panic attack is over, at least there is a kind of reward in the sense of rest that follows.
Author’s Note: Since these articles are meant to be educational, I have not included in them the various assignments for someone who is working the program. However, some are too important to leave out. Here’s one such:
Your Emergency Kit.
One of my favorite psychiatrist authors (D. W. Winnicott) dedicated one of his books: “To my patients who have paid to teach me”. So true. I think a therapist has failed to attend the most important school there is if she ignores the many creative and effective solutions people have devised to deal with their own problems. Thus, it was my patients who taught me to advise agoraphobics to always leave themselves an exit from any situation they enter.
Another solution developed by my patients is the Emergency Kit – a collection of items to enable them to deal with whatever might befall when out in the world. You probably have one – even if it is only called your purse or briefcase. In this assignment, I am passing along some of the excellent ideas other agoraphobics have worked out in the creation of their Emergency Kits (and some of my own). If you do not have one, definitely put one together. If you already have yours, you may want to add to it from the list below.
- Cell phone or Emergency CB radio. - Cab fare. - Some Benzodiazepines.* - First aid basics (band aids, antiseptic, adhesive tape, gauze pads). - Aspirin. - Snake bite and/or bee sting kits. - Flashlight. - AAA card. - “In Case of Anticipatory Anxiety” Instructions.* - “In Case of Panic” Instructions.* - “Information For Physicians Regarding Agoraphobia” (in the last article). - Notebook including Anxiety Diary.* - Pen. - Swiss Army Knife. - Pepper Spray (if legal). - Matches or lighter. - Hotel-type sewing kit. - Kleenex. - Hair Spray - One-ounce sprayer. (Yep – men, too. Can you guess why? See next month’s article.) - Whistle or siren. - Paper bag for breathing into. - Motion sickness bag. - Space blanket (looks like aluminum foil – sold in camping stores) - Emergency food.
*These will be explained in future articles.
Next month’s article is the key to my understanding of Agoraphobia and Panic Disorder. Namely, it is the answer to why people go in and out of periods in their lives when they have lots of panic attacks or very few. Also, it is the basis for how to stop having them! I think you will find it quite illuminating.
Until then, I wish you Peace and Progress,
Mark Eisenstadt, M.D.
You can now find the Forth article Here
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