Panic Disorder

by Food and Drug Administration (FDA)

Every night for five years, Sherry Menter would postpone sleep as long as she could. When it beckoned, she would clean the house, sew, read, bake cookies — do anything to avoid the terror she had come to expect once she drifted off. But eventually, sleep overtook her, and with it, the inevitable.

"I could hear a noise like a siren or freight train coming in my head," she says. "I could feel my jaw lock, my teeth grind, and my limbs become totally immobilized, yet shaking uncontrollably, while this freight train comes charging into my head, and by the time the train gets there I'm consumed by fear. I feel my heart pounding and there have been times when I thought I stopped breathing. I guess my conscious mind takes over and I think, 'Oh my God, your heart's not beating. You're going to die.' And I scream at the top of my lungs for anybody to wake me."

Menter is describing a panic attack. She says that while it's happening, she's aware that she's asleep and that in order to make the fear stop, she has to wake up. So she screams for someone to wake her. But those who have heard her "screams" tell her that, in reality, they are just "squeaky little noises."

More than a million Americans, like Menter, suffer from panic disorder, according to a statement issued by a panel of experts at a National Institutes of Health (NIH) consensus development conference last September. It is not a new phenomenon; among its many past rubrics it has been known as "housewife's disease" and "soldier's heart. For most, the attacks begin in the middle teens or early adult years, but they can start at any age.

FDA recently approved panic disorder as an additional indication for a drug already approved for treating anxiety. Other marketed drugs, although not specifically approved for panic disorder, have been reported helpful in treating the condition.

The illness is characterized by episodes of intense fear that occur "out of the blue," says Thomas W. Uhde, M.D., chief, Section on Anxiety and Affective Disorders at the National Institute of Mental Health in Bethesda, Md. "They typically last from 2 to 10 minutes and are associated with a number of different psychological and physiological symptoms."

Unlike Menter, whose attacks occur only during sleep, most patients experience attacks while awake. Uhde says that 60 to 69 percent of patients will have at least one severe sleep panic attack in their lifetime, about a third of patients have recurring sleep panic attacks, and 5 percent have panic attacks more often during sleep than while awake.

Many patients experiencing a panic attack for the first time rush to an emergency room complaining of chest pain, shortness of breath, flushes or sweating, and rapid, irregular heartbeat. Many fear they are dying or going crazy. They may have chills, dizziness, shaking or trembling, choking, nausea or abdominal discomfort, and numbness or tingling sensations as well.

"Some people also have a profoundly altered perception of the environment. They might perceive objects as particularly bright or dull, sounds can be experienced as dull or unusually sharp, and there may be alterations in the sense of time," Uhde says. Patients sometimes feel "depersonalized," as if they're somehow strange or different and disconnected from the immediate environment.

"Distancing" a Symptom

Patti Griffith (not her real name) felt herself becoming "distanced" from the people and things around her when she had her first attack a year ago at age 35. It happened suddenly during a business meeting that ended for Griffith in a four-hour hospital emergency room stay, where doctors tried in vain to discover what was wrong.

"I had a sensation almost like going into a tunnel and the light was receding. I could hear people talking, but they were like 'other.' I had to recede from the activity and try to focus all my thoughts on trying to stay calm, because I knew that if I could talk myself into calming down, maybe I could get my heart to slow down."

Panic attacks do not inevitably signal panic disorder. Some people have only one isolated incident of a panic episode or perhaps experience them just occasionally, with no lasting impact on their well-being.

According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, panic disorder is diagnosed only in people who have at least four attacks within four weeks, or one or more attacks followed by at least a month of persistent fear of having another. At least some of the attacks must occur spontaneously and unexpectedly, not in response to a phobic trigger such as snakes, closed spaces, public speaking, or other objects or situations that evoke fearful avoidance in some people.

"If panic attacks continue without treatment, people begin to wonder about the causes," says Uhde. "Are they crazy? Is it something they did or didn't do? Or is there something about the situation in which they had the attack that somehow makes them vulnerable?"

About the Author

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