By Michel J. Gimeno, M.D.

Panic Disorders are recurrent panic attacks that occur spontaneously and unpredictably with feelings of intense apprehension, fear, terror, impending doom as if the sufferer might just be about to die. The victim experiences shortness of breath, palpitations with the heart going "a hundred miles per hour" or so it would seem. There may be choking sensations, dizziness, light-headedness, unsteadiness, vertigo, buzzing sensations with tingling over the arms, hands, legs, on top of the head or around the mouth. Almost always the sufferer of this panic attack would experience a dreadful feeling that he or she is going to die, pass out, or "snap" and lose control, go crazy.

Should this panic attack occur while the person is engaged in a particular activity such as driving a car, or shopping in a supermarket, he or she will automatically associate the panic attack with that particular activity and would, from that point on, start avoiding such activity. This avoidant behaviour is called Agoraphobia.

One could think of Agoraphobia as a conditioned reflex that the person with sudden, spontaneous panic attacks might develop in his or her attempt to avoid another such dreadful bout of terror. In due time, if these attacks are not treated effectively, the sufferer will avoid driving alone or over bridges, riding elevators, shopping, going to the movies, and flying. Soon the victim of Panic Attacks will be a recluse in his or her own home. Some might be a little bit luckier and they will still go out to do the shopping with great discomfort, always feeling apprehensive and will constantly scan for a "safe place" or an exit. This constant apprehension in the absence of an attack is called anticipatory anxiety. Eventually the fear of anticipating having another attack might trigger the attack. The victim then becomes trapped in a vicious cycle: Anticipating an attack - having an attack - having more intense anticipatory anxiety. The person becomes a wreck and can no longer do the things he or she used to be able to do. To compound the problem further, the sufferer develops other kinds of anxiety: "free floating" anxiety, "performance" anxiety and "phobic" anxiety.

Untreated, this biochemical imbalance in the brain chemistry will produce not only physical symptoms like palpitations, chest pains, headaches, etc., but extreme mental and emotional anguish thus interfering in all aspects of the victim's life, including marital discord. Panic attacks with or without Agoraphobia can be a truly disabling condition.

It could be said that the patient afflicted with this disorder becomes a prisoner of his or her own brain biochemistry gone awry. But there is hope. There is an effective treatment that combines both a medical and a psychological approach.

Psychoanalysis is ineffective, expensive and the sufferer hasn't got time to wait years for the promise of relief that never comes. Counseling alone will often not work and it is impossible to deny the illness. It will not just vanish. It will progress and get worse if untreated. There is now a medical and rational approach for the treatment of Panic Attacks, with or without Agoraphobia that is very effective both in terms of cost and outcome.

The patient should receive a thorough biochemical evaluation that should include a thyroid function test and other tests that may be indicated. Quite often, the patient has already received batteries of evaluations from their physician, emergency rooms, walk-in clinics, and the like. Invariably these patients are told that "there is nothing wrong" with them, that it's all "in their heads." Needless to say, this causes more agony, frustration, anger, hopelessness, despair and a tremendous amount of guilt.

This disorder is very real. It has a physical cause. In a manner of speaking, it is true that it is "in the head," but not the sense that most doctors will mean or most people will understand. The cause is in the brain, in the brain chemistry. Furthermore, there are many substances that will aggravate panic attacks, such as alcohol, caffeine, tea, aspartame, many over-the -counter preparations, and even some food additives.

Panic Attacks with or without Agoraphobia are a crippling disorder that has a physical basis (biochemical cause) and that is fueled by a learned conditioned reflex. Its symptoms are physical and emotional: Tremors, chest pains, palpitations, shortness of breath, nausea, vomiting, sweating, urinary frequency, hot and cold flashes, face flushing, nightmares, insomnia, depression, fears of going crazy, of dying, of choking, or losing control, numbness and tingling in different parts of the body, etc.

But there is hope and there is help!

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