Panic Attack Or Generalized Anxiety Disorder?

Your day has been unremarkable when suddenly you experience an overwhelming sense of dread. Your heart rate begins to increase, you break into a sweat, you cannot catch your breath, your chest tightens, and you feel dizzy. You wonder, “Is this a heart attack? Is this simply anxiety? Or, have I just experienced a panic attack?”

Differentiating a panic attack from a generalized anxiety disorder can be a challenge. Generalized anxiety disorders involve chronic worry regarding a wide range of life’s activities. The lifetime incidence is estimated to be 5%, with women being twice as likely as men to experience it. And while everyone at some time in his or her life has the discomfort of overwhelming anxiety, the Diagnostic and Statistical Manual of Mental Disorders ED V (DSM-VTR) defines  generalized anxiety disorders as occurring most days within a six-month window, often beginning in the teenage years and, at times, linked to alcohol or drug abuse.  Typical sensations are those of restlessness, fatigue, depression, poor concentration, irritability, and negative feelings that can lead to cutting or other bodily injury as the individual seeks distraction from his or her sense of helplessness or lack of self-worth.

Panic attacks, in contrast, present as a more acute event, at times awakening a person from sleep. Officially diagnosed if experienced more than four times per month, they occur more often in women than men and may have a family predisposition.  At times, the individual may even develop agoraphobia or fear of open spaces as he or she anticipates being helpless if another attack occurs.

Because of the chest tightness, high heart rate, and breathing difficulties, these episodes often are misdiagnosed initially as a cardiovascular event. The biology of panic attacks suggests a sudden fight or flight reaction to a seemingly unrecognized or ill-defined threat. The sudden release of epinephrine and norepinephrine leads to the rapid heart rate and sweating, and with the hyperventilation comes numbness and lightheadedness.

Despite the physical characteristics of panic attacks, results of numerous clinical and laboratory studies to define the specific brain regions responsible for these bodily changes have been inconclusive. They have, however, clearly defined panic attacks as a biologic process subject to pharmacologic and psychiatric management.  Brain imaging and related research have demonstrated changes in oxygen, glucose, and blood flow in the limbic system and the locus ceruleus, areas that are responsible for arousal, anxiety, and fear.

Management of panic attacks in the past has utilized benzodiazepines, a family of drugs that calm the nervous system by increasing calcium channels within neurons and selective serotonin receptor inhibitors, which are antidepressants.  Breathing into a bag has not been shown to be effective, whereas controlled breathing (using the 5-2-5- rhythm of five seconds to inhale, two seconds to hold one’s breath, and then five seconds of slow exhale) has been shown to help. More recently, cognitive behavioral therapy has proved as effective as medications. This seemingly simple approach, where one is brought to realize that he or she cannot affect the outside world but only his or her inner response to those outside events, has proved effective as long-term therapy.

For those who have experienced panic attacks, those moments are terrifying. Our better understanding and newer approaches to treating panic attacks are providing tools for an improved life. 

By James Woods, M.D. and Elizabeth Warner, M.D.

References Available Upon Request

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James Woods | 8/12/2015