In the last two years, life has been difficult for everyone. Lockdowns with closed schools, colleges and offices have left many people stranded at home. Reverse migration occurred with many returning home. Now that life is limping back to normal, some people cannot deal with the crowds and the necessity for social interaction.
Around 10 per cent of teenagers and young adults are now suffering from “panic attacks”. They develop sudden attacks of feeling like their heart is going to stop, palpitations, sweating, tingling, numbness, chest pain (often on the left side) and a fear of impending death.
These “attacks” have become commoner after the Covid pandemic. They are more likely in women, can be precipitated by a sudden adverse life event and sometimes run in families.
A single attack is terrifying both for the patient and the bystander. The racing pulse and sweating simulate a heart attack. The person often reaches emergency medical care. Blood tests and an ECG, if taken immediately, will rule out a heart attack.
If a second or third attack occurs, tests have to be done to rule out medical conditions precipitating the problem. Blood sugars have to be checked as low sugars can cause identical symptoms. So can low haemoglobin or an overactive thyroid gland. The heart has to be completely evaluated. An ECG will pick up any abnormality in the heart’s electrical conducting system. The four chambers of the heart may not be working in perfect synchronisation. Sometimes a portable “Holter monitor” may have to be worn for 24 hours as the problem is intermittent and not continuous. An Echo will reveal abnormalities in the heart’s size and if the valves are functioning effectively.
If no correctable cause is found, then the diagnosis is likely to be a panic attack. If remedial action is not taken, the condition can become chronic. More and more everyday occurrences — loud noises, bad news, closed spaces, darkness, and loneliness — can precipitate attacks. Eventually, the person is unable to function efficiently and may become a recluse. The family is often unsympathetic, especially once they discover that all the medical parameters are normal. They feel it is all “in the head”
Unfortunately, these people really have an exaggerated response to real or imagined threatening events. All people respond to such circumstances with a “fight or flight reaction” in which the body secretes adrenaline and noradrenaline. These chemicals produce all the typical responses seen in panic attacks. In most people, once the perceived threat is removed, the body goes back to normal in 10-20 minutes. In people with panic disorder, the symptoms return with increasing frequency at shorter intervals until day-to-day functioning becomes difficult.
Treatment reduces panic attacks. The likelihood of developing an attack can be lowered by cutting back on stimulants such as tea, coffee and cola, drinks which contain caffeine. Do not drink or smoke. Some medications taken for other conditions such as asthma can produce similar symptoms. Herbal tonics and supplements contain several ingredients. Some of these might affect certain people idiosyncratically, producing panic attacks.
Exercise for at least 40 minutes a day. Join a yoga class and learn relaxation and meditation. Do not buy sleeping pills over the counter and self medicate. If taken incorrectly, they can become addictive.
Panic attacks are often precipitated by underlying stress, depression and anxiety. Several groups of anti-depressants and anti-anxiety drugs are beneficial when taken under medical supervision. Often a combination of medications has to be used. Improvement often occurs within a few weeks. At this point, it is important not to discontinue the medication abruptly. Instead, the dose has to be gradually tapered off to prevent a relapse.
The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in
