Becoming an au pair in Germany was exotic and exciting for 18-year-old Linda Formichelli. She couldn't wait to get there. Then, all too suddenly, she couldn't wait to leave. "I woke up in the middle of the first night feeling nauseous, dizzy, and extremely nervous," recalls the now 36-year-old Massachusetts writer. The next four nights were just as bad-before the week was out, Linda was on her way home.
Once back with her family, the long nights of fear and physical discomfort stopped as mysteriously as they started, but only briefly. When she left for college, they began again. Frustrated, Linda eventually became afraid to travel anywhere. "Even driving made me nervous if I was by myself," she says. "My world was getting smaller and smaller."
THE SIGNS OF PANIC
Do you have intense feelings of fear for no apparent reason? Here are some of the most common symptoms of panic attacks:
Chest pains, palpitations, or a racing heartbeat
Shortness of breath, a smothering sensation, or choking
Feeling dizzy, unsteady, or as if about to faint
Nausea or stomach problems
Shaking or trembling
Numbness or tingling sensations
Feeling out of control or unreal (as if detached from reality)
Fear that you are dying or going crazy
Sweating, flushes (hot flashes), or chills
Unfortunately, Linda's story is not unique.
Each year, some 2.4 million of us will experience at least one panic attack, according to the National Institutes of Health. Women are twice as likely as men to experience them, usually before age 24.
The characteristics of a panic attack - a sudden episode of intense fear accompanied by physical reactions like a racing heartbeat, tightness in the chest, and difficulty breathing?send many people to the emergency room, then on to cardiologists, endocrinologists, and a lineup of other specialists.
"People who experience a panic attack for the first time often think they're having a heart attack, a brain tumor, or some other life-threatening medical condition," says psychotherapist Jerilyn Ross, MA, LICSW, director of The Ross Center for Anxiety and Related Disorders in Washington, D.C., and president and CEO of the Anxiety Disorders Association of America.
"By the time many people are diagnosed and in proper treatment, they've already developed a phobia as a result of avoiding places, situations, or objects they think might bring on an attack."
Like Linda, you might, for example, have a panic attack while driving on the highway, associate the attack with highways, and then develop phobia toward it. Some people with panic disorder go on to develop agoraphobia-a fear of being in a public place, not having access to safety, and having a panic attack. Thus, they begin avoiding more and more places, watching their world get smaller and smaller. In worst-case scenarios, they are barely able to leave their homes.
WHY ALL THE PANIC?
Nobody really knows the precise cause of a panic attack, but heredity, other biological factors, and stressful life events are all believed to play a role, and each is the subject of intense scientific investigation.
"We know from the research that there are genes that make some people more vulnerable to having panic attacks," says Alexander Neumeister, MD, director of molecular imaging at Yale University School of Medicine. "They actually have a gene variance that increases the release of norepinephrine-adrenaline-in the brain."
That's an important discovery since a panic attack is essentially the explosive release of brain chemicals-including norepinephrine-that charge through your body, preparing it to deal with an imminent threat or kick you into a run for your life. It's these same chemicals that give you the strength to fight off a mugger, run from a marauding bear, or grab a child out from in front of a speeding car. In a panic attack, however, those chemicals send fear messages screaming through your brain as its fight-or-flight response system misfires. Instead of needing to run for your life, you stand there, often gasping for air and dripping with sweat, wondering what on earth is going on.
"If you just got bad news and your body went into a shocked state, and your heart began pounding wildly, you wouldn't think 'Oh my, I must be having a heart attack.' You'd think, 'I feel this way because of what's happening,' which is a rational reaction," says Ross. "But when, not only do you have extremely unpleasant physical sensations, but you also have the psychological aspect, the disconnect that leads you to wonder: Am I going crazy? Am I dying?"
Drugs and Panic Attacks
Some drugs have the potential to trigger a panic attack. According to psychotherapist Jerilyn Ross, MA, LICSW, director of The Ross Center for Anxiety and Related Disorders in Washington, D.C., these are common culprits:
Stimulants like caffeine, Ritalin, and Adderall
Sudafed and other decongestants and allergy medications
Excedrin and other headache medications that have caffeine
Novocaine-this local anesthetic has epinephrine, which is the synthetic equivalent of adrenaline; ask your dentist for a numbing agent without it
Nicotine-withdrawal can bring about panic attacks
Illicit drugs like marijuana and cocaine
WHAT YOU CAN DO
Using brain imaging technologies and other techniques, researchers like Dr. Neumeister are trying to understand the mind's processing of fear and anxiety in order to develop specific treatments for panic disorder-the term for when one experiences repeated panic attacks.
Today, panic attacks are treated with psychotherapy or medication, or both. The medication commonly used is the newest class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), which act in the brain on the chemical messenger serotonin to block the attacks. Among these, Paxil, Zoloft, and Effexor are commonly prescribed. Antianxiety medications, called benzodiazepines, are very effective at interrupting panic attacks, but they are sedating and habit-forming, so they are best only for short-term use. These include Valium, Xanax, Klonopin, and Ativan. Because they're so fast-acting, benzodiazepines are generally prescribed on an as-needed basis until the antidepressants-often prescribed at the same time-build up enough muscle to achieve a therapeutic effect. That can take several weeks.
The most effective form of psychotherapy is cognitive behavioral therapy (CBT), a short-term form of therapy that teaches how to change the way we think and react to panic-inducing fears and situations. "We teach people to recognize some of the 'what if?' thinking," says Ross, "and then replace negative thoughts with positive, healthy ones." Basically, you learn to calm yourself down. Your internal dialogue might go something like this:
"What if I have a panic attack?"
"So what if you do, frightening, but it won't hurt you."
"I feel I can't breathe."
"Well, I'm in good health and capable of taking a deep breath."
"In some cases, we get patients to try and bring on the panic attack in the safety of our office so that we can show them that while panic attacks are real and they're frightening, they're not dangerous," says Ross.
"While the only treatments that have been scientifically proven to be effective are therapy and medication," adds Ross, "my philosophy is if you find a healthy alternative that works for you and brings your anxiety down, do it."
And Linda Formichelli would probably agree. "The antidepressant did stop the panic attacks," she says, "but I still had some level of anxiety and the medication had so many unpleasant side effects-I packed on 20 pounds." Then, three years ago, Linda started taking karate lessons for fun and was pleasantly surprised to find that it helped with her anxiety. "I quickly realized that its physical and mental aspects-it's said to be meditation in motion-are very calming," she explains.
Today, Linda travels without medication-and without fear. She's visited friends in Arkansas, studied karate in Japan, and found that, clearly, from modern medicine to martial arts, there are many ways to combat panic attacks.
PSST I had seven years of panic attacks. What worked for me was to find a quiet place to sit or lie down. I would listen to my breathing and focus on relaxing one part of my body at a time-my toes, legs, tummy, shoulders, neck, and head. Then I would repeat this from head to toe. -Peg Saam,
DIANE ADVISOR AND CURVES OWNER, CHUGIAK, AK
HELP IS OUT THERE
For more information to help you or someone you know who suffers from panic disorder, contact any of the following:
American Psychological Association www.apa.org 800-964-2000
Anxiety Disorders Association of America www.adaa.org 800-922-8947
National Institute of Mental Health www.nimh.nih.gov 866-615-6464
National Mental Health Association www.nmha.org 800-969-NMHA (6642)
JODIE GREEN is a New York-based writer and editor who specializes in health and fitness coverage. She is a regular contributor to diane.
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Neat Article About Panic Attacks!!! 
Panic Attack
