Introduction
A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, the person may feel that he is having a heart attack or even dying.
Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if a person has had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, it is a condition called panic disorder.
Although panic attacks themselves aren’t life-threatening, they can be frightening and significantly affect the quality of life and relationships. But treatment can be very effective in most of the cases.
Signs & symptoms
Panic attacks can happen anytime, anywhere. It starts all of a sudden and gets worse within minutes. Mostly they subside on their own within some hours but the person may feel extremely tired & exhausted or worn out after the episode.
Panic attacks typically include some of these signs or symptoms:
- Sense of approaching danger
- Fear of loss of control
- Fear of death
- Rapid, pounding heart rate
- Sweating
- Trembling or shaking
- Shortness of breath or tightness in throat
- Chills
- Hot flashes
- Nausea
- Abdominal cramping
- Chest pain
- Headache
- Dizziness, light-headedness
- Numbness or tingling sensation
- Feeling of unreality or detachment
One of the worst things about panic attacks is the intense fear of another episode.
Causes
It is not clear what causes panic disorder. In many people who have the biological vulnerability to panic attacks, they may develop in association with major life changes (such as getting married, having a child, starting a first job, etc.). The tendency to develop panic disorder may run in families. They are more prone to depression, suicide, alcohol or drugs than others, too. These factors may play a role in the development of panic attack:
- Genetics
- Major stress
- Temperament that is more sensitive to stress or prone to negative emotions
- Certain changes in brain functions
Pathophysiology
The amygdala, the hub of fear processing networks, is closely associated with the pathogenesis of PD as well as panic attack. Structural and functional neuroimaging findings with regard to the amygdala in patients with PD are not perfectly consistent, but a pattern may be noted. Increased reactivity of the amygdala with structural deficits, similar to the findings in other anxiety disorders such as post-traumatic stress disorder. Whether structural deficits of the amygdala cause its hyper-reactivity or hyperactivation of the amygdala for a prolonged period elicits overuse atrophy is not known.
Decreased gamma amino-butyric acid (GABA)-benzodiazepine receptor binding has been reported in the medial temporal lobes that may include amygdalar regions. In the amygdala, decreased 5-HT1A receptor binding has also been reported. Both of these receptors are involved in inhibitory neurotransmission. Defective inhibition of the amygdalar activity may result in paroxysmal elevations in anxiety. Chemical neuroimaging studies have reported lower levels of GABA in patients with PD than healthy comparison subjects. Decreases in the GABA level may cause dysfunction in GABAergic inhibition of brain activity. Genetic polymorphism and early-life experiences may also contribute to amygdalar abnormalities.
The role of amygdalar pathology in developing PD
Electrical or chemical stimulation of the amygdalar central nucleus causes constellation of symptoms that are very similar to those of panic attacks. Electrolytic lesions made in the central nucleus would also disrupt fibers connecting laterobasal nucleus and bed nucleus of the stria terminalis, which has outputs to the hypothalamus and brain stem, where the centers for autonomic and neuroendocrine response regulations are located. When the efferent fibers from the central nucleus are stimulated, similar effects are produced. By abruptly blocking the tonic GABAergic inhibition in the laterobasal subregion of the amygdala, symptoms mimicking panic attacks are induced.
The amygdala has been reported to have a crucial role in the pathophysiology of PD. In animal studies, behaviors similar to those of panic attacks were observed when the amygdala was stimulated.
As an important element of the anxiety neurocircuitry, altered amygdalar function and structure may facilitate the progression to PD. Typical PD symptoms such as phobic avoidance and irrational worry of panic attacks may also be attributed to amygdalar structural and functional abnormalities.
Diagnosis
- A complete physical examination and detailed medical history
- Blood tests to check thyroid and other possible conditions
- Electrocardiogram (ECG)
- A psychological evaluation
Treatments
Treatment can help reduce the intensity and frequency of panic attacks and improve the quality of life. The main treatment options are psychotherapy and medications. One or both types of treatment may be recommended, depending on the case.
Psychotherapy
Psychotherapy, also called talk therapy, is considered an effective first choice treatment for panic attacks and panic disorder. Psychotherapy can help the person understand panic attacks and panic disorder and learn how to cope with them.
cognitive behavioural therapy is a form of psychotherapy which helps the person learn, through experience, that panic symptoms are not dangerous.
Medications
Medications can help reduce symptoms associated with panic attacks as well as any underlying issue like thyroid problems or depression. Several types of medication have been shown to be effective in managing symptoms of panic attacks, including:
Selective serotonin reuptake inhibitors (SSRIs).
Serotonin and norepinephrine reuptake inhibitors (SNRIs).
Benzodiazepines.
Prognosis
Patients with good health before first episode and a brief duration of symptoms tend to have a good prognosis. About 10-20% of patients continue to have significant symptoms. Overall, the long-term prognosis is usually good, with almost 65% of patients with panic disorder achieving remission, typically within 6 months.
Complications
- Development of specific phobias, such as fear of driving or leaving the home
- Frequent medical care for health concerns and other medical conditions
- Avoidance of social situations
- Problems at work or school
- Depression, anxiety disorders and other psychiatric disorders
- Increased risk of suicide or suicidal thoughts
- Alcohol or other substance misuse
- Financial problems
Disease & Ayurveda
Signs and symptoms of panic attacks are often similar to Vaatika unmaada. In some cases, Pitta anubandha is also observed.
Nidana
Physical
Dry, cold and old food items
Excess travelling & exertion
Trauma/injury
Exposure to wind
Loss of sleep
Psychological
Trauma or grief
Fear
Stress
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors, Vaatadosha vitiates and move irregularly all over the body and cause imbalance in circulation & metabolism. When it enters the manovahasrotas, causes the development of disease in the mind. Here, the vitiated Vaata affects in the activities of body and mind.
Lakshana
Shivering and shaking of body or body parts
Fear
Lack of confidence
Disturbed sleep
Sweating
Divisions
Not mentioned
Prognosis
Yaapya
Chikithsa
Treatment of Panic attacks according to Ayurvedic viw is, to balance the aggravated Vaata. It can be done by using snigdha(moist) and ushna(hot) guna(qualities) as medicine. In cases with aama(metabolic toxic waste), it should be removed first and then the treatment for pacifying Vaata in the form of brumhana(nourishment) should be done.
Samana
Anulomanam
Abhyangam
Thalam
Moordhapichu
Brumhanam
Sodhana
Snehapanam
Swedanam
Snehavasti
Kashayavasti
Virechanam & vamanam can be done in needed cases in suitable conditions.
Commonly used medicines
Mridweekadi kashayam
Brahmeedrakshadi kashayam
Drakshadi kashayam
Brahmarasayanam
Chyavanaprasam
Brands available
AVS Kottakal
AVP Coimbatore
Vaidyaratnam oushadhasala
SNA oushadhasala
Home remedies
Practising meditation and auto-suggestion techniques at home
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, cow’s ghee, sesame oil
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid bath in cold water immediately after exercise. Allow body to be in normal temperature.
Yoga
Stretching exercises, meditation for relaxation and following a specific Yogacharya with yoga asanas like suryanamaskara, pavanamuktasana, vajrasana, etc are recommended for improving circulation and digestion.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Suryanamaskara
Pavanamuktasana
Vajrasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2153497/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354045/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598964/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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