Don't Panic! It's Just a Panic Attack! Simplifying Anxiety Neurosis With An Award Winning Neurologist

Dr Sonia Lal who was awarded ‘neurologist of the year’ at the India health and Wellness Summit 2014 speaks to Chaiti Narula on the chemical imbalances that lead to anxiety and how once can overcome them and lead a normal life.

Let’s understand what exactly are the dominating symptoms to identify anxiety neurosis and cardiac anxiety?

Anxiety neurosis and cardiac anxiety are other names used for panic attacks. Panic attacks are episodes of severe anxiety like an intense rush of fear. This is accompanied with symptoms like shortness of breath, racing heart beat or palpitations, sweating, chest pain, nausea and dizziness. These episodes can last for several minutes to an hour. As the symptoms are very similar to a heart attack, many times people seek emergency care when they initially have them. When people start having recurrent panic attacks, they are diagnosed with panic disorder which is a form of anxiety.

What is a panic attack and how can it negatively impact a person’s life?

It is quite normal to have some extent of anxiety in a human being. In fact this can be positive as it pushes you to achieve your goals. For instance, experiencing anxiety before an examination is normal for students. It pushes one to study harder and you feel more confident. Anxiety becomes a problem when it becomes so frequent and overwhelming that it starts affecting your day to day activities and doesn’t let you function normally. That’s when you know you have a problem that needs medical intervention. Panic attacks are these overwhelming episodes of fear that can take over a person’s life and disrupt their normal functioning.

How does one differentiate between a panic attack or a heart condition like supra ventricular tachycardia that involves palpitations and overlapping symptoms?

Panic attacks and a cardiac event like a heart attack can have very similar symptoms like chest pain, impending doom, palpitations, difficulty breathing. Usually in the initial attacks, one is prompted to go to the emergency room and have a cardiac workup done. If someone has such symptoms for the first time, it is always a good idea to have a cardiac work up done like an ECG to ensure that it is a panic attack and nothing more. People with risk factors like high blood pressure, diabetes, high cholesterol, smoking should even be more careful and get medical help if they get these symptoms.

Most patients I spoke to feel they will die during a panic attack. What do you have to tell them?

Once panic attacks are diagnosed, it is important to help the person understand what anxiety is and how it can cause similar symptoms and they try and relax. Treatment is required and usually a combined approach of medications, psychotherapy, exercise, meditation. All help relieve symptoms of anxiety when practiced regularly over time.

What are the chemical changes that your brain goes through during any of these anxiety attacks?

When our body undergoes stress, our ‘stress-response system’ called the sympathetic system, gets activated and gets ready for action causing symptoms of anxiety. Our ‘calming-response system’ called the parasympathetic system usually responds to this stress and releases chemicals to help calm our brain down. When the balance between the two gets disrupted, we start experiencing anxiety. Chemicals like GABA, dopamine, serotonin are all involved in maintaining balance in our brain and their imbalance can push people into anxiety and at times having panic attacks.

Research over the years has also shown the hyperactivity of a part of our brain called the amygdala during anxiety. The amygdala plays an important role in managing our emotions and is connected to our hippocampus which is another part of the brain involved in managing fear, emotions and stress.

How can timely medical intervention help the patient?

Unattended and untreated anxiety that affects one’s day to day life can get worse. Treatment includes medication that work on the brain chemicals. This helps create balance and hence lower anxiety levels. Apart from medications, psychotherapy, regular exercise, mediation all work together to help the person overcome anxiety.

There is a growing concern that these pills taken for immediate treatment and long term too may be addictive. If you can break the myth...

All medications have their benefits as well as possible side effects. When taking a medication, your doctor usually looks into how the medication will help you. Not all forms of treatment have addiction potential when taken under medical supervision. Meditation and psychotherapy also complement medications and many times, can be practiced life- long to keep anxiety under control. Medications can be used for shorter durations and stopped once symptoms are better. Always remember to take these medications under the supervision of your doctor and do not abruptly stop them without discussing it first.