A nxiety and Panic Disorders

There is a widely held belief that one should be able to control all of one's actions and even certain bodily functions. An extension of this thought is that we should be able to control our own behavior. However, there is a range of behaviors from nervousness, through to irritability, anxiety and even depression that no matter how hard we attempt to control these feelings they escape us. When we get anxious certain body changes may occur. They may include our hearts beginning to pound; there may be a sense of butterflies in the stomach or that our stomach is in knots; or we may experience sudden loosening of the bowels, or, in extreme situations, people have been known to pass out because they simply stopped breathing! Before you should get the idea that all anxiety is bad, please remember that some anxiety is good. The excitement that we experience when we are going to an event we've anticipated, such as a child who has been thinking for weeks about his favorite theme park or seeing an old friend after years of separation. This is the good side of anxiety. In fact, it has been known to motivate many people when starting a new job, for example.

People who suffer from anxiety disorders will often have the anxiety reaction that is out of proportion to the circumstances surrounding or causing the reaction. On occasion, anxiety or panic attacks have a physical cause. Some of these physical causes could include, but are not limited to, overactive thyroid, steroid use, elevated blood pressure, hypoglycemia, menopause and, on rare occasion's, epilepsy. However, the vast majority of anxiety appears to be based on psychological factors. With appropriate treatment these fears can be traced back to emotional trauma that was experienced earlier in life. Anxiety can often run in families and, at this point, it is unclear whether this is due to genetic factors or more environmental, " .little Johnny is just like his father when it comes to that." This is because little Johnny watched how his father reacted to a certain set of circumstances and is probably going to react in a similar fashion.

There are several different types of anxiety disorder listed below.

Simple Phobia

Panic Disorder

Generalized Anxiety Disorder (GAD)

Social Anxiety Disorder

Obsessive Compulsive Disorder (OCD)

Post Traumatic Stress Disorder (PTSD)

When we are discussing anxiety of a serious medical nature, we are usually attempting to exclude simple nervousness. Depending on which medical authority you are familiar with, anxiety may even be classified as a type of fear. Going along with the idea that there may be some fear associated with an anxiety reaction, some individuals report being frozen during these episodes. This is very much like the deer in the headlight description, where the person affected is simply unable to move even to the extent of protecting themselves.

There are changes that occur in the body during these episodes or attacks. People describe heart palpitations or racing, chest pain /discomfort, hot flashes, sweating, chills, tremulousness or trembling, shortness of breath, nausea, dizziness, lightheadedness, vertigo, numbness, irrational fears of losing someone or dying or strange sense of being detached from others or the world in general.

Panic attacks are one of the types of anxiety listed above. Many ST'rs, when they feel comfortable with their physicians, will report a certain number of these events. Panic attacks can occur in similar sets of circumstances, e.g. each time one gets on an airplane, or they can occur "out of the blue". Often times the mysterious cause of the panic attack is forgotten and what starts to occupy the mind of the affected individual is the "worry" of another panic attack. And guess what, that worry of the panic attack can be the very cause that will trigger one! This constant cycle of worry about an attack and, subsequently, having one, and so forth, can lead some individuals to lock themselves in their homes or some environment where they feel safe. If this sort of behavior sets in, then it can be very difficult to get those individuals to get the help that they need.

The goal of treatment for these anxiety reactions or panic attacks is medication and psychotherapy. We're talking Freud, the couch, the whole nine yards in some severe cases. Medications that have been used include usually the antidepressants and the long-acting benzodiazepines. The benzodiazepines are usually acceptable for patients with ST. However, care should be exercised when using some of the other antidepressants. These would include the serotonin reuptake inhibitors (SSRI's), tricyclic antidepressants and the monoamine oxidase (MAO) inhibitors. As a rule of thumb, ST'rs should attempt to avoid the tricyclic antidepressants when at all possible. Usually the MAO inhibitor drugs are marginally better for torticollis. But my preference in the choice for a cervical dystonia patient will usually involve the SSRI's for antidepressants.

It is extremely important to recognize that these fears and anxieties may signal a more serious problem such as depression. When someone is depressed there is a sense of worthlessness and even some thoughts or plans for suicide. Do not hesitate. Get that particular individual in to see the appropriate medical and psychiatric personnel. Most major cities have some sort of rescue crisis and even many rural counties have means of transporting persons dangerous to themselves, or to others, to the appropriate health care facilities. It is also very important to note that individuals suffering from anxiety and panic disorders are usually not "crazy" in the traditional sense, but, should this condition go untreated for a long period of time, it may take an "equal" amount of time to attempt to reverse it. The sooner one gets started the better.

James A. Auberle, M.D.

Medical Director, ST/Dystonia

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