Panic Attacks And Depression

Panic attacks can be devastating for those suffering from the condition. Attacks come at random and can occur frequently or can have long periods of time between episodes. The fact that attacks can't be anticipated causes more anxiety. Ultimately, two thirds of the people who have a panic attack will be diagnosed with a panic disorder within a year following their first attack, and half of those who go through a panic attack will develop clinical depression within a year. It seems that panic attacks and depression often go hand in hand.

The first thing to do after experiencing a panic attack is to go through a medical evaluation so physical conditions can be ruled out as the cause of the panic attack. Overactive thyroid, heart problems, too much nicotine or caffeine, certain medications, and abuse of alcohol or illegal drug use can cause symptoms similar to panic attacks. Scientists aren't sure what causes true panic attacks. They may be caused by chemical imbalances in the brain. Sometimes panic attacks are an inherited condition. Many times there is no physical reason for an attack, but it is best to get medical help to rule out physical causes.

Repeated anxiety attacks can cause depression and panic attacks can turn into a panic disorder. The anxiety of wondering if another panic attack is on the way causes severe stress and sometimes thoughts of suicide in people who suffer from them. Since panic attacks are frighteningly similar to symptoms of serious medical conditions such as heart attacks, people naturally become more anxious that their attacks may be life-threatening. The lack of control that sufferers go through is often depressing as is the fact that they can't anticipate an attack. If a person has lived with panic attacks for a while, the anxiety they feel can give them low self-esteem or may lower their self-image which also can result in depression. Panic attacks and depression combined can make people feel like they are in a downward spiral that can never be escaped.

When panic attacks and depression occur together, it is best to get help from a qualified psychiatrist. Early intervention can help the person before the condition affects their lives too much since often people will avoid the places or situations they feel bring on their panic attacks, leading to a decreased quality of life. Depression is a serious condition and needs to be treated separately from the the panic attacks. But, anti-depression medication, certain types of psychotherapy, or a mixture of the two can effectively treat the individual who suffers from panic attacks and depression. Dr. Darvin Hege, an Atlanta-based psychiatrist, says "addressing the core panic disorder or other condition with the vast selection of tools with which psychiatrists are familiar will likely result in relief and success."

Dr. Darvin Hege has 25 years of experience dealing with patients who have panic attacks and depression simultaneously. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an evaluation for relief of your panic attacks and depression and for help deciding the most effective and safest treatment. 

Panic Attacks At Night

Panic attacks are common for many people. It doesn't matter where you are or what you are doing - a panic attack can come on randomly and disrupt your day (or night). Over 6 million Americans suffer from panic attacks and between 44 percent and 71 percent of those people have also experienced panic attacks at night.

While it would seem that people should have more anxiety during the day, due to stresses of work and home, panic attacks at night are more common than you would think. Panic attacks at night are characterized by waking abruptly from sleep in a state of anxiety, and for no obvious reason. Episodes of panic attacks at night are generally over within ten minutes or so, but those few minutes can set the tone for sleeplessness the rest of the night. The physical symptoms of a panic attack include a sense of impending doom combined with a pounding and rapid heart beat, sweating, shakiness or dizziness, a feeling of shortness of breath or hyperventilating, and sometimes either chills or flushing. It can be hard to go back to sleep after the body is revved up from the attack. Also, the sense of panic during an attack is increased by the knowledge that these same symptoms can be signs of more serious conditions, such as a heart attack, which raises the person's level of anxiety.

Part of the distress of panic attacks at night is the sense of loss of control. Patients suffering from an attack may also feel the night brings with it a sense of being defenseless while unconscious (sleeping) and the thought that something might happen while they are most vulnerable. Panic attacks at night can be precipitated by events that happened during the day. Things that happened during the day may be revisited at bedtime, causing anxiety before sleeping. Events at home may leave an emotional imprint on the mind, causing the patient to be more anxious than usual. Even eating late at night just before going to bed can keep the sufferer awake and make them more prone to panic attacks at night.

There are some things people can do to help them deal with panic attacks at night:

1. Learn and practice calming techniques like yoga, tai chi, and meditation.


2. Learn and practice slow, deep breathing exercises.


3. Reduce stress at night by taking time to relax and forget the worries of the day before retiring to bed at night.


4. Develop healthy eating habits and exercise programs to help reduce stress.

If these techniques are not enough to help you deal with panic attacks at night, counseling and medication are an important next step. Find a therapist who has experience in dealing with panic attacks at night. Treatment such as cognitive behavior therapy and anti-anxiety medications can alleviate or eliminate panic attacks for most people. Dr. Darvin Hege provides help for panic attacks in the Atlanta area. Dr. Hege most commonly prescribes Xanax XR, Klonopin, Zoloft, Prozac, Celexa, Lexapro, Paxil, Effexor, or Cymbalta for panic attacks at night. For more information from Dr. Hege about panic attacks and the most effective medications for stopping panic attacks at night, go to the Panic Attacks Information page on his website.

Although having panic attacks at night can be a frightening experience, they aren't something you just have to live with. Medications, therapy, and stress reduction can help sufferers face the night without fear.

Dr. Hege has 25 years of experience dealing with patients who have panic attacks at night. Call him today at 770-458-0007 for an evaluation for relief of your panic during the night, and for help deciding the most effective and safest treatment. 

ADULT ADHD: HOW DO WE DIAGNOSE IT?

There are several clues that a new patient has adult ADHD before I ever see them for an ADHD evaluation. Staff may comment to me about a new patient who is having difficulty following directions to get to our office. New patients who arrive too late for their first appointment and have to be rescheduled often have ADHD. 

My initial observations and interactions with the patient often give me clues and can help with the ADHD evaluation. Anxiety about meeting a psychiatrist may make it hard to pay attention to direct them into the correct door to enter my office. I help with directions including telling them and pointing to the doorway where we are going and suggesting where they may want to sit in the consulting room. They also may need some more time to scan the room and if they get distracted by my diplomas or pictures, I will try to give him some structure to focus on the interview at hand by asking them how I may help. Quite occasionally people with ADHD say they don't know how I may help. Often if I ask them what symptoms are bothering them that caused them to come see me, then they can get specific about their concerns. 

Chief complaint:

The patient's chief complaint usually include a previous diagnosis of ADHD or their belief that they may have ADHD. Those who believe themselves to have ADHD have often been to my website and review the criteria for ADHD and have completed ADHD evaluation questionnaires. Usually they have fulfilled or much surpassed the threshold for the diagnosis. Frequently patients come to me under pressure from a partner or an employer for forgetfulness, not completing tasks, not listening or paying attention to detail, tardiness. Other patients come for anxiety, depression, bipolar, substance abuse issues, relationship problems and I discover they have ADHD when I do my usual comprehensive exam on all new patients that includes ADHD symptoms questions. 

History of present illness:

Most patients give a history of having had problems for many years that usually goes back into childhood before there was an evaluation for ADHD. Distractibility and inattention usually usually first caused problems during the school years. However, it may have been in high school or college that the patient first realized it took them longer than their classmates to read a chapter because of having to reread so much and that they were not making grades as good as peers that they knew were not as smart as they . Others became aware of their inefficient use of time when they started working in a job that required a lot of paperwork. Others only became aware of the nature of their problem when they became involved in a serious relationship or marriage and their partner confronted them about their not paying attention when they were talking to them or kept interrupting them. Others started their own business and found they were procrastinating at doing what they had to do to make their business go. Examples are not doing paperwork for taxes, not returning calls punctually to business clients, not writing proposals, or not invoicing regularly. 

Specific symptoms:

I have developed my own practical questions over the years to elicit the various ADHD symptoms that make up the criteria for the formal diagnosis of ADHD in adults. Most patients who have the condition can resonate and confirm if they have symptoms or not. Also, I do some preparation with the patient before I ask the questions. I ask them to simply answer yes or no to each question, choosing a yes or no based on which is closest to the truth. I asked them not to start elaborating by changing the criteria I have set, and not to start expounding with examples to confirm a yes. If I don't set the structure, they may talk for several minutes and neither of us know if the answer is a yes or a no. I alert them that if they start expounding that I will try to gently interrupt them and I hope I don't insult them with this structure. 

Here are the questions I use to help with an evaluation of ADHD:

(This first set of questions are criteria for the inattentive type of ADHD. Yes to six of these questions are necessary for the diagnosis.) 

1. In classes over the years have you had trouble keeping your mind on the teacher and found yourself daydreaming a lot?
   
   


2. Do you have pattern of making a fair amount of careless mistakes on tests, even when you knew the correct answers? 
   
   


3. Have you had a good many complaints over the years about your not listening? 
   
   


4. Have you been plagued by procrastination fairly regularly throughout your life? 
   
   


5. Can you write up a project plan, i.e. can you write an outline for an essay or project that includes points or steps in a logical sequence? 
   
   


6. Do you have a pattern of avoiding most things that require sustained mental effort? 
   
   


7. Do you have pattern of frequently misplacing or losing things? 
   
   


8. Have you tended to be easily distracted throughout your life? 
   
   


9. Do you have pattern throughout your life up being somewhat absent-minded or forgetful? 
   
   
   
   

(Four of these hyperactivity-impulsivity symptoms are necessary to meet the criteria for the subtype of hyperactivity.) 

Hyperactivity: 

1. Are you chronically a rather fidgety person, i.e., regularly squirm in your seat, drum with your fingers, shuffle papers, or do things that annoy people around you? 
   
   


2. Do you have pattern throughout life of having difficulty staying in your seat for one hour for classes or meetings? 
   
   


3. If you go into a room where a group of people you know are sitting around having a sedate conversation, do you try to liven it up by making it fun or exciting? 
   
   


4. Are you the type of person who is usually on the go and/or driven by a motor and/or would rather be doing something physical more than something mental? 
   
   


5. Do you talk excessively or quite occasionally get feedback that you talk too much? 
   
   

Impulsivity: 

1. Do you tend to blurt out the answer before the person has finished their question? 
   
   


2. Does it seem harder for you to wait on your turn than for the average person? 
   
   


3. Do you tend to interrupt others conversations? 
   
   

Through this ADHD evaluation, if the patient meets the criteria for one or both subtypes of adult ADHD, I'll proceed with a conversation with them about the medication choices, benefits, and potential adverse reactions, and begin treatment if the patient is ready to start it at this time.

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and need an ADHD evaluation. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an ADHD evaluation and for help deciding the most effective and safest treatment. 

Panic Attacks And Menopause

First of all, let's agree that menopause is no walk in the park for many women. Their hormones are constantly fluctuating back and forth, they have hot flashes and mood swings, and they either can't sleep or they wake up with night sweats. Add in anxiety and panic attacks and many women will feel like they are going right over the edge. Panic attacks and menopause just don't mix well.

Simple anxiety is something everyone experiences on occasion. We all stress over projects at work or issues at home. But, panic attacks are anxiety attacks on steroids. A panic attack can make the sufferer feel like they are having a heart attack! The most common symptoms people have with panic attacks are racing heart beats or heart palpitations, chest pain or discomfort, a feeling of shortness of breath or choking, sweating, dizziness or feeling lightheaded or faint, and unnatural fear and anxiety. To get an idea of what a panic attack is like, think about how you feel when you are cut off by another car and narrowly miss hitting someone or something. Now, multiply that feeling tenfold!

Women who are experiencing a panic attack are likely to breathe shallowly and rapidly. Their racing heartbeat makes them more upset, and the terror and fear that something horrible is happening to them only increases their panic. Panic attacks are not triggered by something in the environment around the sufferer or by something they did; rather the attacks begin for no apparent reason and are as likely to affect someone who is sitting calmly while reading a book as they are to affect a woman in a stressful situation.

While people can be prone to panic attacks at any stage of life, women are more likely than men to suffer from them, and panic attacks and menopause seem to go hand in hand. Many women today are stressed out and overworked, and put themselves at the back of the line behind family and work needs. When women enter perimenopause and menopause, their bodies begin to have hormone imbalances. It is believed that these hormone imbalances, coupled with stress, are at least partially to blame for an increased susceptibility to panic attacks.

Many women will go through perimenopause and menopause, and panic attacks will only happen once or twice during the entire process. For other women, menopause and panic attacks will become a way of life until menopause is completed. For these women, medication may hold the answer to getting them through this troubling time of life.

Dr. Darvin Hege, an Atlanta, GA psychiatrist says "there are two classes of anti-panic medicines that are highly effective. They are Benzodiazepines (Group 1) which consist of Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Tranxene, Serax Valium, Librium, and others, and Antidepressant/Anti-panic medicines (Group 2) consisting of SSRI's (Zoloft, Prozac, Paxil, Celexa, Lexapro, and Luvox) and tricyclics (Tofranil, nortriptyline, protriptyline, Elavil, Sinequan, Surmontil, and others)." Dr. Hege further notes that "the most important difference between Group 1 and Group 2 is that medicines in Group 1 work much quicker, i.e. stop panic attacks in twenty minutes to a couple of weeks in worse cases. Group 2 requires 1-8 weeks to be effective. However, Group 1 can be physically addictive. Group 2 medicines are just as likely to stop all panic attacks as Group 1 after a lag period. The lag period is 1-3 weeks to the onset of reducing the severity and frequency of attacks. It takes Group 2, 3-10 weeks to totally stop all panic attacks in 70% of patients. Most people need to be on medicine for at least 1 year to significantly reduce the risk of relapse back into panic attacks soon after stopping the medicines."

Menopause and panic attacks are not something that women just have to "put up with". For those women who suffer relatively few attacks, natural therapies or stress reduction can help. Yoga, meditation, and exercise can help calm otherwise frantic lifestyles. Just the simple fact of knowing what a panic attack feels like can help women respond less negatively if they have one. For those women who can not deal with the anxiety and fear that a combination of menopause and panic attacks can bring on, there is relief in the form of counseling and medication.

Dr. Darvin Hege has 25 years of experience dealing with patients who have panic attacks and menopause simultaneously. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an evaluation for relief of your panic attacks and for help deciding the most effective and safest treatment. 

Panic Attacks And Pregnancy

Panic attacks and pregnancy simultaneously create risks for the fetus. Stress and anxiety in the mother increase adrenaline and cortisol that can reduce oxygen to the fetus and contribute to risks during labor and delivery. The peak age of onset is in the 20s and more women than men get panic attacks. Therefore, the incidence of panic attacks and pregnancy together is elevated. The prevalence of panic attacks and pregnancy is about 1 to 2%.

In a retrospective study of first onset of panic attacks in childbearing age women, 10 times as many women reported their first panic attack occurred in the first trimester of a pregnancy. Other retrospective studies suggested that breast-feeding reduced the risk of panic disorder during the postnatal period and weaning increased the risk. If a woman has had panic attacks before pregnancy, studies have suggested that they may have worsening of the panic attacks during pregnancy and/or the postnatal period if the panic disorder was severe.

Medical causes of panic attacks need to be ruled out. These include thyroid disorders, anemia, preeclampsia, and pheochromocytoma. Comorbid psychiatric conditions frequently underlie panic disorder. These include mild bipolar disorder, depression, ADHD, other anxiety disorders such as PTSD, generalized anxiety disorder, or alcohol or drug abuse or withdrawal.

Panic attacks and pregnancy present challenges for treatment. Self-care strategies include elimination of caffeine, reduction of sleep deprivation, and relaxation techniques. Non-medication therapy with cognitive behavioral therapy with a professional therapist may be effective.

Medication treatment for panic attacks and pregnancy are often very helpful, but risk and benefit analysis include the following: as mentioned in the beginning there are medical, physical development, labor and delivery, postpartum, and later physical and mental developmental risks for the baby when the mother is having uncontrolled panic attacks during pregnancy, postpartum, and early childhood stages.



Now I will address some of the concerns of taking medication during panic attacks and pregnancy. Medications that help panic attacks the quickest are benzodiazepines. Benzodiazepines include Xanax, Klonopin, Ativan, Valium, Librium, Tranxene, and Serax. There was at least one study suggesting an increased risk of cleft palate if Valium is used during pregnancy. That suggestion was about a 1% risk. SSRIs retrospective studies have not suggested any congenital malformations except possibly in Paxil. Hence, the other SSRIs are first choice. These include Prozac, Zoloft, Celexa, and Lexapro. The drawback of the SSRIs are that they require one to two weeks of administration before getting any benefit and one to two months before getting full benefit against panic attacks. Withdrawal or discontinuation symptoms of any of these medicines in the baby after delivery are additional concerns.

Dr. Hege has 25 years of experience dealing with patients who have panic attacks and pregnancy simultaneously. Call today at 770 458-0007 for an evaluation for relief of your panic during the planning or managing of a pregnancy or postpartum, and for help deciding the most effective and safest treatment.