Panic attacks: how to cope with an attack on your own? How can you tell if you're having a panic attack? Use of antidepressants and antipsychotics

»» №1 2000 CITO! O.V. VOROBYEVA,
ASSOCIATE PROFESSOR, DEPARTMENT OF NEUROLOGY, FACULTY OF POSTGRADUATE PROFESSIONAL EDUCATION, MOSCOW MEDICAL ACADEMY. THEM. SECHENOVA

Panic disorder is an extremely common, chronic disease that manifests itself at a young, socially active age. Its prevalence according to epidemiological studies is 1.9-3.6%. It is observed 2-3 times more often in women.

The main manifestation of panic disorder (PD) is repeated paroxysms of anxiety (panic attacks). A panic attack (PA) is an inexplicable, painful attack of fear or anxiety for the patient in combination with various vegetative (somatic) symptoms. In the domestic literature, the term “vegetative crisis” has been used for a long time, reflecting ideas about the primacy of autonomic dysfunction nervous system. It is acceptable to use both, although the term "panic attack" has worldwide recognition and is included in the International Classification of Diseases, 10th revision.

How to diagnose a panic attack?

The clinical assessment of any paroxysmal phenomenon by a physician should include the following items:

• analysis of symptoms that make up paroxysm
• identifying the presence or absence of prodromal and post-attack symptoms
• assessment of the duration of paroxysm
• analysis of situations and factors provoking paroxysm
• analysis of the representation of a pathological phenomenon in the sleep-wake cycle.

Diagnosis of a panic attack is based on fairly strict criteria. A panic attack is characterized by paroxysmal fear (often accompanied by a feeling of impending doom) or anxiety and/or sensation internal tension in combination with 4 or more of the list of panic-associated symptoms.

The intensity of the main criterion of a panic attack - paroxysmal anxiety - can vary widely: from a pronounced affect of panic to a feeling of internal tension. In the latter case, when the vegetative component comes to the fore, they talk about “non-insurance” PA or “panic without panic”. Attacks that are depleted of emotional manifestations are more common in therapeutic and neurological practice[Z]. Also, as the disease progresses, the level of fear in attacks decreases.

The presence of at least 4 symptoms from the list in an attack is not an absolutely strict criterion. As a rule, patients, along with “full-scale” attacks, experience frequent attacks, limited to 2-3 symptoms (“minor” PA). In addition to the symptoms presented in the list, the attack may include others, most often conversion ones (feeling of a lump in the throat; gait disturbance; visual or hearing impairment; cramps in the arms or legs, pseudoparesis, etc.). However, the presence of more than 5-6 atypical (non-panic-associated) symptoms during an attack casts doubt on the diagnosis of PA. We have proposed an express method differential diagnosis panic attack and demonstrative seizure based on the PA typicality index.

It is important that, unlike many paroxysmal conditions A panic attack is not characterized by a prodromal period (aura). Panic-associated symptoms develop suddenly and reach their peak within 10 minutes. The post-attack period is characterized general weakness, brokenness. Some patients report a feeling of “relief” after the attack is over. The presence of post-ictal confusion and post-ictal sleep makes the diagnosis of a panic attack questionable.

Attack duration is also important diagnostic criterion. The short duration of the paroxysm argues against the diagnosis of PA. The duration of PA is calculated in minutes (on average 15-30 minutes). although some patients report longer attacks. There is a direct relationship between the presentation of atypical symptoms in an attack and its duration.

Assessing attack triggers can also help with diagnosis. Most patients report spontaneous (unprovoked) attacks. However active questioning of the patient makes it possible to identify, along with spontaneous attacks, situational attacks that occur during the period socially “threatened” situations. Such situations may be using transport, being in a crowd or confined space, the need to leave your own home, etc. PAs occur predominantly in the waking state (during the day or evening time). However, in some patients, in addition to daytime attacks, night attacks that arise from sleep are also observed. It is extremely rare for patients to have only sleep PA.

Do panic attacks have nosological specificity?

Panic attacks are not a nosologically specific phenomenon. A one-time occurrence of PA cannot be considered from the perspective of a disease at all. It is believed that most people, under certain circumstances, experience this dramatic phenomenon at least once in their lives. In this case, panic attacks represent a physiological response to emotional stress. PA can occur with somatic, as well as with mental illness, especially in depressive disorders. But most often doctors encounter the phenomenon of PA within the framework of panic disorder.

Panic disorder has a special stereotype of the formation and development of symptoms. The first attacks leave an indelible mark on the patient’s memory, which leads to the appearance of an anxiety syndrome of “anticipation” of an attack, which in turn perpetuates the repetition of attacks. Repeating attacks in similar situations (transport, being in a crowd, etc.) contributes to the formation of restrictive behavior, i.e. avoiding places and situations that are potentially dangerous for the development of PA. Anxiety about possible development attacks in a certain place (situation) and avoidance of a given place (situation) is defined by the term agoraphobia. The increase in agoraphobic symptoms leads to social maladjustment of the patient. Due to fear, patients may be unable to leave home or be alone. The presence of agoraphobia in PD indicates a more severe disease, a worse prognosis and requires special therapeutic tactics.

As panic disorder develops, the disease may be complicated by the appearance of symptoms of depression. Although in a third of patients, clear depressive symptoms are detected before the manifestation of PA, the frequency of complications with depression (comorbidity) progressively increases with the duration of the disease of PA. Many researchers have proven that when PD and depression are combined, both disorders manifest themselves in a more severe form.

At all panic disorder is characterized by a high frequency of comorbid conditions, which generally aggravate the prognosis and reduce the likelihood of remission.

What factors contribute to the chronicity of panic disorder and complicate the prognosis?

Much depends on the patient's assessment of the first panic attack. The more catastrophic it is assessed by the patient (myocardial infarction, suffocation, “brain” catastrophe, etc.). the more severe the disease and the faster the onset of comorbid conditions, especially agoraphobia. The prognosis becomes even more complicated with reinforcement medical workers catastrophic assessment of PA by the patient.

Many patients, when experiencing the terrifying symptoms of panic for the first time, resort to emergency medical care. Hospitalization of such a patient by ambulance reinforces his catastrophic assessment of the attack and convinces him of the “seriousness” of his illness.

The patient’s interpretation of a panic attack as a manifestation of some somatic disease leads to frequent visits to the doctor, consultations with specialists in various fields, unjustified diagnostic studies and creates in the patient the impression of the complexity and uniqueness of his disease. The patient's misconceptions about the essence of the disease lead to the appearance of hypochondriacal symptoms, contributing to the worsening of the disease.

Finally, the chronicity of PR is facilitated by inadequate and untimely therapeutic measures. Anxiety disorders, including panic, are diagnosed in only 50% of patients with obvious symptoms. Less than 50% of patients receive any treatment and less than 30% - adequate therapy. Despite the obligatory nature of autonomic dysfunction during an attack and its often masked nature emotional disorders, the basic method of treating PD is psychopharmacological. The use of so-called vegetotropic drugs (anaprilin, pyrroxan, belloid, bellaspon) in combination with vascular-metabolic therapy (cinnarizine, cavinton, trental, nootropil, piracetam, cerebrolysin) is ineffective, which in turn undermines faith in the possibility of a cure and contributes to the chronicity of the disease. Not all classes of psychotropic medications are equally effective against panic. The practice of using classic benzodiazepines (diazepam, chlordiazepoxide, phenozepam), less often antidepressants (amitriptyline) and minor neuroleptics (eglonil, sonapax, teralen) or a combination of these groups of drugs in case of PR does not lead to a stable and pronounced effect [b]. However, it would be incorrect to associate the severity and chronicity of panic disorder only with diagnostic and therapeutic errors, since panic disorder tends to become chronic even despite adequate treatment. Nevertheless, it is extremely important to promptly and correctly diagnose PR and apply the most adequate therapy possible.

What therapeutic strategies are used?

There are several strategies in the treatment of panic disorder: the first is stopping the panic attack itself; the second is the prevention (control) of a panic attack and comorbid panic syndromes (agoraphobia, depression, etc.).

How to stop a developed panic attack?

Many patients empirically find a set of drugs that can stop an attack. This “gentleman’s” set, as a rule, includes beta-blockers, Corvalol, Valocordin, sedatives. Patients constantly carry medications with them; the absence of medications causes severe anxiety and serves as a provocateur of an attack. Most effective drugs To relieve a developed panic attack, benzodiazepines are used. Of these, drugs are more preferable fast acting: diazepam. lorazepam. Average therapeutic doses are used. Possible both oral and intravenous administration drug. Stopping the attack is achieved after a few minutes (15-30) after administration of medication. However, frequent (daily) use of these drugs leads to the development of addiction syndrome and they stop working in the usual dosages. At the same time, irregular use of benzodiazepines (“on-demand use”) and the associated rebound phenomenon may contribute to an increase in PA.

What medications can prevent the development of a panic attack?

The ideal medication to control a panic attack should meet the following requirements:

• high anti-panic efficiency
• impact on comorbid symptoms
• favorable tolerability profile
• Possibility of combination with other medications
• Possibility of use as maintenance therapy Currently used drugs that have proven (in placebo-controlled studies) anti-panic efficacy do not fully meet the properties of an ideal drug.

tricyclic (tetracyclic) antidepressants of non-selective action, for example:

Imipramine (melipramine)

Clomipramine (anafranil)

Amitriptyline (tryptisol)

Mianserin (lerivon)

Maprotiline (ludiomil)

High-potency benzodiazepines (HPBs), for example:

Clonazepam (antelepsin, rivotril)

Alprozalam (Xanax)

Selective antidepressants (selective serotonin reuptake inhibitors (SSRIs), for example:

Paroxetine (Paxil)

Fluvoxamine (fevarin)

Sertraline (Zoloft)

Fluoxetine (Prozac)

Cytolapram (cipramil)

Tianeptine (Coaxil).

The latter is a drug with a special mechanism of action (serotonin reuptake inducer) and has a neuromodulatory effect.

Each class of anti-panic drugs has both certain advantages and disadvantages (table 1).

Tricyclic antidepressants (TAD) - first class medicines, which had a full-fledged anti-panic effect. The effectiveness of TAD is 25% higher than the placebo effect and is about 70%. The most important effect of TADs is their influence on such serious clinical components of PD as anticipatory anxiety and depressive symptoms. agoraphobia. An extremely negative property of TADs is their delayed anti-panic effectiveness. The first improvement usually occurs 2-3 weeks after the start of treatment, and a complete therapeutic response may occur after 8-10 weeks. Sometimes, in the first weeks of treatment, an exacerbation of the disease is observed (the frequency of PA and the intensity of secondary psychopathological symptoms increase). Most often, deterioration of the condition in the first weeks of treatment occurs when using antidepressants with a pronounced stimulating effect (imipramine, fluoxetine, etc.).

The delay in improvement is extremely distressing for patients seeking immediate relief from their suffering. Unjustified expectations may lead to the patient's refusal to use TAD. During this important period of treatment, the patient especially needs psychological support from the doctor, and sometimes the use of corrective medications. Such correctors can be benzodiazepine drugs. The main task of the doctor- prevent refusal to use TAD on initial stage treatment. The lack of anti-panic effectiveness is one of the strongest arguments against the use of TAD.

The spectrum of side effects of TAD includes dry mouth, weight gain, skin rash, constipation, and most importantly, cardiotoxic effect (palpitations, orthostatic hypotension). The occurrence of side effects in patients with PR can become a serious obstacle to further use of the drug. If side effects occur, it is necessary to convince the patient of the possibility of correcting the complaints that have arisen, using beta blockers, benzodiazepines, etc. for these purposes. Withdrawal symptoms are also described for TAD, but are not big problem for patients with panic disorder.

Currently, it is believed that when deciding to treat a patient on antidepressants, it is advisable to give preference to SI 03 C. These drugs are considered the safest; they do not have the side effects characteristic of TAD. It is extremely rare when using SSRIs that symptoms of exacerbation of the initial period of treatment occur. These drugs can be used in long-term schemes treatment during long-term prophylactic therapy. Among the serotonergic drugs, the most wide range Balanced drugs (tianeptine, paroxetine, sertraline) have an effect. They affect panic, agoraphobia, competing depression and anxiety. Moreover, the effect on anxiety is not accompanied by a sedative side effect.

High potency benzodiazepines (HPBs), in addition to controlling panic attacks, are also highly effective against anticipatory anxiety. However, these drugs are less effective than TADs and SSRIs in treating agoraphobic disorders. The effect on depressive disorders in VPB is also less pronounced. Their indisputable advantage is the rapid onset of effect. Control of a panic attack is achieved after a few days, while antidepressants take several weeks to become effective. As a rule, by the end of the first week of treatment, the advisability of further taking the medication becomes clear. The absence of the deterioration of the condition characteristic of TAD in VPB at the initial stage of therapy is also one of the significant advantages of this class of drugs. The most significant problem in the use of VPB is the development of addiction and dependence, which makes their long-term use impossible.

From the data presented, it is obvious that SSRI antidepressants are closest to the level of an “ideal” anti-panic drug.

The advantages of the new class of antidepressants over classical drugs are demonstrated by our own study of the antipanic effectiveness of amitriptyline and tianeptine (Coaxil).

A four-week controlled study of the antipanic effectiveness of amitriptyline, the drug most popular and available in Russia from the TAD group, revealed its effectiveness (average daily dose - 75 mg) in this series 77%, placebo 42%, intolerance to the drug with subsequent refusal to take it was observed in 22% sick. In all patients taking amitriptyline, after 8-10 days there was a deterioration in their condition, manifested by an increase in frequency and greater severity of panic attacks, which in most patients passed by the end of the 3rd week. We found sustained tachycardia that persisted despite the clinical and psychometric benefits of amitriptyline. Taking into account the received last decades data on a greater likelihood of cardiovascular mortality in men suffering from panic disorder should be kept in mind when choosing therapy possible risk cardiovascular side effects.

A six-week course of tianeptine therapy was effective in 67.5% of patients (complete control of PA). In patients with persistent attacks, their frequency significantly decreased. It is highly likely that with a longer period of treatment, the percentage of patients in whom panic attacks completely disappeared would be greater. Tianeptine demonstrated equivalent effectiveness against comorbid depression, anxiety and autonomic disorders. Tolerability of tianeptine in the study sample was high. All patients completed the six-week course of treatment. Side effects were observed in 3 (7.5%) people. Observed side effects were unstable and did not require additional therapy.

We can say with confidence. that when using tianeptine, the ratio of the benefit of treatment to the risk of its implementation significantly exceeds this indicator when using amitriptyline.

How are the main tactical issues of PR therapy resolved? (When to treat. Choice of drug. Dose and frequency of administration. How long to treat. Criteria and withdrawal strategies.)

Treatment should begin when attacks recur and anticipatory anxiety appears. Treatment strategies are tailored according to the severity of the disease (Table 2) .

The choice of the basic drug is determined clinical picture disease and the characteristics of the drug. Average therapeutic doses are used. Drugs such as TAD and IAP need to be titrated (therapy should be started with small doses: 1/3 -1/4 of the planned dose with a gradual increase over 7-10 days). For SSRI drugs, the initial dose is equal to the therapeutic dose, so they do not require titration, which certainly facilitates the doctor’s work. Most of the new generation antidepressants are long-acting, and a single dose per day is sufficient, and short-term omissions in taking the drug are possible without leading to any consequences, which is very convenient for the patient and ensures regularity of use.

It is still unclear what the optimal duration of treatment for panic disorder should be. The usual duration of treatment for complete control of PA is at least six months or even longer - up to nine months. But most controlled studies reflect a short treatment period (6-8 weeks). Single studies long-term use TAD in patients with PR showed that the effectiveness of TAD does not decrease over time, i.e. addiction to the drug does not develop, unlike VPB, which you should try to use for no more than 4 months. Only SSRIs can be used as maintenance treatment against relapse.

The indication for discontinuation of the drug is a complete reduction of the panic attack (a period of 30-40 days free from panic) and the disappearance of anticipatory anxiety. Cancellation should be carried out gradually, granularly: removing 1/8-1/4 of the applied dose over 1-2 weeks. The new generation of antidepressants can be discontinued at once. After discontinuation of antipanic therapy, relapses occur in 26–70% of patients. A relapse, of course, requires a return to medication. At a minimum, patients who relapse after each attempt to discontinue the drug require long-term maintenance therapy with antidepressants (SSRIs are the drugs of choice).

We hope that the presented material will help the practitioner in individual selection of adequate treatment tactics for panic disorder.

LITERATURE

1. Perkonigg A, Wittshen HU. Epidemiologie von Angststorungen. In: Kaster S, Muller HJ, eds. Angstund Panikerkrankung. Jena: Gustav Fischer Veriag, 1995, 137-56

2. International classification diseases (10th revision). Classification of mental and behavioral disorders. WHO/Trans. from English edited by Nullera Yu.L., Tsirkina S.Yu. Russia., S.P., "ADIS". 1994

3. Vein A.M., Dyukova G.M., Vorobyova O.V., Danilov A.B. Panic attacks (neurological and psychophysiological aspects). Inst. honey. marketing S-P, 1997, p. 304

4. Lender D. Panic disorder and comorbid conditions In the book: Anxiety and obsessions Ed. Smulevich A.B. Moscow 1998: 66-75

5. Sartorius N, Ustun TV, Lecrubier Y, Wittchen HU. Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry 1996, 168, 38-43

6. Mosolov S.N. Clinical Application modern antidepressants. S-P. 1995.

7. Katschnig H, Stolk JM, Klerman GL, et at. Discontinuation and longterm follow-up of participants in a clinical drug trial for panic disorder. lid Psychiatry 1992; 1; 657-660

8. Boerner RJ, Moller HJ. Pharmakotherapie der Panikstorung und/oder Agoraphobie - Leitlinien und Ulinische Anwendungsstrategien. pychopharmacotherapie 1996; 3 (4); 168-177

Panic attacks (PA) usually occur suddenly in certain situations and are accompanied by both emotional-neurological and somatic symptoms. Despite their situational nature, panic attacks require consultation with a specialist, like other disorders. Constant panic attacks can negatively affect your overall mental condition person. Therefore, panic attacks simply need to be treated.

The main mistake of many patients is to avoid phobic situations. Such a decision cannot be called correct: panic attacks require treatment, because sooner or later a person will find himself in a situation that frightens him, no matter how much he avoids it.

At the beginning of treatment, it is very important to help the patient realize that he has a disease, tell him in detail about the symptoms and treatment methods used, about the mechanism of formation of the disorder. You cannot treat panic attacks at home on your own. Monitoring by a doctor and the opportunity to discuss unclear symptoms of the disease must be present.

Therapy for panic attacks includes:

• relief of an attack of PA;
• PA warning;
• elimination of “secondary” disorders (phobias, anxiety, depression).

Stopping a panic attack

A panic attack can be controlled with medication; the most effective in this case are benzodiazepines. Typically, the effect of the drug begins to appear within a few minutes after administration. If the effect is not achieved, after 15-20 minutes it is recommended to take the medicine again.

Psychophysiological techniques for stopping an attack of PA are also very effective: relaxation, diaphragmatic breathing and other breathing techniques. Non-medicinal relief of an attack is more preferable for the patient, as it contributes to understanding the mechanism of disease development. In addition, the patient knowledgeable methods relief of PA, the fatal fear of an attack disappears. This happens because the patient realizes that he can cope with panic on his own. This is very important for further recovery. You can master psychophysiological techniques for stopping a panic attack in the course.

Panic Attack Prevention

The specificity of panic attacks lies in the situational nature of their manifestation. However, it is incorrect to assume that treatment for panic disorder is limited only to stopping the panic attack. Panic attacks will stop bothering a person if the disease is prevented in time. Necessary long-term treatment, aimed at constant monitoring of the patient’s condition and elimination of even the most minor symptoms of the disease.

Cognitive behavioral therapy is mainly used to treat panic attacks. During it, the patient learns to relax and control breathing, and also changes his attitude towards the disease. The patient begins to understand the nature of the disease, acquires a set of strategies necessary to combat the disorder, and gets rid of “avoidant” behavior. The patient understands that he can independently resist fears and panic. It is quite often used in combination with psychotherapy. It is with the help of biofeedback therapy that a patient can be taught to relax, as well as regulate the body’s reactions to a frightening situation.

For a mild form of panic disorder, psychotherapy is usually sufficient: the doctor will explain to the patient the causes of panic, talk about its symptoms, methods of getting rid of it, and help eliminate catastrophic ideas about the situation.

In more severe cases, drug treatment of panic attacks is required at the stage of preventing the disease, and not just to stop the attack. It all depends on the severity of the symptoms of the disease. Drug treatment can also be prescribed if the patient suffers from other disorders, for example, etc.

The most effective remains complex treatment, including drug therapy, cognitive behavioral psychotherapy, and various non-specific methods, for example, hypnosis. The specialists at the Mental Health Clinic have extensive experience in treating panic attacks. We prescribe only proven and safe medications, and also conduct sessions of cognitive behavioral psychotherapy. We are ready to help you cope with difficulties!

What should a person who has periodic seizures do? causeless fear- panic attacks? How to fight on your own when it seems that there is no one to expect help from and you are alone with this misfortune? Relatives don’t understand, doctors shrug their shoulders, say you’re healthy, but you feel like you’re about to die. Endless trips to doctors like vicious circle, from which it would seem impossible to escape. In fact, there is a way out: we need to understand the problem, and most importantly, understand that almost every person has one or another vegetative-vascular disorders.

Panic attacks as a component of vegetative-vascular dystonia

Panic attacks are a companion for people with VSD. First, let's understand the terms. A panic attack is an attack of unreasonable fear for one’s health, a feeling of approaching death. The attacks can be so strong that the person will rush around the room, unable to find a place for himself, and he may be trembling. High blood pressure, pulse is such that it’s close to fainting. burning and pain behind the sternum. Signs may be very similar to myocardial infarction. There are pains in the heart area, which can be distinguished from angina pectoris by the fact that they last longer (several days, weeks). A drug called Nitroglycerin does not relieve such pain, while taking a drug such as Validol can alleviate the condition.

VSD is not a disease, but a set of symptoms indicating a disturbance in the activity of the central and peripheral parts of the autonomic system.

Divided into several types:

• Hypertensive is caused by high blood pressure tachycardia may be present. People with this type are prone to panic attacks.
• Hypotonic is characterized by low blood pressure, dizziness, weakness, headaches.
• The mixed type includes symptoms of the other two types and is the most common.

The presence of vegetative-vascular disorders is not life-threatening, but they can aggravate the course of existing diseases, as well as in combination with others unfavorable factors contribute to the development of diseases such as bronchial asthma, arterial hypertension, ulcer (in the presence of irritable bowel syndrome - IBS), coronary heart disease.

Physical manifestations of psychological problems

In Russia, people are not used to seeing doctors for every reason; few of us have family doctor or a personal psychologist. For some, their financial situation does not allow it, for others, the frantic pace of life does not allow it. Many people believe that going to a psychologist is a waste of time. The question constantly haunts me: if I have panic attacks, how to deal with it? You can’t always cope on your own, you should remember this.

The habit of solving all problems alone often leads to aggravation of the situation and can lead to a sad outcome. There may be daily panic attacks. How to fight them on your own when you have no strength? You need to ask for help from your family, who will try to understand and support. When your loved ones are powerless, there is no need to waste time; you should urgently contact a specialist. There's nothing wrong with this. A visit to a psychotherapist in no way means that a person is mentally ill, there are simply difficulties that each of us periodically experiences. Mostly we're talking about about depression, which can accompany many diseases and conditions such as VSD with panic attacks.

Is it possible to cope with panic attacks on your own? Experts' opinion on this matter

Panic attacks are accompanied by suffocation, choking, death, or contracting an incurable disease. Moreover, a person will worry about his parents, children, and people dear to him.

The trigger for the onset of PA can be anything: psychological fatigue, stress, factors such as an accident, being in a cramped, stuffy bus, illness or death of a loved one. At one of these moments you may experience your first PA. Then they begin to repeat every day, usually in the evening. When panic grips a person (no matter what he does) every day, for example, at exactly 18.00, on a subconscious level he begins to wait, worry, worry, which further aggravates the situation.

During PA, the body experiences severe stress, after which a person may feel completely exhausted.

On the other hand, knowing the exact time of the attack, you can prepare yourself mentally, accept everything necessary measures. The time has come: panic attacks. How to fight? Kurpatov, a famous psychotherapist, suggests looking at all this from the other side. His books are written in simple, understandable language. People with PA should read “The Remedy for VSD.”

Dr. Kurpatov says that the main thing for such people is to realize that they will not die from PA. He gives a peculiar, but very useful piece of advice, which goes something like this: “When you think you are about to die, lie down... and die.” Naturally, it is not possible to die, and understanding this has a good psychotherapeutic effect.

Panic attacks: how to deal with them. Reviews from VSDshnikov

Patients suffering from panic attacks are usually prescribed sedatives, tranquilizers, and adrenal blockers. They also prescribe massage and exercise therapy. It is necessary to figure out whether such methods will really defeat the PA.

Judging by patient reviews, exercise therapy and massage have a positive effect, but sedatives do not always. They often make you want to sleep, but they do nothing to stop the attacks.

Massage helps you relax and improves blood circulation. Why is sport so useful? The fact is that PA begins due to uncontrollable blood. Normally, this process should occur when a person is in an extreme situation, and not sitting quietly in a chair. If you know the time of onset of a panic attack, you can do physical activity. It won't hurt to go for a run fresh air or training at home on a simulator. This is very effective method, which will help stop the attack, because the adrenaline will have somewhere to go.

Methods for treating panic attacks

You won't be admitted to the hospital if you suffer from panic attacks. How to deal with seizures at home? There are several ways:

You can also visit medical institution for some procedures such as:

• hypnosis;
• acupuncture;
• professional massage.

Rest is very important, communication with people is useful. If possible, you should go to the sea or to a sanatorium.

Medicines used for panic attacks

The next question that should be considered in the topic “Panic attacks, how to deal with” is the medications used for PA. Drug treatment includes the following groups of drugs:

• sedatives (tinctures of valerian and motherwort, “Validol”, “Corvalol”, “Novo-Passit”);
• tranquilizers (drugs "Relium", "Elenium", "Librium");
• adrenal blockers (beta blockers, such as Atenolol, Anaprilin, have the best effect).

Folk remedies for the treatment of panic attacks

Now it’s clear how to attack, how to fight. Folk remedies What treatment can be offered to help combat this disease? Since it is impossible to lie down or sit during a panic, and all attempts to distract yourself are futile, you can resort to the following methods:

How to deal with a panic attack when you don't have enough air

Consider the question: “Panic attacks, how to fight when there is not enough air?” Often during an attack there is a feeling of suffocation: it is impossible to take a full breath (as if you want to yawn) - hyperventilation syndrome with VSD. There is a fear of suffocation.

In this case, you need to do the following:

• constantly remind yourself that it is impossible to suffocate - air is supplied in the required quantity;
• breathe into a paper bag ( plastic bottle, scarf);
• drink mint tea;
• rub the nasal sinuses with the usual “Star” - this will soothe and make breathing much easier.

Is it possible to get rid of panic attacks forever?

You can win forever How to fight on your own - that's what you need to understand to achieve this goal. There is no need to be upset if it doesn’t work out, this is not a matter of one day. Every victory, no matter how small, will make a significant contribution to the fight against the PA.

It is necessary to learn self-control, understand that people do not die from PA, and believe in it. And to make sure, you need to carefully understand the problem with the help of literature, talk with people who also suffer from panic attacks.

A condition that is caused by the release of an excess amount of adrenaline into the blood is called a panic attack (vegetative crisis, cardioneurosis, neurocirculatory). As a result, symptoms such as palpitations, a feeling of shortness of breath, and increased breathing occur. All panic attacks are accompanied by strong uncontrollable fear, although visible reasons no worries.

According to some reports, panic attacks varying degrees severity occurs in approximately 5% of the population, but in an expanded form, repeated vegetative crises can be observed in 2% of people. The most common age of their occurrence is 20-40 years, and women suffer 2-3 times more often than the stronger half of humanity. The main causes of attacks are emotional stress and other disorders in mental sphere. The same conditions often provoke the development of sleep paralysis. Plays an important role hereditary predisposition to panic attacks, condition hormonal levels and the presence of somatic diseases.

Panic attacks and their symptoms: from respiratory to mental. It should be taken into account that among panic attacks there are typical and atypical. They are characterized by different symptoms. In a typical attack, the symptoms are very extensive; several groups of characteristic signs can be distinguished:

1. Cardiovascular: (rapid heartbeat), pressure or stabbing pains behind the sternum in the region of the heart, arrhythmia (interruptions in the heart), increased blood pressure.

All these manifestations imitate heart attack or a hypertensive crisis, so often such patients call an ambulance and are hospitalized in the cardiology departments of hospitals.

2. Respiratory: increased breathing, feeling of suffocation, lack of air.

3. Digestive: discomfort in the abdominal area.

4. Vegetative: sweating, paleness or, conversely, redness of the skin, hot or cold flashes, dizziness.

5. Mental: anxiety, fear of death, derealization (lack of understanding of what is happening around).

If an atypical panic attack occurs, it manifests itself in the form of the following symptoms:

• loss of consciousness;
• visual and hearing impairment;
• pseudoparesis and pseudoparalysis (when there is no movement in the limbs);
• muscle cramps;
• loss or impairment of speech.

In case of atypical vegetative crisis, it is important to exclude organic lesion nervous system, since all its manifestations imitate a stroke, which becomes the reason for hospitalization of such patients in the neurological department.

Panic attacks begin suddenly, usually during the day. The clinic quickly increases and progresses, reaching a maximum within 10-15 minutes. Such patients do not give in to any persuasion; they are completely captured by their fear. At the end there is copious urination. The duration of the attack is no more than 30 minutes, so if the symptoms persist longer, the correctness of the diagnosis is highly doubtful. Patients in the interictal period cannot get rid of the feeling of fear of a repetition of the experience, and over time they develop chronic mental illnesses. Even if it occurs only once in a lifetime, an attack leaves an indelible impression; a person will never forget this feeling of enormous inexplicable uncontrollable fear, subsequently trying to avoid the situation that provoked the attack.

The form of a panic attack and the severity of its symptoms may differ from person to person, and there are also different forms of manifestation of pathology in the same person depending on the situation, emotional and mental state.

The connection between panic attacks and VSD. Doctors often equate these two concepts, because their manifestations are similar. In fact, vegetative-vascular dystonia is the same panic attack, only without mental manifestations. In addition, VSD can last for many months and even years with periods of exacerbations and remissions, while exacerbations take a longer time, from several days to weeks. Panic attacks are characterized by a crisis course, the attack lasts no more than half an hour and patients clearly indicate a strong feeling of inexplicable fear.

Modern medicine clearly distinguishes between the concepts of “panic attack” and “VSD”, because this is the key to successful therapy. If for dystonia all treatment comes down to normalizing the work and rest regime, getting positive emotions, the use of light (usually herbal) sedatives, then during panic attacks, along with all these measures, one cannot do without taking more serious medications: and tranquilizers.

Recommended treatment: no fear. Panic attacks should be treated by a competent psychotherapist. But, as a rule, people are embarrassed and do not want to seek psychotherapeutic help, repeating to themselves: “I’m not mentally ill.” At first, such patients are patients of a therapist, cardiologist, or neurologist. Unfortunately, most of them see a psychotherapist after the development of depression and other mental changes, which slows down treatment and reduces the chances of recovery.

Types of help for victims of panic attacks:

1. Psychotherapeutic involves analyzing the patient’s entire life, finding out the causes of panic attacks. By presenting logically sound reasons and arguments, the doctor convinces that the experiences are unfounded, teaches methods of self-soothing, which helps reduce fear during an attack and thereby alleviate the person’s condition. In addition to individual conversations, methods of group psychotherapy and hypnotherapy can be used.

2. Psychopharmacological involves taking medications under the strict supervision of a doctor. At the same time, you should be patient, because treatment will take a long time, from 3 to 6 months. Depending on the severity of certain symptoms, antidepressants (amitriptyline, maprotiline, fevarin) may be prescribed; tranquilizers (diazepam, elenium); neuroleptics (aminazine, olanzapine).

Typically a combination of these two methods is used.

How to deal with seizures on your own. When a panic attack is approaching, you should:

1. Try to calm down, distract yourself, focus on something pleasant. Some wear a tight rubber band on their arm and, at the first sign of panic, they pull it back with force, the rubber slaps on the arm and severe pain is felt, which stops the development of symptoms. Another way to distract yourself is by counting, you need to start counting the surrounding objects (cars, houses).
2. Go out into the fresh air and try to normalize your breathing by taking a few slow, deep breaths. The “breathing into a paper bag” technique helps a lot, when you inhale and exhale into a paper bag pressed tightly to your lips. This allows you to avoid excessive ventilation of the lungs and thereby stop the attack.
3. Drink a glass of plain water or herbal sedatives (motherwort, valerian).
4. Relax your muscles and take a comfortable position.
5. A leisurely walk in the park helps many people.

Life without panic attacks: preventive measures. The main principle of preventing panic attacks is strengthening physical and mental health. First of all, a rational regime of work and rest is important. In order to avoid mental and nervous system disorders, each person is recommended to stay in the fresh air for at least 1-2 hours a day, preferably combined with physical activity(running, walking).

Night sleep should be at least 8 hours. It is better to avoid drinking alcohol, caffeinated drinks, and smoking. Everyday nutrition should be healthy, eat plenty of vegetables and fruits. You should also avoid stressful and traumatic situations and “collect” positive emotions

A feature of panic attacks is the following circumstance: attacks of fear appear suddenly, without any logical explanation. The factor that caused a person to become so frightened that he begins to lose control over his emotions and actions is almost impossible to determine, and this state can last up to several hours. The attack deprives the person himself of the ability to adequately respond to time, and while it lasts, for the patient this period turns into an eternity of staying in hell. Medicine does not provide a clear answer as to why panic attacks occur. It is almost impossible to stop or control the feeling of fear.

Types of sudden panic attacks

Experts classify sudden panic attacks based on the characteristics of the symptoms and the factors under which they manifest themselves, into the following types:

spontaneous attacks— the difference is the suddenness of manifestations. Despite the fact that neither the atmosphere in which a person is nor other factors absolutely cause a feeling of anxiety or overstrain, he may suddenly be overwhelmed by a feeling of panic;

situational- this group of attacks is more predictable and is a reaction to certain factors or conditions in which a person lives. Possible overstrain or emotional outburst can cause fear of heights, confined spaces and other similar situations that trigger at the level of a reflexive reaction of self-preservation. Over time, the pathology can progress, which, in turn, can provoke constant attacks of fear;

conditional attacks- the factor that provokes attacks is most often biological or chemical. It affects the body in the form of toxic poisoning. Symptoms may occur due to the use of drugs or other drugs that cause hallucinations, including alcohol.

Using alcohol as a treatment for uncontrollable seizures

Wrong lifestyle, frequent stressful situations may cause panic attacks. Any kind of distraction can be a way to help cope with attacks. There are many people who claim that alcohol is a form of sedative.

Experts assure that treating panic attacks with alcohol will lead to the fact that over time a person will simply develop addiction. The fact is that panic attacks and alcohol, which will be used as a means of calming, can provoke a reverse reaction. In other words, the lack of alcoholic beverages can cause an attack, and frequent attacks will lead to an increase in the dosage of alcoholic beverages.

Having experienced an attack of uncontrollable fear for the first time, a person is ready to agree to any conditions in order to save himself from repeating this. The bad thing is that for the most part, people are embarrassed by such attacks, and if they go to see a doctor, they do not always explain all the details to the specialist. The consequence of such omissions is incorrect diagnosis of diseases and treatment.

What are the symptoms of sudden panic attacks?

Experts distinguish two types of symptoms through which the disease is diagnosed: somatic and mental.

TO somatic symptoms relate:

discomfort in the stomach;
nausea;
sweating, fever or chills;
paresthesia (“pins and needles”);
frequent and uncontrolled urination;
suffocation;
lump in throat.

Psychiatric symptoms may include:

• fear of going crazy or dying during an attack;
• a condition that can lead to fainting.

How to stop a panic attack?

Most people associate the relief of a panic attack with the purchase and use of all kinds of means that can resist an attack. On the one hand, this decision is caused by self-care, but on the other hand, the lack of medications can provoke an attack of fear.

Drug therapy for stopping attacks is ineffective, since the effect of the drugs begins half an hour later, when the attack has already passed. Therefore, you will have to overcome the attack on your own.

The first thing to do is try to calm down. To do this, you need to learn to control your emotions by doing exercises for at least half an hour a day. Correct breathing, together with physical exercise, will help control your pulse rate and heartbeat.

Attention!

It is important at the very beginning of the attack to try to remember your favorite poems or song: this method often helps to cope with the fear of heights, fear of enclosed spaces and in other similar situations. Excellent prevention of sudden attacks - systematic reception contrast shower, which relieves tension and reduces stress.

Using various ways prevention, do not forget about healing effect recreation in the fresh air, where there are no provoking factors.

If you still hope for the effect of medications, you need to understand that their independent use is unacceptable, since any drug aimed at stopping a panic attack must be prescribed by specialists who themselves determine the treatment regimen and dosage. During the treatment process, specialists take into account the degree of effectiveness of the drugs, their compatibility with other drugs, the level of tolerability and the possibility of use for maintenance therapy.

Most drugs have a lot of side effects, therefore, the final word in the choice of medications should remain with a qualified specialist.

How to solve the problem of panic attacks using traditional methods?

Use of medications leads to addiction, and can also negatively affect the psyche, so you can try to cope with the problem yourself. In folk medicine there are several proven remedies that, in combination with other methods, help cope with uncontrollable seizures fear, if they are observed infrequently:

Chamomile flowers and tea rose fruits in quantities of 100 g. Each plant is mixed with lemon balm, St. John's wort and yarrow (50 grams each). Before pouring boiling water, add 20 grams. ordinary hop cones, valerian root and mint. The decoction is infused for 5 days and taken twice a day before meals, 20 minutes beforehand, slightly warmed up.

Dry oregano is poured with boiling water (400 ml), left for 15-20 minutes, decanted and, divided into three portions, drunk once a day shortly before meals.

Leaves of young birch (100 grams) are infused for up to three hours, pouring 0.5 liters of boiling water.

But before resorting to herbs, check to see if you have any health problems that would contraindicate them. Be healthy!