When Each Day Begins with “What if…” By Dr. Sachin Baliga

What is panic disorder?

A panic attack is an acute episode of intense fear that triggers physical reactions when there is no real threat or apparent cause. If one has recurrent, unexpected panic attacks and spends a lot of time in constant fear of another imminent attack, it is called as panic disorder. Many also experience what is called as agoraphobia — avoidance of places or situations that cause anxiety because of the fear of being unable to escape or get help if they have a panic attack.

Understanding its symptoms: a case example

Sandesh lost his friend Jay to a heart attack. It happened while they were playing tennis at their society’s clubhouse. By the time Jay was taken to the hospital, the doctors declared that it was too late. Everything happened so quickly that it all felt like a hazy dream each time Sandesh thought of it. He couldn’t believe how a man as fit as Jay could’ve met his end like this.

Two weeks later, Sandesh woke up suddenly in the middle of the night drenched in sweat. The immediate next thought that popped into his mind was: “Hadn’t Jay’s heart attack started this way? What if I am getting a heart attack as well?” The thought of imminent death and its consequences on himself and his family brought a surge of anxiety. Sandesh began to experience restlessness, palpitations and an intolerable heaviness in his chest, as though someone had dropped a cement block on it. He started hyperventilating, his body shivering as a strange sensation of pins and needles washed all over him. His mouth felt as dry as the Saharan desert. He somehow managed to scream and wake his wife up. In the next few minutes, he was rushed to a nearby hospital with the help of the neighbours. The ER team quickly checked his ECG and found nothing odd, apart from an increased heart rate. They sent his blood sample for his cardiac enzyme levels to rule out a heart attack, which were normal as well. By then, Sandesh had calmed down considerably. He was given some IV fluids and medications for gastritis and discharged. He underwent a 2D echocardiogram the next day, which was also clear.

A few days later, he experienced a vague sense of heaviness while stuck in traffic on his way back from work. The immediate thought was: “What if it IS a heart attack this time? Who will help me reach a hospital while I am stuck in traffic? What will happen to my family?” and the same spiral began. He somehow parked his vehicle by the side of the road till it had passed and then rushed to the hospital. And so, in the next few weeks, Sandesh had already experienced the same episodes dozens of times: while having a bath, while driving, while jogging, and even in the middle of a meeting at his office. Further visits to cardiologists (each doctor more senior than the previous) always showed everything normal. It brought some relief, but the attacks happened anyway, and with it the fear of dying. As a result, he stopped exercising. He would only drive with his wife sitting beside. He would hastily come out of the meetings the moment the uneasiness began. He wouldn’t dare lock the bathroom door while having bath: he had to be sure his wife could reach him just in case, he had a heart attack. Each day was probably the day he would meet his end like Jay. And thus, despite not really dying at the end of each day, Sandesh was dying every day in his mind.

Getting over the fear

While panic attacks aren’t actually life-threatening, they are extremely frightening and can significantly affect one’s quality of life. Unfortunately, what tends to prolong the disorder are three kinds of behaviours that individuals generally adopt: avoidance (not exercising), escape (stepping out of the meeting) and safety behaviours (not travelling unless his wife is with him). It is only when you repeatedly face your fears that you realise there is nothing that is actually going to happen. Fortunately, with a combination of medications and therapy, this can be achieved quite effectively.