Q: Dr Neuman What do you think is going on with me? I was diagnosed with panic disorder early this year and have sought therapy to help me deal with it. For a while the therapy seemed to be working – I dont avoid any places, I fly, I go to work, etc – but I have a panic attack almost every day! I wake up most mornings with a panic attack. I refuse to take medication because of fear of the side effects. I also have a health anxiety in that I think every ache or pain or palpitation or dizzy spell means a stroke or heart attack. I have had numerous ekgs and cat scans and all is well but I am still overly worried about my health. I am overweight. What do you advice.
– Many thanks Ann Q
A: There is a difference between an uncomplicated panic disorder and the panic attacks that accompany an underlying depression. (Do not get misled by the word “depression.” The sufferer does not have to feel sad. Someone who wakes up during the night panicky, and wakes up early every morning panicky, is really depressed and will respond to anti-depressant medication. The panic attacks that occur usually in a panic disorder are very short-lived and usually occur in phobic situations. Those due to a depression recur every morning and can last as much as an hour. The other symptoms such a patient usually has is a loss of appetite to the point of losing weight and feeling worse in the morning–also a lessening of sexual interest. This sort of picture almost always responds to anti-depressants.
The right attitude to have about a drug’s side-effects is that they may be a reason to stop taking a drug, they are not a reason not to try them. I’ve written a book about health anxiety, “Worried Sick?” which talks about these fears and other connected fears. Any irrational fear must be confronted in order for it to go away. Without drugs a depression can last as long as a year. It tends to recur.
– Dr. Neuman