About the treatment of panic attacks, panic disorder and panic disorder with agoraphobia

In the definition of panic attack, it can be said that our body is anatomically and physiologically healthy, but the functioning is stimulated in different ways by false alarms. In other words, the distress caused by unnecessary defensive training in the person is caused by anxiety, restlessness, uneasiness, worry, anxiety, fear, tension or automatic thoughts that are wrong in perception, no matter what you call it. These thoughts must be changed and the avoidance behaviors must be treated.

While antidepressants or psychotherapy can be applied alone in treatment, treatment protocols in which both are used are also very effective.
The most important thing in a panic attack is to distinguish the disease from other medical diseases. This is achieved by the examinations to be carried out under the supervision of a medical doctor and the initiation of appropriate treatment after the examination. Patients may usually come to an internist or surgical doctor beforehand, or they may ask the psychiatrist for the necessary examinations after the examination, either from the doctor or from the relevant branch. Then, if there is therapy-oriented training, he either does it himself or plans the treatment together with a specialist clinical psychologist. The psychiatrist can also take the patient’s anxiety away in the form of psychotherapy along with appropriate drug therapy. This is necessary for the motivation and healthy conduct of therapy in cases where the patient’s anxiety is at a very high level. If a psychologist has been consulted, it is absolutely necessary for the patient to take the treatment with a consultant psychiatrist for the safety of the patient. For example, conditions such as goiter disease, heart failure, heart rhythm disorders, asthma attacks, interactions or side effects of drugs used; Any medical illness may be missed because it will be confused with panic attack symptoms such as palpitations, tremors, shortness of breath, numbness, headache, chest pain. Apart from this, doctor support should be requested in cases where the therapy conditions that require drug treatment and the anxiety increase too much cannot be created.

Medication Use in Panic Attack

Antidepressants and some anxiolytic drugs are used as anxiety relievers in panic attacks. These drugs vary according to the patient’s age, gender, job status and, if any, used in combination with other drugs used for another disease.
Appropriate drug selection is increased from the initial dose to the treatment dose, resulting in minimal side effects. Anxiety causes weight gain in some patients and weight loss in others. These should also be taken into account when choosing drugs. If the job he is doing is a job that requires attention, this situation should be asked to the patient while choosing the drug. If there is alcohol-substance intake, pregnancy, breastfeeding, liver, kidney and cardiovascular diseases, appropriate drug selection should be made for this situation.

While antidepressants show their effects within an average of two weeks to a month, side effects are very rare after the first weeks. In drug therapy, it is necessary to use drugs for a sufficient time so that resistance to the disease does not develop. It is important not to discontinue the drug before the end of the treatment. It should be used for at least four months. Depending on the course of the disease, the drug may need to be used for several years, sometimes even for a lifetime. The drug is tapered and discontinued under the supervision of a doctor. Otherwise, drug withdrawal effects due to abrupt discontinuation may be observed. These are symptoms such as restlessness, dizziness, irritability, and the feeling that the disease is recurring. Sometimes the possible side effect of the drug may also worry the patient. In this case, he should definitely tell his doctor about the side effects he is experiencing. Side effects include headache, dizziness, nausea, constipation, palpitation, dry mouth, metallic taste in the mouth, blurred vision, sexual reluctance, weight gain.

While the side effects of sexual function are reluctance in women, difficulty in achieving orgasm, sexual reluctance in men, delayed ejaculation, and erectile dysfunction. These side effects mostly go away after the first weeks. If it continues, it can be switched to a drug that has no or minimal sexual function side effects.
If the anxiety is very serious, some green prescription drugs with anxiolytic (anxiety relief) properties can be used for a very short time. Later, when the antidepressant drug’s anti-anxiety properties begin to occur, it is appropriate to discontinue the other drug.

The biggest concern of patients and their relatives in drug treatment is the false belief that antidepressants are addictive. This delays the treatment of patients, causes progression of the disease and development of resistance to treatment. The drug can be stopped very easily, and it also has reducing effects on medical diseases related to the stress caused by anxiety in the body. It can be said that most stomach diseases, skin diseases, cardiovascular diseases are affected by stressor factors. In this case, the importance of treatment becomes more important.

Cognitive Behavioral Therapy in Panic Attacks

In this treatment, the patient is given extensive information about how the disease occurs. Then, in order to reduce anxiety, breathing exercises and positive thoughts that create anxiety are replaced by positive thoughts, and behavioral action plans and the combat part of the fight or fight principle, namely confronting and extinguishing the event, and desensitization treatment are applied. Many techniques can be applied as psychotherapy. These are very effective in minimizing anxiety and preventing recurrence according to the patient’s compliance.

Psychiatrist Dr. Dr. Zenzibar Ozarslan

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