R. Murali Krishna, M.D. President

Imagine you're sleeping peacefully through the night when suddenly you are awakened by a loud crash. Is it the kitchen window being broken? A door being forced open? You lie quietly, frozen with fear. Your heart is beating wildly, completely out of control. Your limbs are trembling, and you have trouble drawing in a complete breath. You hear another noise, this time like footsteps coming toward your room. You begin to sweat, your stomach hurts and your chest tightens. You feel like you may pass out. You wonder if you are about to die. What you are feeling is panic: intense terror, a powerful, gripping fear of being threatened, trapped or out of control.

Now, imagine experiencing these same feelings while simply walking through a mall, standing in a grocery store line or driving your car. And imagine experiencing them several times a month, never knowing when they will come again. That experience is known as a panic attack, and it's an experience shared by about
21 million Americans. It's also one of the most frightening, terrifying things a person can experience.

Panic attacks occur in women about twice as often as they do in men. They can appear at any age, but most often begin in young adults. So terrifying are panic attacks that when people first experience one, they often believe it is a heart attack. That's why about 17 percent of emergency room patients with chest pain are determined to have a panic disorder, and why panic attacks are among the most common reasons for visits to a cardiologist. Oftentimes, it doesn't stop at a cardiologist. Panic patients usually see anywhere from six to eight doctors before the true cause of their condition is discovered and treated.

For people who experience them, panic attacks often seem to come roaring out of the blue. In the last decade, though, researchers have begun to understand the underlying cause of episodes.

Panic disorders have clear genetic, biological and psychosocial components that interact to cause the condition. Fifteen to 20 percent of immediate family members of panic disorders patients also have the condition, a fact which confirms the genetic component. Studies on the brains of people with panic disorders show they overproduce stimulating chemicals and underproduce pacifying chemicals. In addition, it's been discovered that blood flow characteristics in the right side of the brain in people with panic disorders is different than that of people who do not have panic disorders.

Attacks usually last 20 to 30 minutes, leaving sufferers exhausted and wondering if they are going crazy. Many people who experience panic attacks develop "anticipatory anxiety," a fear of when the next attack will occur and a preoccupation with how to avoid it. Because they are fearful of having another attack, people with panic disorders sometimes start avoiding situations in which they believe they can't get help, can't find a way to escape or have no control. This avoidance can lead to a phobia.

Depression is also a concern, since 75 percent of those who experience panic attacks also experience at one time or another symptoms of depression such as sleep disturbances, loss of energy and loss of pleasure in life. It's been estimated that one in five people suffering from panic attacks has attempted suicide.

Because medical science has made progress in determining the cause of the condition, progress has also been made in treating it. Studies have shown that proper treatment - a type of therapy called cognitive-behavioral therapy, medication or a combination of the two - helps 70 to 90 percent of people with panic disorder. Significant improvement is usually seen within six to eight weeks.

Cognitive-behavioral therapy teaches patients how to view panic episodes differently and demonstrates techniques to reduce anxiety, relax or refocus attention. Medications for the disorder fall into four classes that act in different ways to block or reduce symptoms. Different patients respond better to different classes of drugs.

It used to be thought that people with panic disorders could wish away their symptoms, that they could overcome them with sheer willpower. That's not true. What is true is that most people with panic disorder can undergo treatment that is both effective and well-tolerated, and that such treatment can help return their lives to normal.

R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has maintained a private psychiatry practice for more than 25 years and is a clinical professor of psychiatry at University of Oklahoma Health Sciences Center.