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Patrick*, a junior manager at a successful company, always used to catch taxis to work without a second thought. Then, one fateful day he was involved in a traumatic accident in a taxi and was taken to hospital with a fractured leg. Lying in the hospital bed on the night of the accident, he suddenly experienced a choking feeling accompanied by hot and cold flushes, sweating and numbness. Although the sensation only lasted for less than 10 minutes, Patrick was convinced he was dying and had to stifle the need to scream for help. He left the hospital without receiving any treatment for shock or panic, but continued to have these strange sensations regularly. They were particularly bad when he saw taxis. He knew something was wrong but was too embarrassed and scared to talk to anyone about it.

Patrick’s story contains the classic tell-tale signs of someone suffering from Panic Disorder. This anxiety disorder is still far more common than is generally believed. One in seventy three people will have panic disorder during some stage of their life. For women, the average age of onset is during the early twenties whilst for men it is in their forties. Up until 20 years ago, this particular anxiety disorder was relatively unknown. Thankfully, current research and education has increased awareness of this devastating condition somewhat.

Panic attacks are periodic, discrete bouts of panic that occur abruptly and reach a peak within 10 minutes. Such attacks are characterised by at least 4 symptoms of panic, the most common of which are palpitations, tingling in the hands or feet, shortness of breath, sweating, hot and cold flushes, trembling, chest pains, choking sensations, faintness, dizziness, and a feeling of unreality.

Because of these compounded symptoms, many people experiencing a panic attack fear that they will die, go crazy or lose control. When panic attacks occur at a frequency of four in a four-week period or when a single attack is followed by 4 weeks of the anticipatory anxiety of having another attack, the diagnosis becomes one of full-blown panic disorder.

Panic attacks on their own are in fact physically harmless. However, the psychological impact that they have can be very destructive. At the very least, most panic disorder sufferers find that their quality of life is severely impaired, with their work and social lives considerably affected. Patients who associate these attacks with the situations in which they occurred may develop avoidance behaviour in an attempt to prevent further attacks. This is what happened to Sebo, a dental nurse in Krugersdorp, who experienced her first panic attack in her car on the way to work. From then on, whenever she drove in her car she started to fear that something would go wrong. Her car journeys became a nightmare and she would arrive at work anxiety stricken and tense. Eventually she stopped driving altogether. In many cases such phobic avoidance can lead to full-blown agoraphobia and sufferers becoming house-bound.

A further complication is that a large percentage of panic disorder sufferers self-medicate with drugs and alcohol in a futile attempt to control the anxiety or panic. Depression and suicide may also occur in anxiety sufferers. If diagnosed correctly, Panic Disorder is a highly treatable condition. With the right combination of therapy, 90% of sufferers recover fully and the remaining 10% experience significant recovery. Treatments for panic disorder include medication, psychotherapy and self-help methods.

Medication can be very effective at relieving anxiety symptoms. Antidepressant medication is commonly used to treat panic. This type of medication works by restoring the underlying chemical imbalance in the brain. The newest antidepressant drugs available are SSRIs (Serotonin Reuptake Inhibitors). These drugs are convenient, safe in overdose and associated with few side effects. Two which are registered in South Africa for treatment of panic are Zoloft and Aropax. Patrick found that Zoloft worked for his panic. He has been taking if for six years now, and has found that it has mad a big difference in his life. Today there are more medications available in this field than ever before, so if one drug is not successful there are usually others to try.

There area variety of therapeutic modes that can help with anxiety management including humanistic, existential, psycho-dynamic and cognitive-behavioural methods. Studies have shown cognitive behavioural therapy to be particularly effective in panic disorder. This type of therapy teaches patients to react differently to the situation and bodily sensations that trigger panic attacks and other anxiety symptoms. Patients learn to understand how their thinking patterns contribute to their symptoms and to change their thoughts so that their symptoms are less likely to occur. Patients also learn how to master relaxation techniques, such as visualisation, meditation and deep breathing.

The challenge in South Africa remains to increase education and awareness of panic disorder. “People do not know enough about Panic Disorder, and they are scared to go to psychiatrists or doctors,” says Sebo. “Had I not found out about this disorder, I would have thought I was bewitched.” Sebo became aware of her disorder when she saw a programme on panic disorder, phobias and depression on the television. The programme was initiated by the South African Depression and Anxiety Support Group. Sebo contacted the Support Group and was given informative counselling and literature. A phobic aid was also assigned to her. Within a few weeks Sebo understood her disorder and, with the help of her phobic aide, was working on overcoming her phobia of driving. For Sebo, contacting the Support Group was the single most important factor in her recovery: “I feel that without the group I wouldn’t have survived.” The Support Group fills an important gap in South African Mental Health by focusing on awareness campaigns and self-help techniques for sufferers. They can be contacted on (011) 783-1474/6 or 884-1797.

Both Patrick and Sebo have learnt how to control their panic. Patrick runs a support group for fellow panic sufferers in Sibyabuswa and finds it rewarding to help others. Sebo has recovered substantially and is positive about her future: “I am much better than I used to be. I have gained confidence in myself and am learning how to cope. I won’t let panic get the better of me.”

* Names have been changed to protect identity