Panic disorder is a highly disabling condition, which can affect nearly any age group – excluding very young children. Worldwide studies reveal that between 1.5 per cent and 3.5 per cent of people will experience panic disorder at some point in their lives1. Panic patients often suffer from a number of medically unexplained symptoms and, as a result, tend to make excessive use of medical services. There is also evidence that panic sufferers are at an increased risk of death from brain or heart-related disorders.
Unfortunately, for a large majority of panic sufferers this is not where the trauma ends. Panic disorder often occurs in conjunction with one or more other psychiatric illnesses – most commonly depression, but also social phobia, generalised anxiety disorder and agoraphobia. This concurrence of conditions – known as “comorbidity” in medical terms – makes it especially difficult for the sufferer to deal with panic, and also affects the ability of mental health processionals to make a clear diagnosis early on.
Panic disorder has a very high incidence of occurring in conjunction with major depression. Up to 65% of individuals with panic disorder also experience a major depressive episode sometime during their illness2. A significant number of panic sufferers also experience recurrent brief depression and dysthymia (low-grade depression).
Compared to patients that have been diagnosed with either “pure” panic disorder or depression, patients with panic disorder and depression display greater functional impairment, more severe symptoms and increased anxiety and somatic complaints. They also have an increased risk of suicidal behaviour and are more likely to receive a variety of different drug treatments.
It is common to find phobia-related anxiety disorders, such as social phobia and agoraphobia, occurring with panic disorder. Between 35% and 50% of individuals with panic disorder in community settings also have agoraphobia3.
There are a number of theories as to how dual diagnosis disorders – such as depression and anxiety – develop in a patient. Klein and Wittchen have proposed a comprehensive theory that is widely cited: biological or cognitive vulnerabilities can worsen the problem presented by the development of these disorders. Current life stress and situational risk factors also play a part. Klein and Wittchen make use of a stage model to explain the possible concurrence of panic disorder, agoraphobia, depression and substance abuse.
In the first phase, the patient experiences spontaneous panic attacks. This leads to the second phase in which the patient becomes sensitised, both biologically and cognitively, to these panic sensations. If the panic attacks do not dissipate over time, the patient in question develops full-blown panic disorder, which is the third phase. Untreated panic disorder often leads to phase four, where the patient displays avoidance behaviour through avoiding all objects or places that are associated with his or her panic attacks. Severe avoidance may lead to agoraphobia, a condition in which the patient is afraid to leave the safety of his/her house. The demoralisation and shame that accompanies debilitating anxiety disorders can finally lead to phase five – the development of major depression. Some desperate sufferers also progress to a sixth phase, where drug-abuse is common as a futile attempt at self-medication.
The good news is that antidepressants, such as SSRIs – Selective Serotonin Reuptake Inhibitors – and tricyclics, are very effective for dual-diagnosis disorders such as depression and anxiety. Various therapeutic techniques, such as cognitive behavioural therapy and support group work, can also make a significant difference and result in successful recovery.
It is important for both patients and mental health professionals to be aware of the possible concurrence of panic with depression and other disorders. Greater recognition of this fact will allow for a correct diagnosis and the choice of an optimum treatment programme.
Many ex-sufferers who have overcome both panic and depression at the same time have inspiring success stories to share. “At one stage I thought I would never beat the awful anxiety and depression that hung over me,” says one such ex-sufferer, Patricia. “But, with the correct treatment and the right attitude, I have overcome my fears. If I can do it, so can others.” The Depression and Anxiety Support Group offers counselling and information, and can be contacted Monday-Friday between 8am and 8pm on (011) 783-1474/6 or 884-1797.
1, 2, 3: Baldwin, D.S. Depression and Panic: Comorbidity. Eur Psychiatry 1998; 13 (Suppl 2); 65s – 70s.