When 27-year-old Ravi Kumar started experiencing chest pain and breathlessness one late evening, he thought he was having a heart attack. Needless to say, he rushed to the nearby hospital, where a slew of tests were conducted to understand what was wrong with his body. But all the test results were normal and he was soon sent home. But the same thing happened a few days later and he was again rushed to the emergency room, where he was evaluated by many doctors including a cardiologist and a neurologist. However, once again, all his body functions were found to be normal, including the functioning of his heart and lungs. That was when it was suggested to him to go see a psychiatrist.
“It was a panic attack that he suffered from,” says Dr B. Kapur, consultant psychiatrist, Vikram Hospital, Bengaluru. “Once we did a psychiatric evaluation, took his history and spoke to him, it was revealed that he had lost his uncle recently to a heart attack. The shock of his sudden death had triggered panic attacks. We counselled him and told him that it is not a life threatening condition. We started counselling and soon after started with medications. The treatment usually takes eight to 10 months. We also advise yoga and exercise routines. He is fully recovered and back to work now,” says Dr Kapur adding, “This is a typical presentation of panic disorder.”
Understanding the problem
A panic attack is a sudden feeling of intense fear that triggers many physical reactions. “It comes suddenly and is usually seen in young to middle-aged people. It is extreme or heightened anxiety,” explains Dr Kapur. “One may experience symptoms like shaking of limbs, dryness, trembling, giddiness, chest pain, and breathing difficulty. The patient feels like something really bad is happening. There is a fear of impending doom. They feel like they are going to die and rush to the hospital in extreme fear,” adds Dr Raghu Krishnamurthy, consultant psychiatrist, BGS Gleaneagles Global Hospital. Usually the symptoms will last a few seconds to a few minutes, sometimes extending beyond that. “Within half-an-hour to an hour, things completely settle. But the experience is quite distressing,” points out Dr Krishnamurthy.
People, who have had one panic attack, are at a greater risk for having subsequent panic attacks than those who have not suffered from a panic attack. “When one has three to four episodes of panic attacks, is it characterised as panic disorder,” states Dr Venkatesh, consultant psychiatrist, Fortis Hospital.
“Apart from palpitations and shortness of breath, one can also experience numbness, tingling sensations and loss of control. There is also a fear of the next episode of panic attack,” he says.
Studies over the years have indicated that mental health problems in India are increasing at an alarming rate. In fact, the National Mental Health Survey (NMHS) 2015-16 states that ‘India needs to talk about mental health. Every sixth person in the country needs mental health help.’ Dr Kapur believes that the increasing stress in life is leading to an increase in anxiety disorders.
“Earlier we hardly saw patients with panic disorders, but now just in my morning session, I see 5 to 6 such patients,” he says. “Chronic exposure to multiple stressors or acute stress can lead to a panic attack. Stress leads to biochemical changes in the brain causing the symptoms,” he explains.
“There is an increasing trend in mental disorders,” concurs Dr Venkatesh. He explains that when there is a mismatch between expectation and reality, there is anxiety. “And many don’t know how to deal with that. There is less bonding today, change in family structures. There can be many social conditions that can contribute to such problems,” he says.
The treatment for panic disorder includes therapy along with medications to treat anxiety. “We study anxiety behaviours of the person and develop strategies to combat that. We help them detect early anxiety symptoms and teach them how to deal with it. We help them identify the warning signs,” adds Dr Krishnamurthy. This can help reduce the incidence of full-blown attacks. “Yoga and exercise are also immensely helpful in dealing with the problem,” he says. “Treatment must go on for months,” adds Dr Kapur.
Preventing the problem
Since this disorder is often triggered by stressors, it can be prevented by a healthy lifestyle. “Following good food habits, exercise and pursuing positive activities can help prevent such disorders. Yoga is of tremendous help in prevention and treatment of panic disorder,” says Dr Kapur.
The main problem believes Dr Krishnamurthy is that no one takes care of their mind. “People need to know how to keep the mind in good condition. If you don’t do that the mind takes them for granted as well. The two important things one can do to keep the mind in good shape are — walk regularly and learn meditation and practice it for half-an-hour every day. This can help prevent anxieties and stress,” he summarises. It is also important, say doctors, to not ignore such attacks and seek help from a certified mental health professional.