Wednesday, June 23, 2004

'I Thought I was Losing my Mind'

John, a 44-year-old broker, thought he was having a nervous breakdown. While riding in his office elevator, he became so lightheaded he thought he might faint. It seemed as if the world was spinning. He thought his legs might buckle.

But then, just as suddenly as they arrived, the feelings passed.

Two days later, the symptoms returned, and soon John was having dizzy spells several times a day. There was no pattern to them. They happened on the subway, while he was brushing his teeth, even during a relaxing dinner with friends.

John went to his internist, who thought he might have vertigo, a condition usually caused by an inner-ear infection. But the exam showed no evidence of a problem, and John passed the doctor's balance tests. Unable to pinpoint a specific cause, John's doctor referred him to a neurologist. John made an appointment, terrified that his upcoming CAT scan would reveal a brain tumor.

When the test uncovered no discernible neurological abnormalities, John reasoned that if his doctors couldn't find a physiological reason for his symptoms, something psychological must be wrong. Maybe he really was losing his mind.

At Behavioral Associates, a psychology clinic on the upper East Side, John met Dr. Robert Reiner, the executive director, who is also a psychology professor at NYU Medical Center. Reiner told John he wasn't going nuts - he was having panic attacks. And the problem could probably be eliminated simply by changing his breathing.

Though anxiety can spawn panic attacks, it's not always the cause. In fact, there is no recognized biologic or genetic trigger. Sufferers can even have attacks while sleeping, with such symptoms as rapid heartbeat, dizziness, trembling, a feeling of choking and hot flashes.


The American Psychological Association defines a panic attack as "a sudden surge of overwhelming fear that comes without warning and without any obvious reason."

Doctors are beginning to understand, however, that breathing patterns may be a trigger. Shallow "chest" breathing, explains Reiner, causes an increase in blood levels of oxygen and a decrease in carbon dioxide - followed by dizziness. (One solution is to breathe into a paper bag, thus drawing in more carbon dioxide.)

"In this situation, you start to hyperventilate, which leads to panic," says Reiner. "It's a problem that snowballs and runs both ways: Hyperventilation causes the initial panic, but once it's happened, the fear of experiencing the symptoms again can trigger them."

While there are a variety of treatments for panic attacks, including anti-anxiety medication and traditional behavioral therapy, Reiner has found that just teaching patients how to breathe deeply can often blunt the attacks.

While John was skeptical, he was willing to give it a try. Reiner hooked him up to an EEG machine, which transmitted his breathing pattern onto a graph on a television screen. With the doctor's guidance, John learned how to watch his breathing pattern on the screen and take deep breaths from his belly.

This, explains Reiner, prevents the oxygen buildup in the blood and ultimately makes panicking a physical impossibility. He advised John to practice deep-breathing once daily for a half-hour, ideally getting his breathing down to 10 deep, slow breaths a minute. With practice, the belly-breathing became second nature, and John's dizzy spells virtually disappeared.

Panic disorder, nevertheless, can require further treatment. Because the anticipation of an attack can bring one on, patients often need behavioral therapy to learn how to stop the anxious thought processes that trigger attacks.


Medications, particularly Xanax, can also be helpful, though Reiner advises caution. "Internists aren't trained to spot panic disorder," he says, "yet some doctors just throw anti-anxiety medications at their patients without any follow-up, despite the fact that some of the meds often make the problem worse."

For instance, some anti-anxiety medications, including Paxil and Zoloft, take up to six weeks before they start to work. The drugs can cause jitters, which often triggers an increase in panic attacks.

The bottom line, says the APA, is that most patients are greatly helped just by understanding what panic disorder is - and by realizing they're not going crazy.