When you have panic disorder, the panic attacks are unexpected and come out of nowhere. You can be sitting in your chair, resting in your bed, or walking, when suddenly and unprovoked, a panic attack takes hold. There are no apparent triggers- you just have an unexpected panic attack.
These unexpected panic attacks then lead to anticipatory anxiety about having the next panic attack. The worry about having another panic attack can be so debilitating that it takes hold of you so that you can’t do anything else. Soon, you start avoiding places or situations due to the fear that you may have a panic attack there or that no help may be available. And this anticipatory anxiety about having another panic attack seems to make future panic attacks worse!
So this all starts with the unexpected panic attacks. The unprovoked panic attacks are caused by malfunctioning in the fear circuit based on the amygdala. The fear circuit malfunctions on an intermittent, unexpected, and catastrophic manner, leading to the panic attacks. Exacerbating this malfunction is the ongoing activation of the worry circuit located on the CSTC (cortico-striatal-thalamic-cortical) circuit. So the intermittent and catastrophic malfunctioning of the fear circuit leading to unexpected panic attacks is exacerbated and perpetuated by the malfunctioning in the worry circuit, where you are having anticipatory anxiety about when the next panic attack will occur. So it seems that worrying about the next panic attack only serves to kindle future panic attacks.
Thus, knowing the neurobiology of panic attacks can help to optimize the treatment for it. The intermittent and catastrophic malfunctioning of the fear circuit requires medications to help quell the severe panic attacks. After the panic attacks are successfully treated with medications, then the work continues with the anticipatory anxiety and the avoidant behaviors which contribute to the overactive fear circuit. So besides medications, the second part of treatment involves thinking more adaptive thoughts, and not engaging in avoidant behaviors.
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I have been on Zoloft 200mg in the morning and 300mg Trazadone at night. I have been on medication for 25 years.
Recently I started exercising (I’m 66), walking briskly up hill for 15-20 minutes and downhill for the return trip. It has been very hot and humid lately. I added some arm exercises on the downhill trip and 3 days ago my bronchial tubes started aching and still are. I also tend to wheeze gently, not too bad, after exercise or in the humid summers and cold winters.
I find I am getting panic attacks again but it may be the asthma!
Whenever I focus on breathing, I tend to get hyperventilated. Hard to tell what is doing what!
I have a new inhaler but its the weekend and I don’t want to try it until Monday in case there’s an adverse reaction!
Is there a new medication available that would help me?
There are no anxiety specialists anywhere near me! Thank You!
Dear Lynne, first off, you may indeed be suffering from an asthma attack. Please click here to find out more about how to differentiate a panic attack from an asthma attack.