Indy psychiatrist discusses panic attacks
by Dr. Chris Bojrab
Robert, a patient whose real name I’m withholding for privacy’s sake, works as a geologist who specializes in fieldwork. Oil companies helicopter him to remote areas, where he spends up to two weeks backpacking, hiking, rock climbing and rappelling to take soil and core samples for survey work.
Most people would describe Robert’s line of work as adventuresome, even risky, but it doesn’t phase him. Yet, he experiences panic attacks — crippling anxiety that include chest pain, a racing pulse and shortness of breath — when he drives across an overpass.
About 5 percent of people — or one in 20 — will at some point in their life experience panic disorder, which is a member of the same family of anxiety disorders that includes generalized anxiety, obsessive-compulsive and post-traumatic stress disorders. Although women are disproportionately affected by panic disorder, men also suffer their share of panic attacks and the disorder often begins in adulthood. The average age of onset is 24.
Robert came to me when he was in his early 30s, at a loss for how to stop his panic attacks. He occasionally suffered the attacks at random. But they were mostly triggered by irrational thoughts he might drive off an overpass, even though he wasn’t suicidal.
It’s difficult to describe panic attacks — brief periods of intense fear or discomfort — to someone who doesn’t have panic disorder. But imagine the feeling of narrowly avoiding a car accident: those fleeting seconds where time stands still, your heart races, and the awful, hollow, heaviness in the pit of your stomach. Now multiply that many times, and factor in never knowing when it might happen again.
Because panic attack symptoms range from heart palpitations to chest pain, they’re frequently mistaken for a heart attack or stroke. People who suffer from panic disorder often land in the emergency room, undergo expensive medical testing, and visit multiple specialists before clinicians can zero in on the real problem.
Patients I see with panic disorder come from every walk of life. Sometimes the disorder starts in an understandable way, brought on by a life stressor such as divorce or a death in the family. At other times, as in Robert’s case, symptoms occur without any apparent trigger and the disorder can advance swiftly. In a matter of weeks, Robert went from never having panic attacks to experiencing frequent bouts of anxiety.
Thankfully, Robert responded very well to a relatively simple combination of medications, such as Zoloft, an antidepressant also used for anxiety, along with Xanax, another anxiety medication. Not everyone is as fortunate. Still, in many cases, panic disorder can be successfully treated, but it often takes trials of several medications or combinations of medications and talk therapy to control symptoms.
Although treatment is typically covered by insurance, out-of-pocket cost without insurance is around $255 for the first appointment and $238 for follow-up therapy (or around $100 without therapy).
I find it’s important to keep patients motivated and engaged throughout. Part of my job is to remind them we can control the symptoms and not to settle for just feeling better. Our goal is to make them feel well.
Highly rated Indianapolis psychiatrist Chris Bojrab is president of Indiana Health Group, a multidisciplinary behavioral health practice based in Carmel. He’s a past president of the Indiana Psychiatric Society and a Distinguished Fellow of the American Psychiatric Association.