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WHEN PANIC RECURS

Panic disorder is often a chronic, relapsing illness. For many people, it gets better at some times and worse at others. If a person gets treatment, and appears to have largely overcome the problem, it can still worsen later for no apparent reason. These recurrences should not cause a person to despair or consider himself or herself a "treatment failure." Recurrences can be treated effectively, just like an initial episode.

In fact, the skills that a person learns in dealing with the initial episode can be helpful in coping with any setbacks. Many people who have overcome panic disorder once or a few times find that, although they still have an occasional panic attack, they are now much better able to deal with the problem. Even though it is not fully cured, it no longer dominates their lives, or the lives of those around them.

COEXISTING CONDITIONS

At the NIH conference on panic disorder, the panel recommended that patients be carefully evaluated for other conditions that may be present along with panic disorder. These may influence the choice of treatment, the panel noted. Among the conditions that are frequently found to coexist with panic disorder are:

Simple Phobias

People with panic disorder often develop irrational fears of specific events or situations that they associate with the possibility of having a panic attack. Fear of heights and fear of crossing bridges are examples of specific phobias. Generally, these fears can be resolved through repeated exposure to the dreaded situations, while practicing specific cognitive-behavioral techniques to become less sensitive to them.

Social Phobia

This is a persistent dread of situations in which the person is exposed to possible scrutiny by others and fears acting in a way that will be embarrassing or humiliating. Social phobia can be treated effectively with cognitive-behavioral therapy or medications, or both.

Depression

About half of panic disorder patients will have an episode of clinical depression sometime during their lives. Major depression is marked by persistent sadness or feelings of emptiness, a sense of hopelessness, and other symptoms.

When major depression occurs, it can be treated effectively with one of several antidepressant drugs, or, depending on its severity, by cognitive-behavioral therapies.

Symptoms of Depression

• Persistent sadness or feelings of emptiness
• A sense of hopelessness
• Feelings of guilt
• Problems sleeping
• Loss of interest or pleasure in ordinary activities
• Fatigue or decreased energy
• Difficulty concentrating, remembering, and making decisions

Obsessive-Compulsive Disorder (OCD)

In OCD, a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. Such rituals as counting, prolonged handwashing, and repeatedly checking for danger may occupy much of the person's time and interfere with other activities. Today, OCD can be treated effectively with medications or cognitive-behavioral therapies.

Alcohol Abuse

About 30 percent of people with panic disorder abuse alcohol. A person who has alcoholism in addition to panic disorder needs specialized care for the alcoholism along with treatment for the panic disorder. Often the alcoholism will be treated first.

Drug Abuse

As in the case of alcoholism, drug abuse is more common in people with panic disorder than in the population at large. In fact, about 17 percent of people with panic disorder abuse drugs. The drug problems often need to be addressed prior to treatment for panic disorder.

Suicidal Tendencies

Recent studies in the general population have suggested that suicide attempts are more common among people who have panic attacks than among those who do not have a mental disorder. Also, it appears that people who have both panic disorder and depression are at elevated risk for suicide. (However, anxiety disorder experts who have treated many patients emphasize that it is extremely unlikely that anyone would attempt to harm himself or herself during a panic attack.)

Anyone who is considering suicide needs immediate attention from a mental health professional or from a school counselor, physician, or member of the clergy. With appropriate help and treatment, it is possible to overcome suicidal tendencies.

There are also certain physical conditions that are often associated with panic disorder:

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