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Suggest Treatment For Panic Attack

Posted on Sat, 22 Mar 2014

Question: Dear Dr XXXXXXX It's good to be in touch with you again. Since my last talk with you, things seem to have become worse. The "attacks" are still episodic, and consist of Severe vertigo, ataxia, aphasia, memory loss (temporary), and confusion. All of it comes with no warning, so I am not allowed to drive. My son is looking after me, and I have yet to see an Immunologist, a Neurosurgeon, and an Endocrinologist. There seems to be a consensus of opinion that it could possibly be Cerebral Vasculitis, but there will be a lot of tests ahead for me. There are now 6 doctors looking into this. The 3 I have already seen are my GP, a Psychiatrist and a Neurologist. I would like you to add your opinion, and will provide any information you may need. XXXX

Answered by Dr. Srikanth Reddy (1 hour later)

Brief Answer: Panic Disorder Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. The condition that you are having might basically be a panic attack. It may have confusion, anxiety, vertigo, memory disturbances, aphasia which appears paroxysm XXXXXXX and then disappears on its own. This is a disorder of anxiety and occurs cause of imbalance of certain neurotransmitters in the brain. especially serotonin, nor adrenaline, and dopamine to some extent. Medicines are the best options to take care of these symptoms. Paroxetine is the the most popular medicine and my drug of choice. I generally prescribe my patients 12.5 mg per day at night which takes care of anxiety symptoms. Also certain medicines like propranolol and clonazepam can be give as required when there is a panic episode or expected situation where panic attack can appear. The other possibility is complex partial seizure. The complex partial seizures may mimic a panic attack and even this lasts for a short period to vanish. This can be diagnosed by an EEG and it will show abnormal bursts of electrical activity in the brain. Carbamazepine are the drugs of choice for this illness. You have shown your sysmptoms to a neurologist and a psychiatrist and probably you are on the right path. Just keep persisting with the treatment and probably you would be fine soon. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (4 hours later)

Dear Dr XXXXXXX I am quite ready to believe that my problem could be a Mental Health issue, but my Psychiatrist does not think so. I had severe encephalitis last May, have no memory of the first 3 days, and found out about 2 weeks later that I had almost died the first night. My neurologist feels that there is a connection between the two bouts of illness, and I was slowly recovering from the encephalitis ..... very slowly. I needed to use a walking frame for several months. The onset this time was again very sudden and again I was in hospital, but only for 2 days. That was in mid-December last year. This time the symptoms were somewhat different, and even now I remain unaware of any of them except the Vertigo. My memory is very unreliable and I don't notice that I appear very confused. To me, it feels as if the vertigo is the only problem. I find it difficult to make someone else understand me and I feel quite annoyed when I am not understood. I was again booked on a holiday in Europe, but have been strongly advised not to go overseas, especially alone. I am very disappointed, but can see the sense in that. Only twice before have I experienced a Panic Attack, and both times I felt an overwhelming undifferentiated terror, which lasted bout half an hour. The time-frame in this latest set of symptoms is quite different, and can last up to 2 days. The main emotion I feel is anger, not fear, and the disappointment of losing my holiday. All the doctors I have seen so far are adamant that I can't go alone, which makes me feel vary annoyed ..... until the symptoms hit again I have had an EEG, but there are no signs of epilepsy. The MRI showed a calcified Meningoma, and apparently signs of many very small TIA's. BP is normal though I was checked for Postural Hypotension .... negative. If it is all to do with Mental Health issues, it would be a relief, as I could adjust my lifestyle accordingly, but many questions remain. Thank you for your opinion, XXXX

Answered by Dr. Srikanth Reddy (44 minutes later)

Brief Answer: Could still be a anxiety disorder Detailed Answer: Hello Thanks for the detailed information. I understand that your symptoms do not fit into a classic panic episode but still it can be a type of anxiety disorder. It being episodic even if 2 days rules out quite a many organic conditions. You may be given a trial of anti anxiety treatment and looked if the symptoms improve. If they improve then you will spared of lot many costly investigations that you are planning to proceed on. Regards Dr. Srikanth Reddy Md

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (20 hours later)

Dr. XXXXXXX Thanks for your answer. I have been on Efexor for about 2 years, and as you would know it is also an SSRI. I also take Seroquel 200mg, 2 nocte. Should this not make a difference? Since you are a Psychiatrist, I can tell you of my other problem .... Dissociative Identity Disorder. I have known about it since I was 36 years old, though it started in my very early childhood. There are 63 of us, both genders and all ages. Each is the result of a severe trauma. There are so many of us because I didn't learn from experience, always another was created to deal with each new traumatic situation. We are well on the way to resolving all this, though it is not easy. There is quite a lot of fear amongst us at present, and control is rapidly handed back to me if the symptoms start. I cope with it better than any of the others. How do you think this fits in with Panic Disorder? Thanks,XXXX

Answered by Dr. Srikanth Reddy (7 hours later)

Brief Answer: Brief psychodynamic Psychotherapy Detailed Answer: Hello Thanks for the follow-up information. Yes you are right that effexor has two components, first is an ssri and the second one is norepinephrine acting component. But clinically its doesnt act that clearly and I have personally seen many patients who have had not much improvement on effexor but then still showed improvement on an SSRI. Well your dissociative identity disorder is a new revelation and its unfortunate that it has been this complicated that that there are 63 different personalities. Its not commonly heard. This complicated identity disorder will require brief dynamic psychotherapy or hypnotherapy. Believe me, go ahead with a course of paroxetine for a few weeks. if its effective, it will save you from lot many costly investigations. Regards Dr. Srikanth Reddy

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar