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What medicines should one suffering from OCD and panic attacks take to avoid attacks during traveling ?

Hello doctor. Am 22 years old, female girl . I have OCD and sometimes have panic attacks. I am not following any kind of treatment. But what is worrying me is that I am coming to Mumbai next week and I fear that I may get phobia and panic attacks on the planes. Please, can you suggest any kind of medecine or herbal medecine that I can take during the flight? Please help me. Am really worried to go in the flight.
Asked On : Thu, 9 Feb 2012
Answers:  4 Views:  124
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Psychiatrist 's  Response
Thanks for your query. Both OCD and panic attacks are anxiety disorders. You might be by now aware of some premonitory symptoms of panic disorder like an unpleasant sensation, giddiness and generalised apprehension. The methods to abort panic attack would be benzodiazepines like clonazepam 0.5 mg which would provide temporary relief.
Hope you on long term SSRI medication as well for your anxiety disorder. Breathing relaxation exercises during the flight would also be beneficial. Wish you good health.
Dr Sundar
Answered: Sat, 30 Mar 2013
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Psychiatrist Dr. Satyajeet Kumar Singh's  Response

A 22 year old female with OCD and panic. But I am afraid, the symptoms you have mentioned above is more suggestive of agoraphobia. It is very common co morbidity with OCD. Agoraphobic fear often leads Panic attacks. Common fear in agoraphobia include either alone or in combination "fear of close spaces, fear of crowded spaces, fear of height, fear of unknown or unfamiliar, fear of situation or places from which escape might be difficult".

As you have mentioned you have to travel in the incoming week in a aircraft (a closed space) with so many people (unfamiliar faces) travelling together (crowded Place) in air (height). This represents your pre-anxiety (if something wrong happens escape might be difficult) due to your inner psychological fear of close space, height and crowded place with unfamiliar peoples.

What intervention you need is both short term measures for immediate symptomatic relief & long term measures to have long lasting impact on your psychological fear.

Short term intervention include use of anxiolytics like clonazepam 0.5 mg at least twice daily initially, later you have to taper this drug gradually. You also need to use propranolol 10 mg thrice daily to prevent palpitation, nervousness & other features of panic attack. Use one extra dose of above medication (Clonazepam .5mg & Propranolol 10mg) half an hour before travel.

Long term intervention include behavioural therapy in the form of yoga, exercises, progressive muscular relaxation, breathing exercises, systematic desensitization (either imaginal or in vivo), flooding etc. In imaginal systematic desensitization, you have to imagine all those panicogenic situation in your mind in graded manner from least distressing first to most troublesome situation at last. This is very simple (Imagination of panicogenic situation in mind as they occurs in reality with the aim to habituate yourself). It cost nothing as no manpower needed. You just need is to learn the right technique & to practice it properly. One week of your air travel is enough time to bring some symptomatic improvement.
Thank you.. (Please do rate my reply with your wisdom)
Answered: Fri, 10 Feb 2012
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Pediatrician Dr. Jasbir S Chugh's  Response
Dear lovely
“Panic attacks” is a psychiatric illness. Before you can be labeled with this diagnosis you should have a thorough medical examination and an EEG. Once diagnosed, the problem generally does not need any medication.
Yoga, aerobic exercises and relaxation techniques can help alleviate the symptoms and reduce the frequency.
Self help During an attack:
•     If a person has been diagnosed with panic attacks in the past and is familiar with the signs and symptoms, the following techniques may help the person stop the attack. You may also try these tips for overcoming the symptoms of a panic attack.
o     First, relax your shoulders and become conscious of any tension that you may be feeling in your muscles.
o     Then, with gentle reassurance, progressively tense and relax all the large muscle groups. Tighten your left leg while taking a deep breath in, for example, hold it, then release the leg muscles and the breath. Move on to the other leg. Move up the body, one muscle group at a time.
o     Slow down your breathing. This may best be done by blowing out every breath through pursed lips as if blowing out a candle. Also, place your hands on your stomach to feel the rapidity of your breathing. This may allow you to further control your symptoms.
o     Tell yourself that you are not "going crazy." If you are concerned about not being able to breathe, remember that if you are able to talk, you are able to breathe.
Medicines: However some medications like anti-depressants or tranquilizers may be needed and can be prescribed by a psychiatrist if the attacks are too frequent and severe.
Best of luck
Answered: Thu, 9 Feb 2012
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Psychiatrist Dr. Amar A Rathi's  Response
Hi Lovely ,
Welcome to HCM Forum.
It seems that you already know about your illness and probably was advised to take treatment for same but you not continuing.
Its important to know that this is also a kind of chronic illness like dibetes/hypertension etc,which is controllable (by means of medicine,meditation and counselling) but not curable.
This illness occurs due to chemical changes in the brain-unless this is not corrected other thing (meditation etc) will not much helpful to you.
There are now safest medicine available with minimum side effects which will help you to get immediate releif and decrease restrictions on you.
Medicine for immediate releif and continuing medicine along with psychotherapy for prolonged time for complete relief is required.
Its not advisable to prescribe online without in person meeting
Still you have a week in hand -which will be enough to help you -So please visit to nearest psychiatrist in person -he will definately help you.
Answered: Fri, 10 Feb 2012
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