Panic attacks cure
The general rules of panic attacks cure
Apart from investigative measures and paying particular attention to various causal personal and social problems, panic attacks cure is carried out mainly by means of pharmacotherapy and cognitive psychotherapy.
In patients with the hyperventilation syndrome panic attacks cure is realized in two ways. The immediate help consists in repeated inhalation of exhaled air from a polyethylene bag to increase concentration of carbon dioxide in the alveolar air. This method is also effective way of demonstration to the patient the connection between his symptoms and hyperventilation. When the patients begin to understand this interrelation, they can be trained to operate the breathing, at first under the expert’s control and then independently.
Psychotherapy:
The technique of cognitive psychotherapy for fear reduction of somatic effects of anxiety is used on the assumption that this fear prolongs panic attacks. Usually the patient is afraid that palpitation will inevitably lead to heart attack, dizziness will end in loss of consciousness, etc. Similar symptoms are caused voluntary (usually by hyperventilation, less often in other ways, such as a strain and tension), and then the patient is explained that symptoms of panic attacks are of the same harmless origin. This demonstration is followed by the further explanation of the origin of the fear symptoms and clarifying the patients’ opinion in their regard. Cognitive psychotherapy can result in significant improvement of patient’s condition. At least, it is proved that frequently it is no less effective than high doses of imipramine.
It is necessary to emphasize that the purpose of psychotherapy at the first stage is the reduction of expectation anxiety and elimination of avoiding behavior, and not the reduction of frequency of panic attacks.
Pharmacotherapy:
Benzodiazepines in high doses are effective. Alprazolam is a highly effective benzodiazepine. It can be given in high doses without any pronounced sedative effect though it is probably no more effective for the reduction of panic attacks than diazepam in an equivalent dose. The taking of the benzodiazepines should be terminated very gradually to avoid withdrawal syndrome.
Among antidepressants, imipramine also stops panic attacks. The first effect of this preparation is frequent occurrence of unpleasant feeling of danger, sleeplessness, and palpitation. For this reason, the initial dose should be small, for example, 10 mg daily within three days, then the dose is increased by 10 mg during three days up to a daily dose of 50 mg, and then by 20 mg a week up to 150 mg day. If at this dose the symptoms do not subside, only somatically healthy patients can be prescribed further increase of the dose by 25 mg up to a daily dose of 175 — 225 mg. At the same time, if there are any doubts concerning the functioning of cardiovascular system, electrocardiography examination should be carried out before prescribing high doses of imipramine. Imipramine is taken a full dose continuously from three to six months. After the discontinuance of imipramine, rather high frequency of relapses (up to 30 %) is observed; however, this frequency can be reduced if the medication is taken in lower doses within several months.
Among other antidepressants clomipramine and selected serotonin reuptake inhibitors fluvoxamine and paroxetine can render the same effect as imipramine.