Issue 2
February
2013
1. WHAT IS PANIC/ PANIC DISORDER, AND HOW SHOULD I TREAT IT?
2. THOUGHTS
3. ACTION
Medical Psychology
ADDRESSING THE NEEDS OF PRIMARY CARE
MEDIC AL PROVIDERS THROUGH THE INTEGR ATION
OF PHYSICAL AND PSYCHOLOGIC AL RESEARCH AND
Update
TREATMENT.
First and foremost, “Panic” and “Panic Disorder” are NOT exacerbations of anxious states brought on by external stimuli or life
stressors. The DSM-IV-TR defines Panic Disorder as the presence of recurrent, UNEXPECTED Panic Attacks which are not due to a
variety of things such as medications, other diagnoses etc. They further state that “a Panic Attack is defined as one that an individual
does not immediately associate with a situational trigger”; “They are perceived to occur ‘out of the blue”, and often occur when an
individual is most relaxed or even ASLEEP.
For over ten years I have been observing medical providers, and even some mental health providers, diagnosing a Panic Attack or Panic
Disorder in individuals who had clearly just reported that their so-called “panic attack” occurred after a series of increasingly
stressful events, of which they were well aware, and attributed the so-called “panic attack” to (Pseudo-panic). Then the Coup-degrace comes when the individual leaves the clinic with a prescription for Xanax!
This is wrong for a variety of reasons, and will most always worsen the symptoms of your patient. Firstly, the diagnosis is wrong, and
someone who escalates into episodes of perceived panic, which they attribute to external events or stressors, most likely
needs psychotherapy not medication. We have all had days where the bad events, screw-ups and other stressors keep building until we
have a mini-freak out (especially those in the medical field). You don’t have Panic Disorder, you had a bad day. People who have
frequent days like that need changes in their life (i.e. psychotherapy). Secondly, if you really did have Panic Disorder, were given an Rx
for Xanax and told to take one “when you feel the symptoms coming on”, this is what would occur. One day you would be napping,
then for no reason wake up in a full fight-or-flight Panic Attack. You would grab those Xanax pills and rush one down the hatch. Before
the medication has even had a chance to be absorbed, your panic subsides (as it does quite quickly with Panic Disorder), you attribute
feeling better to the drug, and then 20-minutes later the Xanax kicks in and you feel even better. Then about 3-4 hours later it quickly
wears off, you get rebound anxiety made worse due to the medication quickly evacuating the receptor sites, and you have to take another
pill.
So, lesson #1 is, never prescribe a short-acting benzodiazepine medication, especially Xanax, to people
who report episodes of true Panic or Pseudo-Panic. It evacuates GABA receptor sites so quickly it leads
to rebound anxiety. Lesson #2 is, learn the differences between Panic /Panic Disorder and PseudoPanic; a quick read through the appropriate section of the DSM-IV-TR will do the trick. Lesson #3, using
scheduled, long-acting benzodiazepine medications such as Klonopin for Panic or Pseudo-Panic as a
means of prevention can be useful, but be careful and consult with an expert in psychopharmacology
before doing so. Lastly, look for medical causes s u c h a s Mitral Valve Prolapse or thyroid
conditions, refer the patient to a mental health specialist for therapy, and consult with a psychopharmacologist before initiating any medication.
Dr. Wylie is a licensed psychologist in Wyoming, Colorado and California. He has completed a residency in Medical & Health
Psychology as well as advanced practice medical and psychopharmacology training, and holds a Post-Doctoral Master of Science
Degree in Clinical Psychopharmacology. To refer a patient or consult with Dr. Wylie you may call his office at (970) 372-8396 or email him directly at DrWylie@medicalpsychassociates.org
Please visit our website
http://medicalpsychassociates.org
Created by Dr. Scott Wylie-Medical Psychology Associates