Many people with panic disorder or other anxiety disorders go to great lengths to keep their symptoms a secret. Although they may disclose their condition to a few select friends or family members, the majority of people in their lives may not have any knowledge about the difficulties they are going through. Many suffer quietly, feeling the need to avoid disclosing their secret at all costs. Both disclosure and secrecy may have certain costs and benefits.

Tell us what you think for an upcoming feature article.

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Having a panic attack is not pleasant! But, I have discovered, that if one has an alcohol problem, the withdrawals can cause them. --danieldidonna1

People with anxiety disorders are up to three times more likely to have an alcohol or other substance abuse disorder than those without an anxiety disorder. But, what begins as a way to cope with anxiety, can quickly have the opposite effect of increasing distress. Problem drinking leads to alcohol withdrawal. This is often called a "hangover."� The symptoms of alcohol withdrawal can include:

• anxiety
• panic attacks
• nausea
• vomiting
• elevated blood pressure and heart rate
• agitation
• increased body temperature

These symptoms tend to create a cycle of heightened anxiety and increased problem drinking. If you're having trouble controlling your alcohol consumption or are self-medicating your symptoms with alcohol or other drugs, talk to your doctor or therapist.

_{Photo © Microsoft Corporation}

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So, here we are just starting the summer season, and we find ourselves in the midst of a flu pandemic. Just the word “pandemic” can make us feel a sense of doom and start our anxiety escalating. But, the declaration of a pandemic is not made on the basis of the severity of the virus, but rather on its global spread. While the World Health Organization believes the current swine flu infections have been mostly mild to moderately severe, there is some uncertainty about how it may evolve in the months ahead. It would be easy to panic given all of the unknowns associated with this pandemic. But, what we really need to do is follow the guidelines by the CDC to stay healthy during this uncertain situation.

_{Photo © gettyimages}

Avoidance of feared situations is a common behavior associated with panic disorder. Avoidant behaviors are “dysfunctional” because they tend to provide only short-term relief from anxiety. They are non-productive in alleviating the actual problem in the long run and may, in fact, serve to reinforce underlying fears.

For many people, the symptoms of panic disorder often trigger an array of avoidant behaviors. This can result in agoraphobia, a common complication of PD. Agoraphobia can take a little time to develop, or it can come on rather quickly. Some sufferers believe their agoraphobic symptoms began after their first panic attack. Once agoraphobia takes root, avoidance behaviors often multiply quickly.

Facing your fears and putting yourself into anxiety-provoking situations is not easy. But, doing so will help you to develop adaptive ways to deal with your anxiety and will aid in your recovery from panic disorder. Systematic desensitization is based on the principles of classical conditioning and the premise that what has been learned (conditioned) can be unlearned. Ample research shows that systematic desensitization is effective in reducing anxiety and panic attacks associated with fearful situations.

_{Photo © iStockphoto}

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Researchers recently conducted a study to determine the risk of diabetes mellitus associated with antidepressant use. The researchers also assessed whether the risk is influenced by antidepressant treatment duration or daily dose. The study found that:

• Moderate to high daily antidepressant use in excess of 2 years is associated with an increased risk of diabetes.
  
  
• The risk was evident in long-term use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). However, the SSRI paroxetine (Paxil) and the tricyclic antidepressant amitriptyline appeared to be linked with the greatest potential for the development of diabetes among the study participants.
  
  
• Shorter periods of antidepressant treatment or lower daily doses were not associated with an increased risk of diabetes.

Like many studies of its kind, the conclusions the researchers present are not definitive. The exact reason for the increase in diabetes in the study group was not determined. Further research is needed to clarify what association, if any, exists between long-term antidepressant use and diabetes.

_Source:

_{Andersohn, Frank, M.D.; Schade, Rene, M.D.; Suissa, Samy, Ph.D.; and Garbe, Edeltraut, M.D., Ph.D. (2009). Long-Term Use of Antidepressants for Depressive Disorders and the Risk of Diabetes Mellitus. Am J Psychiatry Online. 2009 Apr 1.}

A member of the panic disorder support forum started a pen pal thread. It’s a great way to connect with others and share information and personal struggles with anxiety. All are welcome to participate. If you would like to correspond with some new “pen friends,” please join us!

_{Photo © Microsoft Corporation}

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For many people with panic disorder and/or agoraphobia, things once taken for granted, like going to into a store, become anxiety-filled events. Some enjoyable activities, like going to concerts or movies, may be avoided altogether. It is not uncommon for sufferers to experience a sense of shame, weakness and embarrassment as their self-image is redefined by fear. The symptoms of panic disorder, and the many fears that go along with it, are often confusing for the friends and family of sufferers.

Having panic disorder and agoraphobia is often difficult. Explaining it to others can sometimes seem impossible. If you could tell people about what it's like to have panic disorder and agoraphobia, what would you say? Please leave your response for an upcoming feature article.

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For the latest information on panic disorder,
panic attacks and agoraphobia, sign up for the
Panic Disorder Newsletter and visit the PD discussion and support forum.
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In the panic disorder support forum, Mike writes:

I spent the last 2 days in the hospital. A lot of tests and sleeping in the cardiac unit. I can’t understand how the doctors blow us off so easily. They see the heart flutters and palpitations on the monitors and say there is nothing is wrong and nothing to worry about.

If you have panic disorder, you are likely to experience an array of troubling physical symptoms that lead you to a search for an underlying physical disease. Shortness of breath, chest pain, increased heart rate, muscle tension, stomach upset and headaches are just a few of the physical symptoms that may occur with panic disorder. Is it any wonder PD sufferers often undergo extensive medical testing looking for a medical cause? These symptoms are frightening! From my perspective, the scary physical symptoms often leave PD sufferers with a worrisome focus on health issues. This is partly because we know doctors are not infallible – they can, and do, make mistakes. We may also worry that the “tests” may have missed something. And, because the symptoms are so frightening and intense, we conclude they must be serious. Unfortunately, the added health worries only lead to more anxiety followed by more troubling symptoms.

For many people, coming to terms with the physical symptoms of PD helps recovery. This may mean changing how you think about or react to your symptoms. Please share your stories in the comments below about what works for you when dealing with the frightening physical side of PD.

_{Photo © Microsoft Corporation}

It’s thought that about half of all people with panic disorder will develop at least one episode of major depression in their lifetime. The jury is still out as to the exact reasons why these two common disorders so often appear together. But, if you have PD, it’s important to be aware of this connection and seek medical advice if you’re feeling depressed.

How much do you know about depression? Take the Depression Knowledge Quiz by Nancy Schimelpfening, your About.com guide to depression.

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For the latest information on panic disorder,
panic attacks and agoraphobia, sign up for the
Panic Disorder Newsletter and visit the PD discussion and support forum.
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Ivan Pavlov is known for his theory of classical conditioning. This can be thought of as a reaction that is learned through the pairing of stimuli (motivations). During his study of dogs, Pavlov noted that when dog food is presented, the dogs begin to salivate. This pairing seems expected, and the salivation is an innate reaction of the dogs to feeding. But, then Pavlov began to pair the dog food with the ringing of a bell. Through these repeated pairings, the dogs became conditioned to salivate at the sound of the bell even when no food was presented.

It is believed that some fears and phobias develop in much the same way as the conditioning process of Pavlov’s dogs. For example, driving a car is a pretty neutral event that should not elicit an intense fear response. But, if you experience a panic attack while driving, you may begin to associate driving with causing your panic response. But the driving itself is not really the cause of your panic. Rather, you have become conditioned to panic when faced with driving.

_{Photo from Nobel website, PD-US}

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For the latest information on panic disorder,
panic attacks and agoraphobia, sign up for the
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