There is great hope: treatment can benefit virtually everyone who has this condition.

By Cathleen Henning

Last week, I discussed the reasons why researchers believe panic disorder to be a physiological illness with genetic components. These "why's" are almost more important than the "how's" at this point because the "how's" are theories, although they are theories supported by clinical evidence.

This week, I'd like to mention a few of those theories, but mostly I'd like to discuss my reasons why I think it is so important to stay current with this research as well as to thoroughly understand it as best you can. I can sift through articles and books for you and summarize them as best as possible, but it's no substitute for digging into those books yourself. It's really a matter of taking responsiblity for your recovery--by understanding why your doctor is taking certain steps and by actively participating in each step along the way.

Briefly, here are some ideas about what might cause panic attacks. These theories are not mutually exclusive. Perhaps more than one action takes place or perhaps panic disorder is caused by different actions for different people.

• Serotonin: People with panic disorder might have a serotonin deficiency, or serotonin isn't being used correctly by the body. Serotonin reuptake inhibitor antidepressants act by increasing serotonin levels.
• Stress & cholecystokinin (CCK): When you are under stress, your body produces endorphins. When stress ends, the body produces CCK to counteract the endorphins. CCK can cause panic attacks. Thus, for some, stress triggers attacks. Click here for more info.
• Hyperventilation: Improper breathing causes the lungs to exhale too much carbon dioxide, thereby lowering levels in the brain and blood. This goes on to cause dizziness, heart palpitations, further breathing problems and increased anxiety. For example, a stressful situation might cause irregular breathing which then triggers the other attack symptoms.
• Overstimulation of the noradrenergic system: For some reason, this system, particularly the part of the brain called the "locus ceruleus," is more sensitive to stimulation in people with panic disorder.

These are basic explanations for detailed research in this field, so I urge you to read more.

Why, then, am I bogging you down with scientific research? Because this research goes on to influence the actions of your doctor, psychiatrist and/or therapist. Don't you ever wonder why a particular medication is chosen? Or why your psychiatrist doesn't like using certain medications? Or why your therapist is disapproving of medication use? Or why your psychiatrist wants to try a combination of medication and cognitive-behavioral therapy? Don't let them make these decisions without your input!

The Gorman article, mentioned in my "To Read" column (see right), presents an excellent theoretical model of panic disorder. (Note: If Gorman gets to technical for you, try reading William D. Kernodle's interpretation of the article in chapter 15 of Panic Disorder: The Medical Point of View.) This theory shows panic disorder as a three-part illness, each part affected by a different portion of the brain: panic attacks are triggered by activity in the brain stem; anticipatory anxiety comes from the limbic lobe; and phobias are influenced by the frontal cortex.

What does this have to do with my recovery, you ask? Each of these parts, theoretically, respond differently to treatment. This doesn't necessarily mean you need three different treatment methods; some treatments will affect more than one part of the brain, such as antidepressants. However, it goes far to explain why the effectiveness of treatment methods varies from person to person.

The bottom line is that doctors and researchers need those of us with panic disorder to care about our own recovery. And by "caring," I do not mean sit and hope for a cure. Give treatments a chance to work, don't be afraid to try something (after researching it, of course), and never be afraid to tell your doctor that something isn't working, whether it's a particular therapeutic method or a popular medication.

Noradrenaline: A neurotransmitter involved in mood, pain, learning and memory. Also called "norepinephrine."

There is nothing simple about panic disorder. After I learned that I had panic disorder, I faded in and out of denial about it. I had faced the attacks without help for so long and had really managed to convince myself that I was flawed in some way. It was actually easier to hate myself than to accept that I had a chronic illness! I came to accept it, however, as I learned that it is treatable. Yes, it's tough to make so many changes in my life, but it's so much better than not knowing what was wrong.

Cathleen
panicdisorder.guide@about.com