I Am Half a Person…Panic Attacks and Agoraphobia

Reader’s Question

To have a better understanding of my problem I would like to tell you a bit about myself. I am 25, from one of the CIS countries. As a kid and teenager I was very brave, hardworking and purposeful. At the age of 15 I won an exchange program scholarship and studied a year in the USA. When I returned, I got a full scholarship to one of the best universities in our country, moved to our capital and lived with my aunt’s family (my family is from another city).

However, one night about 7 years ago, when I was back home everything changed in my life. As I was trying to go to sleep I suddenly felt a very fast heart rate, pressure on my chest area and I was thinking I’d die. I was taken to a hospital, injected with some relaxing medicines, and had a heart checkup (it was fine). It was explained as nervous breakdown.

I have been taking some medications and treatments. At some point I seemed to have recovered but then it started again, each time showing different symptoms: one period my heart beating fast and not being able to breath, another period sleeping problems, then fear of staying home alone, etc. Now I am at a stage where I can’t eat properly, because sometimes when I try to swallow I feel that I am choking. But the thing that bothers me most is that it has been 2 years that I cannot go anywhere alone. When I try to go out alone, I constantly feel that I am falling down, that I am dizzy and that I want to get hold of somebody. I am married to a wonderful Greek man, and now I live in Greece. My husband takes me everywhere but it’s impossible to live like this; I feel like I am a half person, and I can’t go out to enjoy myself. Two weeks ago I turned to a neurologist here and was diagnosed with “Panic Attacks” and was prescribed Seropram.

Would you, please, answer if my problem concerning going out alone is connected with “Panic Attacks” as my doctor explained? Is it possible to cure?

Psychologist’s Reply

There are many levels to your situation. First, the original panic attack of 7 years ago could have been caused by stress, medication interaction, blood pressure, anxiety, and multiple other issues — including bad food. When we have such a dramatic and feeling-life-threatening experience, we become emotionally traumatized. The brain creates an intense “Emotional Memory” of the event — remembering every detail of the experience and the actual feelings at the time of the event. This is why your chest hurts when you think about it. Once we have an intense, traumatic Emotional Memory in our memory system, we begin having the difficulties you describe.

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Second, now that we have this Emotional Memory (EM — see my article on this topic on this website) — it becomes our strongest memory reference any time we have anxiety of any kind — for any reason. Remember — this EM contains all the panic feelings from seven years ago! From that point, any “normal” situation that might be anxious — late for work, going shopping, attending school, visiting relatives, etc. — now brings up the EM of the panic attack. We start to leave the house and our chest begins hurting and we become dizzy (exactly like it happened 7 years ago). By this time, we are re-experiencing these panic attacks on a daily basis — each event increasing the strength of the memory. If we are traumatized by a dog bite, and then we are bitten several times a week, our fear of dogs increases dramatically.

Third, with frequent panic attacks now, you may develop Agoraphobia or a fear of being away from safe places (home) where there is no escape or where panic attacks may surface. Each attempt to venture out alone brings dizziness, chest tightening, etc. For this reason, your diagnosis is best described by “Panic Disorder with Agoraphobia” or 300.21 in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (if you want to look it up!).

Lastly, the combination of panic attacks and agoraphobic forces you to create a restricted lifestyle — almost in self-defense. You develop “safe” places you can be, “safe” routes to take through the city, and various accommodations such as enlisting friends and family to help.

Your current treatment, being prescribed Seropram or Celexa (in the US), is a partial treatment. Celexa is very active on the neurotransmitter Serotonin and very helpful with depression. However, it does little to deal with the daily sense of panic and overwhelming anxiety. In my experience, a combination of 1) an antidepressant medication and 2) a long-acting anti-anxiety medication such as Klonopin are most effective for Panic Disorder with Agoraphobia. The long-acting antianxiety medication is very important as it suppresses the anxiety-producing system which is overactive in your case. A psychiatrist rather than an neurologist is best suited to provide this combination of medications.

I would also strongly recommend reading my Emotional Memory article on this website. It will describe how your panic attacks formed, how the brain uses the emotional memory to torment you, and how to manage them. I would also recommend researching the Internet on panic attacks and various methods to control them. Counseling would also be helpful in your case. You will need a gradually-increasing return to the community and independence which can be guided by a counselor.

Your situation is very treatable. You are combating the brain’s normal protective memory which works great if we have been bitten by a dog. It alerts us to our dog-bite history and makes us more cautious around animals. In your situation however, it works on overtime and is placing you on alert (the panic attack) when the threat is actually 7 years old at this point. By the way, this memory system is also the basis for Post-Traumatic Stress Disorder (PTSD).