Biopsychosocial Venn diagram of treatment (Diagram may take a while to load)
TREATMENT
Cognitive-Behavioural Therapy (CBT) Cognitive behavioural therapy is a psychotherapy that helps a sufferer of depression and anxiety to change unhealthy thoughts, feelings and behaviours. CBT is just as effective in treating anxiety and depression as medication. CBT is involving the use of self-help methods. These strategies are made to create a more positive view of life to the sufferer. The aim of cognitive-behavioural therapy is to show how ones thinking can affect their mood and perception of life. It is said that the negative thoughts can be treated and broken just like an other habit.
There are three approaches when it comes to treating panic disorder. These are cognitive, physiological and behavioural. The cognitive approach is making an effort to change ones thinking. The physiological approach is trying to teach patients breathing techniques in which they are trying to lower the heart rate and decrease their anxiety. And the behavioural approach is when a patient is exposed to situations in which they had previously feared or had a panic attack because of. This is so that they become used to this situation and eventually won't develop so much anxiety from it.
Medicinal Treatment When panic attacks occur five to seven times a week, the panic disorder is said to be moderate to severe. Medication is typically taken alongside cognitive behavioural therapy. The different classes of medication that are prescribed to panic disorder patients are...
Tricyclic Anti-depressents Imipramine is usually given to sufferers of panic disorder and statistics show that there is a 70% success rate. Medications in this category, tend to only work after an extended amount of time while taking them. This is because of the side affects and the fact that they act on specific chemical imbalances in the brain, which take time to stabilize.
Tricyclics include imipramine, desipramine and nortriptyline. These all require careful attention to the dosing and monitoring. The blood level does change in different categories. What is meant by this is something like age. The patients who tend to be older, may require a smaller dosage of medication. This is because of the decrease in metabolism and kidney function. Gastrointestinal side affects are also common in some patients which can interfere with the absorption from the gut. This then decreases beneficial blood levels. And more on that, the patients who are prescribed tricyclics often develop symptoms such as a dry mouth and low blood pressure. The rate and rhythm of the heart also tends to be altered because of this medicine. Tricyclics also affect a person sexual functioning. Patients tend to stop taking the medication due to the fact that they are experience negative side affects. However, recently, new tricyclics were made and these include, fluoxetine, sertaline, paroxetine and fluvoxamine. These act on specific areas in the brain to correct potential chemical imbalances. Monoamine Oxidase Inhibitors (MAOIs) Monoamine Oxidase Inhibitors are a chemical that assists in storing certain chemicals in nerve cells. MAOI stops the action of MAO. This results in a decrease of specific chemicals in the brain that often influence panic attacks. The success rate for this second option is approximately 75-80%. There are certain foods that must be avoided when taking this medication in order to prevent a hypertensive crisis. This is when the blood pressure increases rapidly. The foods that are to be avoided include cheeses, liver, meat and yeast extracts, some beans, alcohol, soy cause, shrimp and sauerkraut.
Benzodiazepines Benzodiazepines include medications such as diazepam, lorazepam and clonazepam. The success rate is 70-90%. Unfortunately, the dosage for benzodiazepines is approximately two to three times higher for panic disorder than milder forms of anxiety. The increased dosage for patients taking benzodiazepines isn't ideal due to the fact that there is a risk of physical dependence and withdrawal. However, they are used when a patients response to tricyclics is poorly or they have a fear of taking MAOIs due to dietary restrictions associated with eating the wrong foods accidentally.
Alternative Therapies There are alternative therapies which tend to be self-help methods. These include meditation, hypnosis, yoga, exercise, healthy diet and breathing exercises that help relaxation and visualisation. Visualisation is the way you picture yourself in a stressful situation whilst being relaxed. Hypnosis is also very effective when it comes to treating anxiety because it literally, tricks your mind into thinking positively.