“Thanks for making my panic attacks WORSE!”

Have you ever been to the ER for a panic attack? 

Legal and medical disclaimer:  If you are having acute medical symptoms of any kind that you think may be serious, you should seek emergency treatment immediately!  By reading this blog post, you agree not to take anything that follows as medical or psychiatric advice.  

The above disclaimer is REAL, but if you read the rest of the post, you'll see that it is also IRONIC that I have to post it...

So here is a classic phone call I receive from someone seeking therapy for panic attacks:

Caller:  Hi Dr. Melamed.  I found you online when I was searching for help with what I think might be panic attacks.  

Me:  I definitely work with people on panic attacks, but tell me why you think that's what you have. 

Caller:  So I'm not really sure what's wrong with me, but I had this horrible experience a few weeks ago where I [choose one] couldn't breathe, thought I was having a heart attack, got so dizzy I thought I would faint, had to bolt at the next subway stop because I couldn't breathe.  I'd had a few of these before, but this one was so bad that I called my [choose one) husband/mom/friend and went right to the E.R. 

Me:  Ah, that sounds awful.

Caller:  Yeah, well it was kind of ridiculous because as soon as I got to the ER waiting room, I felt better.  But I thought I should get it checked out so I waited for hours, and they did all sorts of tests:  EKG, CAT scan, pulmonary tests, etc.  The doctor finally said that they couldn't find anything wrong with me, so they gave me some Klonopin and said it was probably nothing but I should make an appointment with my [choose one] primary care physician/cardiologist/pulmonary specialist.

Me:  So you've had the million-dollar work-up at the ER, made the rounds of medical specialists, and no one can find anything wrong, but since you're calling me, I assume you're still experiencing these symptoms, and you're worried something might be terribly wrong with you, medically or psychiatrically.  

Caller:  Yeah…

Me:  You probably hate to miss out on your usual activities, but the thought of having risking another one of these attacks has naturally made you avoid the situations you think may trigger them.  You feel like the whole thing seems out of control.

Caller:  Uh-huh!  Plus now I'm taking Klonopin here and there, and I really don't want to rely on that.

Me:  Got it.  So… you finally did an online search and started wondering if these could be panic attacks ---

Caller:  --- Right, but that explanation seems so unconvincing!   I'm telling you, these symptoms are real, they're not just in my head.

Me:  Absolutely, the symptoms of panic attacks are real.  And the good news is you haven't had them for very long, but the bad news is that while the ER visit may have ruled out major medical problems, it doesn't sound like you were given a diagnosis that explains what happened to you.  And the recommendation they gave you, to keep trying to get to the bottom of it medically, may have unintentionally done you a disservice by allowing you to turn one simple panic attack (even if a whopper!) into an ongoing mental health problem.  

One problem is that they sometimes don’t recognize that a panic diagnosis is a real diagnosis, equivalent to a cardiac or pulmonary diagnosis.  So without having an accurate diagnosis, it’s just harder to pursue the right treatment.

The good news is, despite any detours at the Emergency Room, panic disorder is one mental health problem that is definitely treatable, and the CBT protocol is the gold standard in therapy.