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How to distinguish between a panic attack and generalized anxiety disorder?

Roberto León Barriera's picture
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Debemos dejar a un lado los estigmas o las ideas erróneas sobre los trastornos de ansiedad y buscar ayuda de un profesional de la salud mental.

All of us have felt anxious at some point in our lives. The pressures of life, work, studies and money can temporarily cause us anxiety. However, if anxiety interferes with your daily activities and you feel that it is something you can’t control, it could be more than a simple concern. Generalized anxiety disorder affects about 6.8 million people in the United States and is more common in women. In Puerto Rico, up to 25% of the population suffers from this disorder, according to estimates of the Academy of Psychiatry of Puerto Rico.

Generalized anxiety disorder is characterized by an exaggerated concern for any situation such as the family issues, money, illness or work, among others. People suffering from this disorder never or seldom feel like they are at ease with a situation, or show lack of concern. They may also have other symptoms such as tremors, inability to relax, difficulty concentrating, sweating, fatigue, difficulty sleeping, headache or feeling of inevitable catastrophe. It is common to recognize that their concern is exaggerated compared to the situation they face, but they can’t control it. The anxiety experienced by these people is not linked to any particular situation, that is, they are worried all the time and about everything. To consider the diagnosis of this disorder, the person must experience these signs of constant worry for 6 months or more. Certainly, this disorder causes symptoms that could be disabling, so it is important to seek help from a mental health expert.

Although it is known that this disorder tends to be inherited in families, no one knows for sure why it happens. Some theories link changes in activity in brain structures with fear and anxiety. The amygdala is a brain structure where the information perceived by the senses is initially processed to then be transmitted to other brain structures. Some studies show that inappropriate activation of the amygdala could be related to the development of anxiety disorders because of the exaggerated response to stressful stimuli.

Another factor related to the development of generalized anxiety disorder is the release of the hormone cortisol. Stress causes activation of a brain structure called the hypothalamus which in turn activates the pituitary gland in the brain through a chemical messenger called corticotropin releasing hormone (CRH). Once activated, the pituitary releases a mediator known as adrenocorticotropic hormone (ACTH). ACTH travels through the bloodstream to the adrenal glands, small glands that produce hormones located above the kidneys, causing the release of cortisol. Cortisol is then distributed through the bloodstream to organs and parts of our body that help us respond to stressful situations, such as the heart, increasing the heart rate and therefore the distribution of blood to tissues and organs.

This cascade of messengers and activation of glands is regulated by the brain structure called the hippocampus. The hippocampus suppresses the release of CRH once the stressful event is over, thus inhibiting the secretion of cortisol and reducing anxiety. Animal experiments show that when cortisol levels are too high, hippocampal cells die, thereby reducing the ability of the hippocampus to regulate the stress response and as a result, the individual experiences an increase in his anxiety levels.

These theories can help us understand some of what happens in anxiety disorders, however, none can explain the whole problem. All brain structures receive information from many other parts of the brain, making it difficult to know exactly what is happening. It’s notable to mention that genetic and environmental factors need to also be added to this explanation.

A panic attack can be seen in people with generalized anxiety disorder, although it is not unique to this condition. A panic attack is manifested as an intense fear that develops suddenly and is accompanied by physical symptoms. There may be sweating, palpitations, chest pain, blurred vision, tremors, and inability to react. Someone once described to me feeling like his heart was out of his chest, and he could not control his emotions, although he knew there was no reason to feel that way. Many people who suffer a panic attack for the first time call 911 thinking that they are having a heart attack. As with generalized anxiety disorder, the causes are not known exactly, but it is known that also tends to run in families. These episodes can occur at times of intense stress or trauma such as a death, illness, divorce or job loss.

There are certain conditions that may increase the possibility that the individual suffers from panic attacks. For example, patients with a heart condition known as mitral valve prolapse could experience panic attacks because of their condition. Here, the mitral valve, which serves to prevent improper return of blood to a chamber of the heart does not function properly. Currently it is not known why many people with mitral valve prolapse experience these panic attacks. Other possible causes of panic attacks related to previous health conditions are problems with the thyroid gland and drug use.

It is important to mention that there are several treatments that may help you if you have any of these conditions. If you feel your anxiety is interfering with your daily life, it is important to talk with your doctor. He/she can inform you about the different treatments, ranging from therapy with a psychologist to drugs. Similarly, if you’ve had a panic attack, the mental health professionals have the knowledge to help you.

We must put aside the stigma and misconceptions about anxiety disorders and seek help from a mental health professional. They are not just “hissy fits” or “tantrums", as some people like to say. We already discussed how these disorders depend on various factors and, in some cases, on very complex responses from the body to cope with stressful situations. The problem arises when our body can not "switch off" and still reacts to everything that happens around us as if they were life-threatening situations. But there is light at the end of the tunnel.

Inform yourself, speak with your doctor, and suggest a consultation with a mental health professional. This can help you control your symptoms and manage your condition effectively allowing you to obtain peace of mind, tranquility, and improving your quality of life.

Written by: Roberto León Barriera, Student of Medicine of the Medical Sciences Campus, University of Puerto Rico.


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