Fredric Neuman M.D.

Fighting Fear

Anxiety

The End of a Panic Disorder

If treated successfully, a panic disorder does not relapse.

Posted May 23, 2012

A panic disorder can continue for many years. Some people become housebound for decades. I have heard it said that a panic disorder can return at any time, even after years; but this is not true. What is true is that it may not have been treated successfully in the first place. Some people think they are better because they no longer feel uncomfortable in places they used to avoid. And they may not have had a panic attack for months, even years. If they had an accompanying depression, which is not unusual, the depression may have disappeared. But, still, that period of remission does not constitute cure. For one thing, a depression can, indeed, relapse from time to time, indefinitely. Such a depressed person may be diagnosed with panic disorder rather than a depression because he/she may have all the signs of an agitated depression, but not feel sad. People so affected, wake up early, day after day, feeling agitated or panicky. The panic attacks caused by a depression, unlike those from an ordinary panic disorder, are there every day, in the morning usually; and they tend to last for many minutes, even hours. The depressed person has other symptoms: a diurnal variation in mood in which he/she feels somewhat better as the day progresses, a loss of appetite, usually to the point of losing weight, and a loss of interest in sex. A phobia often starts with a depression. During this period of time the depressed person may avoid seeing other people or going out of the house altogether. So, he/she becomes phobic. When the phobia is treated successfully, however, a return of the depression does not bring with it a return of the phobia.

A panic attack goes away when the panicky person is no longer afraid of the attack. Having a bad panic attack, ten or twelve times in different phobic situations without leaving the situation is usually enough to convince that person that the panic attack does not cause a heart attack, a fall to the ground , or any other loss of control Long before that, the fear of at least certain phobic situations has already disappeared. Finally, the phobic continues to experience occasional, very brief panic attacks at increasing intervals until they go away altogether.

A typical person who thought she was cured:  A professional person, who happened to work in this field, told me that she no longer avoided any of the phobic situations that at one time had tormented her. Also, she hadn’t had a panic attack in over a year. She went everywhere except one particular restaurant where she had previously had a number of attacks.

“Not good enough,” I told her. “That means that you are still afraid of a possible panic attack in that place.”

A few months later she began having panic attacks in other restaurants, and soon she was avoiding all restaurants and some other places too.

A lot of people stop treatment at this point, still avoiding a few places. But, under those circumstances, the condition can get worse again. When the condition is gone entirely, though, it is really gone. Consider these two women who had remarkable experiences after getting better:

Amy (I will call her) lived not very far away from my office. When she began to practice driving, something she had not done at all in eight years, she drove first only one exit on a highway. Then she turned back and was three cars behind a truck, when it overturned, blocking traffic for five hours. She was frozen behind the wheel for the first hour before she calmed down enough to get out of the car.  Despite this awful beginning, she persisted and improved over the next number of months. She was doing well when she moved to New Jersey, across the George Washington Bridge. It took her a little while to get over her discomfort driving across the bridge; but in time she was fine.

She came to my office one day telling me what had happened after her previous visit. She had been driving along the same highway she had been stuck in about a year before. There was a tremendous amount of traffic, so she decided to cut across the grass to her old exit to visit some friends. She went over a metallic sign, ripping out all the electrical wires in the car, and possibly ripping a hole in the gas tank. It read empty, although, of course, that might have been because the wiring was gone. She drove into a gas station, where the attendant refused to check her car. (The personification of the unsympathetic stranger the phobic person expects.) Nevertheless, she went to her friend’s house and visited for a few hours. When she returned to the road she discovered the traffic jam was still there. So, she went in a different direction to the Tappan Zee Bridge, where she was waiting for a toll when she saw in the rear view mirror a ball of fire coming at her! It was a truck on fire. Luckily, the truck stopped before hitting her. This extraordinary experience did not cause her to hesitate driving the next few days; and there was subsequently no return of phobic symptoms!

Georgiana (not her name) had her first panic attack in her late twenties. She was at work at the time. She left peremptorily and never returned. She became housebound almost at once; and only later, after some treatment was able to leave her house in the company of her mother. Along the way of getting better, she took her first cruise, which was very threatening. She felt trapped.  But, as time went on, she got better and better. She went to work again and about a year later met and then married a man she met at work. For their honeymoon, they went on a cruise! She told me later on what happened in Costa Rica. “We went to see the jungle, but we got lost. It was a Spanish-speaking jungle, and it closed at five o’clock. So we were afraid we’d miss the boat.”  She then told me her adventures lost in the jungle.  This experience seemed to lend some spice to her honeymoon; but it did not cause a return of her symptoms. Last time I spoke to her she was still fine.

I have run into other patients from time to time years after treatment. Not uncommonly, when I ask about their symptoms, they get mad. “That was a long time ago,” one woman said to me. She did not like to remember what she considered an irrational and somewhat embarrassing fear. And yet, she had been phobic for years.        © Fredric Neuman 2012                                                                                                                                                                Follow Dr. Neuman’s blog at fredricneumanmd.com/blog