Side effects at the end of the tunnel.

This is a follow on from the last post where I spoke about the causes and symptoms of Panic disorder. For now, I'd like to speak about the treatments available. Even though I'm secretly dying to move onto research on the evolution of art and creativity. We had a bitchin' class this morning that has left me certain with my essay topic for that class.

Onward! The best available drug treatments for Panic disorder are antidepressants, given their regulating effects on norepinephrine and other neurotransmitters. The massive downside to these drugs is two-fold. They have hefty side-effects, and the Panic flares back up as soon as they stop being taken (unless paired with Cognitive Behavioural Therapy, say Doyle and Pollack in their 2004 study).

More specifically, Tricyclic Antidepressants (such as imipramine) reduce panic attacks in most patients (Doyle'n'co again). TAs improve functioning of norepinephrine with a smaller effect on serotonin. Perhaps due to both, anxiety is reduced in general. Side effects? Blurred vision, dry mouth, sexual dysfunction, constipation, weight gain and difficulty urinating. Ouch!

Selective Serotonin Uptake Inhibitors (SSRIs) 'increase the functional levels of serotonin in the brain'. I'm not sure what that means exactly. Learning about all these drugs and their effects on random chemicals I know very little about is frustrating. Regardless, side effects of these buggers include irritability, agitation (in what way are those different concepts?) insomnia, drowsiness and again sexual dysfunction. I'd like to see someone maintain constant physiological arousal with these in their system. Yaknowwhatamsayin'? In terms of reducing anxiety, they are on a par with TAs (Doyle and Pollack, 2004. Culpepper, 2004).

Benzodiazepines suppress the central nervous system and influence functioning in GABA, norepinephrine and serotonin symptoms. Culpepper (2004) tells us that they reduce panic and general anxiety very well in people with panic disorder. They are massively addictive both physiologically and psychologically though, which is a bit of a problem, let's be fair. People build up a tolerance and must take higher doses to feel the effects again. Withdrawl symptoms are extremely harsh and range from insomnia and tremors to tingle sensations, seizures and paranoia. The drugs themselves mess with cognitive and motor functioning, to the point where driving ability is inhibited as well as most tasks at work, home or school. Most disappointing of all is the 90% relapse rate into panic attacks after coming off them (Chouinard, 2004).

Hold on... Notice how 2004 seems to be the year for research into these drugs? I wonder why.

I've had a cracker of a headache whilst writing this. So it feels a bit less animated than my usual posts. To cheer us all up, here is an exceptionally beautiful Red-head I found on google.

CBT is my much preferred approach to treating panic disorder. It has one major aim in all the disorders it attempts to treat; it tries to get clients to confront the source of their psychological unease. By exposing the client to these stimuli, their irrational beliefs can be directly challenged using an appeal to logic, and so changed. There has been a load of research claiming that CBT is equal to, or better, than the above drugs at treating the disorder. On top of that, it is certainly more effective in lowering relapse rates (e.g. Barlow et al 2000. Telch et al. 1993).

The process is interesting to me. It is so... simple. I think half the battle is actually attemping to do something about the problems. Something physical and human, rather than throwing down a pill and hoping for the best whilst your willy fails to work and it burns when you pee. Initially participants are taught breathing exercises. By giving them some actual control over their physiological symptoms they begin to feel more calm and receptive to more treatment. At this point the clinician will make an attempt to direct the participant towards identifying the CATASTROPHIC SNOWBALLING THOUGHTS they have been having about their bodily symptoms in different situations. There are a bunch of methods they might use to achieve this, including keeping a written record of their experiences of anxiety throughout the day.

If you've ever experienced a panic attack you're probably more qualified to make this assumption, but I reckon that it would be pretty hard to write "Aaaah crap, here it comes here it comes! This is all because of the trapped surroundings in this packed tube train..." whilst you are going through an actual attack. For this reason, having a panic attack in the office of the clinician can be beneficial for treatment in general, and some clinicians might actually make an effort to induce one. They would use safe methods that would be pretty likely to crack out an attack in those with panic disorder, such as inhaling CO2 or standing up quickly to produce a head rush. As the participants go through the attack, the clinician tries to help them collect their thoughts through it.

The next step is for the clients to practise their relaxation exercises when they're mid attack during therapy. The clinician usually talks through this; pointing out successes, helping them keep control, reminding them they are actually safe. Generally just trying to keep the matter in perspective, which is something people with panic disorder tend to lack. After mastering this, the therapist can challenge (and later, the client can challenge) their errant thought processes using certain straight-forward techniques. One such approach is to find out what physical stimuli are being experienced and what is actually prompting them. Taking accurate data from medical measurements can empirically prove that, for example, their hearts are not about to explode. That information can certainly be heartening (see what I did there?) to the sufferer.

Lastly, the therapist uses systematic desensitisation therapy to expose the clients gradually to their sources of panic in the real world. They work through a list of stressors from least threatening to most threatening, mastering their relaxation techniques along the way until those stimuli are no longer associated with anxiety.

Next step for my study of this stuff, is to get friendly with all the studies I've mentioned, learn more about CBT, and get into specific detail about the functioning of the neurotransmitters. For tonight, though, I'm going to chill out with an episode of Dexter and a sandwich.

Be well, folks.