Column: Dr Avdesh Sharma


Living on the Edge

Remember the last time, you or somebody known to you while being in a malfunctioning lift or closed room suddenly felt extremely restless with thumping heart, breathing difficulty, sweating, trembling of the body, giddiness and fear of dying or doing something ‘crazy’. It subsides after sometime (usually in a few minutes) but leaves behind a sense of exhaustion; fear of another such attack in the future or of similar situations along with feeling of having had a ‘heart attack’. This is a ‘Panic Attack’.

The attack usually begins in late adolescence or early adult life, but may occur in mid-life as well. It also has many associated fears and insecurities. It may be more pronounced in those having to keep deadlines like journalists, beaurocrats, executives etc. These attacks can come on suddenly and may subside in a few minutes. In some people these can be so intense and uncomfortable that the person lives in panic! More usually, the person feels certain that the reason for the attack is some physical illness, like a heart disease. People who have such attacks begin to avoid many situations that they feel may bring it on leading to agoraphobia.

The individual often develops varying degrees of nervousness and apprehension between attacks. The episode of panic is usually characterized by feeling that one cannot breathe properly, racing heart, trembling, sweating, tingling sensation, hot flushes, nausea, chest pain, need to urinate, clammy hands etc. The episode may become associated with situations, specially closed spaces like lifts, toilets, air conditioned buildings, market places, traffic jams, air flights etc. It can be imagined how such a person could be left out from today’s fast paced, modern society. The person may fear these episodes so much that the individual may insist on a close confident to be present all the time, thus severely restricting their personal and professional life. There is also the danger of abuse of Alcohol and minor tranquilizers to reduce the anxiety apart from developing Depression over a period time.


It is usually difficult for the family member of a person affected with panic disorder to understand why there should be such an inappropriately strong reaction to something minor. It is easy to lose patience with someone under the circumstances. The reason for someone developing this disorder are to be found in a person’s life experiences and personality because of which a wrong way of coping with stress comes about. Sometimes, there is some event in the past that has frightened the person or made him or her anxious. After this, even the idea of the situation taking place again makes the person anxious. To make matters more complicated, the person begins to feel anxious about feeling anxious! Sometimes physical illnesses like - Mitral Valve Prolapse Syndrome or Hyperthyroidism may present similarly but careful diagnosis by a Doctor can distinguish between these and panic attacks.

  1. If the attacks are affecting daily routine.
  2. If the person feels the need to have a constant companion for comfort.
  3. If the person cannot be in certain situations that are a must or are a source of livelihood.
  4. If the symptoms have started causing social withdrawal or depression.
  5. If the episodes make a person fear for his/her life and all the physical tests and investigations are normal.


The disorder of panic attacks is treatable. It is important to rule out heart disease or other ‘physical illnesses’. The psychiatrist or psychologist treating the problem will work out a program of behavior change during which the person will be exposed to the panic producing situations. He or she can be helped to face the situation with relaxation techniques. 

In most cases, a course of medication is used to control the symptoms but always under the guidance of a doctor. The medication controls the panic attacks and generalized anxiety and does not allow the episodes to progress. It also reduces the intensity of symptoms allowing the psychological help to show better results. The mental health specialist also guides the family on how to handle the attacks. The support of the family helps a person to deviate the thoughts from anxious situations and feel mastery over it. It is best to treat the problem at the earliest or the anxiety may keep becoming generalized over a period of time leading to avoidance of situations. It has to be a continuous process and slowly self confidence comes back and panic attacks disappear.

—Dr. Avdesh Sharma is a celebrated mental health expert and Heads ‘Media and Public Education Committee’ of ‘Psychiatry in Developing Countries Section’ of World Psychiatric Association.

May 2006

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