Panic Attacks and Panic Disorder
This novel year that is 2020 has seen a worldwide rise in panic, anxiety, fear, and depression in greater propensity than has been seen in many years. It seems to be widely accepted and understood that the human race is going through several major stressors in this season but let’s talk about panic attacks and panic disorder today.
What is a panic attack?
Let's note these symptoms:
Symptoms of panic tend to come on quickly, gradually get stronger, and then dissipate after around ten minutes.
According to the Mayo Clinic, it is normal to have one or two panic attacks in your lifetime. But the regular occurrence of panic attacks, or being worried to go out in public because of fear that you will have a panic attack, points to having a panic disorder.
"The prevalence of panic disorder is approximately 1.5-4% of the general population. It occurs most frequently in the late 20-30 age bracket. With the presence of agoraphobia, panic attacks are twice as common in women than in men. In the absence of agoraphobia, males and females are affected equally." source
Our body reacts to stress and trauma by producing more cortisol and adrenaline to help us survive a threat. However, when this stress is extended for longer amounts of time, we continue to produce adrenaline and cortisol in higher than normal amounts. These higher amounts of cortisol and adrenaline eventually damage areas of the brain including the prefrontal cortex which is critically involved in modulating fear and balancing logic.
Let's look closer: The prefrontal cortex and the amygdala.
When Doctors performed volumetric MRIs on patients with Panic Disorder, they found that the fear center and the lateral and basal nuclei of the amygdala all atrophy. The lateral and nasal nuclei areas of the amygdala are involved particularly in sensory perception during a fearful state, especially on the right side of the brain.
When the prefrontal cortex is weak, but the hippocampus and amygdala are over firing and over-communicating with each other, it is difficult to create new, happy memories. Our brain focuses on negative emotions and makes fear-based decisions with dread of the future because new happy memories and thoughts are not being well-formed. It makes sense then that the result would be anxiety, panic, and possibly depression.
Research has shown that the medial prefrontal cortex and orbitofrontal cortex in the left hemisphere atrophy in panic disorder patients. It is thought that the atrophy in the prefrontal cortex region (which modulates the amygdala) somehow allows the dysfunctional amygdala physiology to relate to panic disorder.
Functional MRI and regional blood flow studies have shown an increase to glucose uptake in the amygdala in panic disorder patients. This raises the question: is the amygdala shrinking because it is over-exciting itself to death?
Interestingly, most anxiety disorders and depressive disorders share an enlargement in the fear center of the brain.
Brain size matters
Researchers are finding that when parts of the brain are overused, they then shrink and synaptic density decreases. Dendrites (parts of a neuron cell body) can become blunted and shrunken in.
When the dendrites shrink, the brain shrinks.
Potentially, this means the amygdala is shrinking as well and that leads to more anxiety and panic.
In the image above, “We can see reduced benzodiazepine/GABA-A receptors in fronto/temporal brain regions in patients with panic disorder. Similar benzodiazepine/GABA-A receptor deficits are also found, though to a lesser extent in patients with Generalized Anxiety Disorder and Post Traumatic Stress Disorder, as well as in epileptic foci. It is thought that the reduction in GABA-A receptors leads to reduced GABA-A inhibition which in turn leads to excessive glutamate excitation that ultimately provokes seizures depending on the brain regions affected.” (Kim YS, Yoon BE. Altered GABAergic Signaling in Brain Disease at Various Stages of Life. Exp Neurobiol. 2017 Jun; 26(3): 122–131.)
Typical medical treatment for Panic Attacks/Panic Disorder:
Prescribe SSRI’s (Selective serotonin reuptake inhibitors) which increase serotonin in the brain. Current literature suggests that these SSRI’s improve the density of the hippocampus which shuts off the fear center next door.
Cognitive therapy treatment which focuses on current thinking patterns and problem solving instead of looking into past experiences.
Daily exercise- the orbitofrontal cortex is stimulated by leg and hip activity.
Regular skewed breathing- breathing in for five seconds, holding for two seconds and then breathing out for seven seconds.
Gates Brain Health treatment:
Supplements to support brain health and strength
Diet to reduce inflammation, and promote healing in the brain
Neuroplasticity exercises to calm the fear center of the brain and rebuild the areas of lower density.
Living with a Panic Disorder can affect every area of life. Thankfully, panic disorders are highly treatable when you deal with the root cause and stop the vicious cycle.
If you are ready to begin your path to healing or have any questions, contact us at (775) 507-2000 or email firstname.lastname@example.org
By: Gemma Ward from information shared by Dr. Gates on this video.
You may also find his video on glutamate helpful as well.