Panic disorder

Everyone experiences fear and anxiety. Fear is a response to an external threat, whereas anxiety can erupt from external events and a person's own thoughts. Anxiety is a stress response that can arise suddenly as in panic, or can occur gradually.

According to the American Heritage dictionary, anxiety is a state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation, often impairing physical and psychological functioning. Panic is a sudden overpowering terror.

Generalized Anxiety Disorder pertains to persistent daily anxiety or worry that interferes with one's life. In addition, there may be three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and insomnia. Three to five percent of adults have general anxiety disorder during a given year. Women are twice as likely as men to have this disorder. It has not been proven that repressed conflicts or chemical imbalances cause anxiety although these are popular theories among mental health professionals.

Panic attacks are acute and extreme anxiety in response to a specific situation. Symptoms of panic attack includes a sudden appearance of shortness of breath, a feeling of smothered, or "closed in," heart palpitations, shaking, fear of going crazy or losing control, feeling detached from the environment, dizziness, sweating, and chest pain. It is not uncommon for people to worry that they have a dangerous medical problem. Although panic attacks themselves are not dangerous, it makes sense to seek a physician to rule out other disorders.

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by exposure to an overwhelming traumatic event experienced by combat veterans, and victims of violent acts, whereby the person repeatedly re-experiences the event. Sometimes a person's symptoms don't begin until months or years after the traumatic event took place. Symptoms include intense fear, hopelessness, and horror. The person reexperiences the trauma in nightmares or flashbacks. The person may have difficulty sleeping or be easily startled. Oftentimes PTSD becomes less severe over time.

Conventional Treatments

Conventional therapies include behavior modification, where the person is exposed to the situation, which causes the fear, panic, and worry. Cognitive behavioral therapy, which emphasizes self help assignments and examining one's thoughts, can be very effective for anxiety, panic and PTSD. (Beck, Judith. Cognitive Therapy: Basics and Beyond. Guilford Press: New York, NY.) Psychiatrists typically recommend drugs such as SSRI's, MAO inhibitors, or trycylic antidepressants alone or in addition to counseling or behavioral therapy. Typical side effects of medications include anxiety, fatigue, gastrointestinal symptom's changes, insomnia, headaches or migraine and sexual dysfunction.

Herbal Approaches

There are several reasons why clients want herbal approaches. Some individuals are afraid of being on antidepressants and other medications for long periods of time, and therefore try herbs first. Other people have not had satisfactory results with typical conventional medications or treatment. Finally, some men and women try conventional drugs, but find their side effects intolerable.

The best way to take herbs is having them administered by a trained herbalist. You may obtain the name of an herbalist from a friend or see resource list. For example, an herbalist trained in Traditional Chinese Medicine (TCM) will note the symptoms of anxiety and panic but will also determine the other symptoms such as nightmares, sweating during the day and at night, mood swings, digestive symptoms, muscle aches, joint pain, sensations of hot and cold. Women may be asked about their period, as well as hormonal changes. ATCM practitioner may examine the patient's face and determine if the client seems especially fearful, timid, or angry. Qualities of the pulse and the tongue are measured. Clinicians may also pay attention to the individual's body type, and speed of movement.

According to TCM, certain lifestyle habits and constitutional factors would predispose one to suffer from panic disorders more than another person. For example, without adequate sleep and mind rest such as Tai Qi, and meditation, one might be more likely to suffer from panic attacks. A poor diet may lead to symptoms such as hot sensations and confusion. Although herbal anti-depressants or sedatives can be administered, well trained herbalists keep in mind constitutional factors when they select herbs. The following examples demonstrate how different patients with panic disorder and PTSD are treated differently by Chinese medicine.

Bob has a hot energetic pattern. He suffers from PostTraumatic Stress Disorder. He feels explosive rage at times; this by itself creates heat. Heat symptoms include his face becoming red, and migraine. Furthermore Bob is always thirsty so he drinks sodas to quench his thirst however, they contain sugar which is warming, and caffeine which removes water which is cooling; thus over time, he is getting dehydrated. In addition, Bob drinks alcohol at night to help him relax and go to sleep. Alcohol is both warming and also a diuretic. Alcohol is known to interfere with sleep so that the rest Bob gets is less than satisfactory, and no wonder he wakes up irritable and groggy and needs plenty of coffee, which is heating, to get going and the whole cycle begins again. During the day, Bob eats fast food, many fried foods, excessive amounts of meats, and sweets. Bob's pulse was rapid and his tongue was red and peeled. These all contributed to heat. In addition to drinking more water and fresh vegetables, we recommended that Bob reduce his alcohol, sweets and fast food intake. We recommended Coptis Purge Fire (Coptis Root Huang Lian, Lophatherum Herb Dan Zhu Ye, Bupleurum Root Chai Hu, Rehmannia Root Sheng Di Huang, Tang Kuei Root Dang Gui, Peony Root Bai Shao, Akebia Trifoliata Root Mu Tong, Anemarrhena Rhizome Zhi Mu, Phellodendron Bark Huang Bai, Gentiana Root Long Dan Cao, Alisma Rhizome Ze Xie, Plantago Seed Che Qian Zi, Scute Root Huang Qin, Sophora Root Ku Shen, Forsythia Fruit Lian Qiao, Gardenia Fruit Zhi Zi, Licorice Root Gan Cao), 2 tablets QID to clear heat and Calm Spirit (3 tablets contain: Magnesium Aspartate (75 mg), Taurine (100 mg) Enzymes: (300 mg) - Amylase, Cere Calase, Protease, Catalase, Alpha-Galactosidase, Lipase, Glucoamylase, Cellulase, Malt Diatase, and Herbs (1,800 mg) -- Biota Seed Bai Zi Ren, Peony Seed Bai Shao, Tang-kuei Root Dang Gui, Fu-shen Sclerotium Fu Shen, Polygala Root Yuan Zhi, Zizyphus Seed Suan Zao Ren, Ophiopogon Tuber Mai Men Dong, Codonopsis Root Dang Shen, Succinum Resin Hu Po ), 2 tablets QID for its heart yin nourishing and stress reducing effects.

After two weeks, Bob noticed that he was more regular and he had less headaches. His pulse was slightly slower and his tongue less red. We continued on the above mentioned protocol for one month and as his heat signs were alleviated, we eliminated Coptis Purge Fire and had him maintain on Calm Spirit and add Nine Flavor Tea (Rehmannia Root Shu Di Huang & Sheng Di Huang, Dioscorea Rhizome Shan Yao, Poria Sclerotium Fu Ling, Cornus Fruit Shan Zhu Yu, Moutan Root Bark Mu Dan Pi, Alisma Rhizome Ze Xie, Dendrobium Stem Ski Hu, Scrophularia Root Xuan Shen, Ophiopogon Tuber Mai Men Dong), which nourishes liver and kidney yin.

Eleanor suffers from nervous exhaustion. She also suffers from insomnia. She is largely housebound because she is fearful. When she goes outside, she is reminded of the time she was mugged. Eleanor is said to have a cold constitution. She was sickly as a child with bedwetting, asthma, eczema, and frequent bronchial infections. Her body type is thin; she is underweight. Eleanor does not work or do volunteer work. She has only recently been able to go out of the house twice a week to see a counselor. Previously, all trips out of the house resulted in panic attacks. Her pulse is slow and weak, and her tongue is pale; she has a pale complexion. We recommended Shen Gem (Ginseng Root Ren Shen, Poria Sclerotium Fu Ling, White Atractylodes Rhizome Bai Zhu, Zizyphus Seed Suan Zao Ren, Astragalus Root Huang Qi, Tang-kuei Root Dang Gui, Salvia Root Dan Shen, Amber Resin Hu Pa, Polygala Root Yuan Zhi, Longan Fruit Long Yan Rou, Jurinea Root Mu Xiang, Ginger Rhizome Gan Jiang, Licorice Root Gan Cao, Cardamon Fruit Sha Re n), 3 tablets QID to tonify Qi and blood, with ginger tea which is warming. After two weeks, response was good, so we added Rehmannia 8 (Rehmannia Root Shu Di Huang, Poria Sclerotium Fu Ling, Moutan Root Bark Mu Dan Pi, Dioscorea Rhizome Shan Yao, Cornus Fruit Shan Zhu Yu, Alisma Rhizome Ze Xie, Eucommia Bark Du Zhang, Cinnamon Bark Rou Gui), 1 tablet QID to tonify her kidney qi. After three months, Eleanor was able to leave the house on a daily basis to walk and to run errands. She attributes her changes to

counseling and herbs.

Jeannette was involved in a serious auto accident, which necessitated many surgeries and the almost constant use of pain-killers such as vicodin, and ibuprofen. She is also taking an anti-depressant, trazadone. She has panic attacks whenever she has to drive on the freeway. Jeannette uses food to comfort herself, and she is 50 pounds overweight. She wakes up tired after ten hours of sleep. In fact, bed is one of the few places she feels safe. However, once the day gets going she begins to pick up energy. She is a teacher who really enjoys her work. However, she has difficulty saying "no," and sometimes feels on the verge of having panic attacks when she thinks of all the things she has to do. Physical symptoms include frequent diarrhea, indigestion, bronchial, and urinary tract infections. Her tongue is pale with a red tip coated with heavy white coating. Her pulse has a slippery quality. Jeannette is said to have a Damp condition.

At the beginning, we recommended Six Gentlemen (Codonopsis Root Dang Shen, Atractylodes Rhizome Bai Zhu, Porea Sclerotium Fu Ling, Baked Licorice Root Zhi Gan Cao, Citrus Rind Chen Pi, Pinellia Tuber Ban Xia, Jurinea Root Mu Xiang, Cardamon Fruit Sha Ren), 3 tablets QID and Quiet Digestion (Poria Sclerotium Fu Ling, Coix Seed Yi Yi Ren, Shen Chu Herb Shen Qu, Magnolia Bark Hou Po, Angelica Root Bai Zhi, Pueraria Root Ge Gen, Red Atractylodes Rhizome Cang Zhu, Jurinea Root Mu Xiang, Pogostemon Herb Huo Xiang, Oryza Sprout Gu Ya, Trichosanthes Root Tian Hua Fen, Chrysanthemum Flower Ju Hua, Halloysite Chi Shi Zhi, Citrus Rind Ju Hang, Mentha Herb Bo He), 1 tablet QID and with 1 tablet with meals). In addition we suggested an elimination of damp producing foods such as dairy products and orange juice. Six Gentlemen tonifies qi, drains dampness and clears phlegm. Quiet Digestion removes food stagnation and drains dampness. After two weeks, she reported more energy; less indigestion and that her "head felt cleare r." After two weeks, we substituted Six Gentlemen for the stronger acting Source Qi. After two months, she rarely had diarrhea and she noticed greater energy and better ability to tolerate stress as her body felt stronger. After six months she was off vicodin and had lost 10 pounds as she no longer had bad food cravings.

Herbs work best when combined with a general health program, which includes a good diet, adequate rest, stress reduction, and daily exercise. For example, seniors or persons incapacitated by anxiety and other disorders may need gentle exercise such as walking, gardening, or swimming or water aerobics. More robust individuals may find more vigorous activity more effective. Making adequate time to eat, saying prayer or thanks before eating, all help promote the calm lacking in so many people's lives.

Can herbs be combined with drugs? In our clinic in Oakland California, frequently clients take herbs and drugs. For example, clients may take sleep medication at night but use herbs during the day for other discomforts due to anxiety, panic or other symptoms. Some of our clients with anxiety disorders are on various prescribed medicines for hypertension, antianxiety drugs, pain medication, etc. However, if they are having side effects from the medication, we can usually help them reduce side effects of their medication. If clients and their mental health professionals think it wise, we can incorporate an herbal program to assist them in reducing their medications.

Herbalists should be comfortable treating the patient on medication. If your practitioner is reluctant, it's best to seek a referral and find someone who is experienced in this area. To avoid herbal-drug interactions, it is important to take herbs and drugs 2 hours apart.

It is important to find an herbalist who can recommend herbs in a way you will comply with. For example, some clients prefer tea, alcohol extracts, or pills. It is not uncommon to start out with teas or alcohol extracts and switch to pills as they are easier to take long term. As the herbs are not drugs, it is common to drink several cups a day of infusion, 8 to 16 ounces of brewed decoction, or 9 or more pills per day. Some herbalists may even recommend herbal baths or bathing with aromatherapy, which can have immediate benefits.

What if you cannot find an herbalist to work with? Although there are many over the counter herbs sold for anxiety, these should be used cautiously with medications. Perhaps the safest are lavender essential oil which can be applied topically to the inner wrists and added to a bath, and Rescue Remedy a gentle herbal medicine which can be added to water and sipped on throughout the day.

In our experience the following popular herbs work best when combined with professionally prescribed constitutional tonic herbs. Like foods, herbs work best when used in combination. The well known herbal antidepressant, St. John's wort, has been found to interact with a variety of pharmaceutical drugs, so it is best used by clients who are not taking medications. In a few cases, it has also caused a photosensitive skin reaction. Ginkgo leaf is used to promote blood flow. Lately it has been used to help alleviate the side effects of sexual dysfunction caused by antidepressants. Clients need to take ginkgo for at least six weeks to observe clinical benefits. It has been reported to interact with blood thinning medications, including aspirin and coumadin. Kava Kava has natural sedative and muscle relaxant properties. Clinical studies have demonstrated it to be safe and effective. It should only be used under professional supervision if clients are taking sedating drugs. It should not be used before driving or operating heavy machinery as a general precaution. Constitutional tonics include Shen Gem, qi and blood tonic for clients with anxiety, fatigue, pallor, and difficulty falling asleep; Calm Spirit for heart yin deficiency with anxiety, dryness or heat, and waking up frequently at night; Source Qi for loose stools, and fatigue; Rehmannia 8 for fear, coldness, low back pain and frequent urination. Shizandra Dreams or Griffonex 5-HTP can be used before bed to help clients enjoy more restful sleep.

Herbal therapy, when appropriately used, can offer many benefits to clients suffering from anxiety and panic disorders. Botanicals are often more suitable than drugs for highly sensitive patients and individuals who have previous herb experience. They should be combined with techniques such as cognitive behavioral therapy. Whenever possible, use herbs under the direction of a professional herbalist.

COPYRIGHT 2002 The Townsend Letter Group
COPYRIGHT 2002 Gale Group