For the last 10 months I am having episodes during which I have difficulty breathing, my heart beats fast and I sweat a lot. Things around me suddenly seem unreal and I feel as if I am going to collapse. These attacks occur suddenly and out of the blue, but mostly they occur if I am under stress, feeling nervous, or in a difficult situation. The attacks, occurring three to four times week, last only a minute although I am frightened and exhausted for about an hour. I have consulted a cardiologist who, after an examination and ECG, asked me to consult a psychiatrist. Do I have a psychiatric disorder?

Name withheld

The symptoms described, with sudden attacks of fear or anxiety accompanied by flushing, pallor, racing heart, palpitation, sweating, cold hands, dry mouth etc., and leading to the expectation of a calamity, are characteristic of panic disorder. It can occur alone or be associated with a fear of being in open spaces, outside the home alone, or in a crowd.

It is a very common problem affecting 1.5 to 4 per cent of the population during their lifetime. It is also one of the easiest problems to treat, though if untreated it will have a chronic course, with remissions and exacerbations.

Some drugs like alprazolam or clonazepam give immediate relief, though they should not be continued for a long period. Other drugs commonly used as antidepressants and available in India can be started concurrently and continued for a much longer period without harm. Behavioural therapy will also have to be started and can maintain remission even after stoppage of all medicines.

Lastly, do remember that ‘psychiatric disorders’ are like any other illnesses and if you do not feel shy of consulting a physician for your hypertension there is no reason why you should hesitate to consult a psychiatrist for your panic disorder.