Researchers Find Panic Attack Link to Suicides : Medicine: Disabling bouts of acute anxiety affect millions. Doctors ought to take the unpredictable episodes seriously, experts say.
People who experience panic attacks are more likely than others to attempt or consider suicide, according to a new study that researchers say should prompt physicians to take more seriously an anxiety disorder afflicting millions of Americans.
The study, published today in The New England Journal of Medicine, documents for the first time a direct link between suicide attempts and panic attacks--bouts of acute anxiety often accompanied by intense fears of death or madness. Suicide is believed to be triggered primarily by depression.
“The bottom line is that panic disorder is another risk factor for suicide attempts,” said Myrna M. Weissman, the Columbia University epidemiologist who headed the study. “I think that panic disorder ought to be taken seriously. It ought to be diagnosed.”
Panic attacks are recurrent, unpredictable episodes of sudden apprehension or fear, as Weissman and others describe them. The symptoms may include palpitations, chest pain, dizziness, a smothering sensation, sweating, faintness and trembling.
As many as 10% of all people experience panic attacks at some point during their lives, epidemiological studies show. About 1.6% to 2% suffer from the more serious panic disorder, in which attacks occur as frequently as once a week.
People with panic attacks and panic disorder tend to worry about their attacks. As a result, many become unable to concentrate or sleep. Chronic fatigue and strain can cause increased anxiety and depression, driving some to alcohol and drugs.
Many turn up repeatedly in hospital emergency rooms, fearing they are having a heart attack. Some become unwilling to be alone, to venture into public places or to return to places where panic attacks have occurred.
The precise cause of the attacks is unclear. In some cases, the tendency may be inherited. The condition has become better known in recent years and can be treated with drugs and therapy. However, specialists say many physicians fail to take the symptoms seriously.
Weissman’s group studied 18,011 adults living in five U.S. communities, including Los Angeles. Each participant was interviewed extensively using a standard questionnaire designed to identify a wide range of established psychiatric conditions.
The researchers then divided the sample into four groups--people who had been diagnosed with panic disorder, people with panic attacks, people with other psychiatric disorders such as depression and schizophrenia, and people with no disorders.
Among those with panic disorder, 20% had attempted suicide at some time in their lives. By contrast, only 12% of those with panic attacks, 6% of those with other psychiatric disorders and 1% of those with no disorder had attempted suicide.
Similarly, 47% of those with panic disorder reported having “felt so low” that they had considered suicide. By contrast, 35% of those with panic attacks, 19% of those with other disorders, and only 4% of those without disorders had contemplated killing themselves.
Weissman, a professor of epidemiology and psychiatry at Columbia College of Physicians and Surgeons and the New York State Psychiatric Institute, said the findings surprised her. So she explored whether other psychiatric conditions might explain the link to suicide.
But a complex series of statistical analyses persuaded the researchers that the suicide attempts and suicidal thoughts were related to the panic attacks--not to any depression, drug abuse or other conditions from which the people suffered.
“We conclude that panic disorder and attacks are associated with an increased risk of suicidal (thoughts) and suicide attempts,” the group wrote. “Physicians working in general medical settings and emergency departments should be alert to this problem.”
Others in the field emphasized that point.
“It is a rare event when new and useful information about suicide appears in the medical literature,” Dr. Peter Reich of the Massachusetts Institute of Technology wrote in an accompanying editorial in the journal.
Reich said the finding “deserves widespread attention” and “may provide general physicians with new opportunities to prevent suicide by recognizing and treating panic disorder.”
Reich, who called panic disorder “a relatively new concept in medicine,” said many physicians may be unfamiliar with the condition. They “may not appreciate the intense distress associated with panic attacks,” and patients may be unwilling to discuss them in detail.
But recurrent attacks can leave patients demoralized and isolated, unable to conduct a normal life. By diagnosing the disorder and explaining to the patient that the cause may be biological, a physician can bring the patient some relief, Reich said.
