Panic attacks and depression in osteochondrosis

Today, many people suffer from attacks of unreasonable panic fear. It can occur suddenly - in the subway, at home, among a crowd of people or completely alone, early in the morning or late at night. Such attacks are called “panic attack” or “vegetative crisis”. In fact, panic attacks and their symptoms are quite diverse, and can manifest differently in different people.

As a rule, at first there is a slight uneasy feeling. Anxiety increases in a matter of minutes - from fear a person cannot move: get up, go outside, go to work. The heart beats faster, the hands sweat, dizziness, headache, nausea, tremors occur, and the arms or legs may even become numb. It seems to a person that he is about to lose consciousness, go crazy, or even die from a heart attack or stroke, and therefore he is afraid to move, so as not to fall in front of many people or, conversely, to be left without help. And so, he can wait for 30-60 minutes until the attack of fear subsides.

“One day I was tinkering with my car in the garage as usual. Suddenly, out of the blue, I felt numbness on the left side of my face and body. I couldn't move, it was like I was paralyzed. At the same time, I began to feel very thirsty - my throat was dry. I felt hot and cold, and I just lay down in the car and waited for it to end. After 30 minutes I was released. From then on, as soon as I approached the car, I felt bad, and if I got behind the wheel, everything swam before my eyes. In the end, I even had to quit my job as a car mechanic,” patient Arthur (46 years old).

It also happens that a person who suddenly has a panic attack, on the contrary, runs as quickly as possible into fresh air because he experiences an acute feeling of suffocation - and this helps him cope with the attack.

Some patients complain that they begin to experience anxiety when faced with a specific situation. For example, when you need to drive or go to work. If a person continues an action that irritates his nervous system, the intensity of the attack increases. If he stops the action and returns home, then the anxiety gradually fades away. Thus, many people who suffer from panic attacks and their symptoms have to quit work, study, and completely change their usual lifestyle. And this method also often helps them to significantly reduce the manifestations of panic disorder, but not get rid of it completely. In addition, not everyone can afford such drastic changes in life.

What to do if you experience regular attacks of panic?

Panic attack symptoms

People with panic disorder very often do not see a doctor for a long time and do not tell their loved ones about the existing problem. As a rule, a person either thinks that there is no problem, and he himself will be able to cope with his poor health, forcibly overcoming all the signs of a panic attack, or he is embarrassed by his “weakness,” or is completely afraid that he will be “sent to a mental hospital.” This is completely unnecessary. However, it is necessary to treat sudden and regular panic fear.

“When I first had a panic attack, I had to call an ambulance. They just gave me glycine and didn't tell me anything else. After that, I went through the entire cardiology center and passed all the tests. I was told that I was absolutely healthy. My family and friends thought I was faking it. I tried not to pay attention to the attacks, reassuring myself that when I came home everything would be fine. Sometimes he deliberately drove himself into a traffic jam in order to overcome his fear. Such a nightmare was happening that you could at least abandon the car and leave. Sometimes I did just that. I would drop my car off at the metro station and come and pick it up the next day. Although before this illness I generally tolerated traffic jams calmly,” patient Pavel (41 years old).

First, let’s look at the symptoms with which you can probably come to the doctor and say: “Doctor, I’m having panic attacks. What to do?"

Psycho-emotional component of a panic attack. Symptoms and signs:

- Sudden, unreasonable attacks of fear/anxiety/panic, lasting from several minutes to several hours

- Waiting for sudden death, waiting for an attack

- Intrusive thoughts (usually related to death)

— Blurred consciousness

- Feeling of derealization (“I am separate, the world is separate”, “the world through cellophane”, “like in an aquarium”)

- Constant feeling of anxiety

— Various phobias (agoraphobia, social phobia, etc.)

— Insomnia, “nightmare” dreams

— Decreased mood, tearfulness

- Irritability, aggressiveness

“In the summer of 2014, I realized that I regularly could not fall asleep until 5-6 o’clock in the morning. The stuffy summer aggravated my condition, I constantly experienced a feeling of lack of air, my heartbeat quickened, obsessive thoughts arose in my head: “What if I’m dying?” - panic grew, but I had no strength to move or call an ambulance. I lay there like that until the morning, when my eyes closed on their own from fatigue and constant tension. This happened several times a week,” patient Elena (28 years old, manager).

Physiological component of a panic attack. Symptoms and signs:

— Dizziness, headache, heaviness in the head, noise in the head/tinnitus

- Lack of air, suffocation, shortness of breath

— Rapid heartbeat, feeling of interruptions in the heart, pain in the heart

- Nausea, abdominal discomfort

- Chills, fever, sweating

- Trembling in the arms, legs, body

- Muscle tension, numbness in limbs

— Gastrointestinal tract disorder

- Feeling tired, weak, lack of strength

“5 years ago I was unsuccessfully treated with antibiotics and after that I started having stomach problems. All these years I suffered from constant diarrhea. I contacted a parasitologist, gastroenterologist, immunologist and other specialists. Tests and clinical studies did not reveal any diseases. I tried to be treated with probiotics and prebiotics, but to no avail. Other symptoms also began to bother me: heaviness in the head, tension in the back and neck, anxiety for no reason, fear for one’s health, sometimes the heart was pounding wildly, in the morning after sleep there was slight dizziness and, of course, constant fatigue and weakness,” patient, Andrey (31 years old).

Important symptoms of panic attacks are also their systematicity and regularity. The interval between panic attacks can vary from a few minutes to several days or months, but their regular occurrence indicates that you are suffering from a panic disorder.

Panic attack. Emergency self-help.

First, learn how to manage your panic attacks yourself to control them and reduce the intensity of your panic attack symptoms.

Try practicing breathing techniques.

Breathe through your diaphragm (belly), in through your nose and out through your mouth slowly and calmly. For example, for 5 counts – inhale, for 10 – exhale.

“Some patients benefit from progressive muscle relaxation. If your muscles are very tense during a panic attack, try tightening your facial muscles: tense your jaw for 8 seconds - then relax, tense your lips for 8 seconds - relax. Repeat the exercise with your arms (palms, forearms) and switch to the next muscle group, for example, the calf muscles, the feet. Alternate tension and relaxation of all parts of the body will help relax the muscles and distract thoughts,” recommendations of a neurologist-vegetologist (“Clinical Center for Autonomic Neurology”).

During a panic attack, try to distract yourself and not think about the symptoms that are bothering you. Use psychological techniques. Visualize some place where you felt good: a house, a vacation spot, a cottage, a forest, a sandy beach - whatever your heart desires. And imagine in detail the entire environment that surrounds you there: a soft chair, a fluffy cat, the smell of pine trees, the crunch of branches under your feet, birdsong, warm sand, etc. Think in advance about where it would be better for you to “go” when you have another panic attack in order to distract your thoughts from its symptoms.

Keep a diary of panic attacks that you can refer to in critical situations. This way you can remind yourself that there is nothing to be afraid of, and the next panic attack will soon pass.

Atarax®

Contraindications for joint use.

Co-administration of hydroxyzine with drugs known to prolong the QT interval and/or cause torsade de pointes (TdP), for example, class IA (such as quinidine, disopyramide) and class III antiarrhythmics (such as amiodarone, sotalol), some antihistamines drugs, some antipsychotics (eg, haloperidol), some antidepressants (eg, citalopram, escitalopram), some antimalarials (such as mefloquine and hydroxychloroquine), some antibiotics (such as erythromycin, levofloxacin, moxifloxacin), some antifungals (eg, pentamidine ), certain drugs used to treat gastrointestinal problems (such as prucalopride), certain drugs used to treat cancer (such as toremifene, vandetanib), and methadone, which increases the risk of heart rhythm problems. Therefore, such combinations are contraindicated.

Co-prescription of drugs requiring special precautions during use

Caution is required when using drugs that cause bradycardia and hypokalemia.

Caution is required when using hydroxyzine in doses higher than recommended in patients receiving concomitant treatment with drugs with arrhythmogenic effects: quinidine, lithium, thioridazine, tricyclic antidepressants, atropine, etc.

The potentiating effect of hydroxyzine should be taken into account when using the drug together with drugs that have a depressant effect on the central nervous system or have anticholinergic properties; in this case, the dose should be selected individually.

Alcohol also potentiates the effect of hydroxyzine. Concomitant use of hydroxyzine with monoamine oxidase inhibitors should be avoided.

In the case of treatment with anticoagulants, control of hemostasis is necessary at the beginning of therapy.

Hydroxyzine exhibits antagonistic properties towards betahistine and anticholinesterase drugs. Treatment should be stopped at least 5 days before an allergy test or a provocative test for bronchial reactivity with methacholine to avoid affecting the study results.

The administration of hydroxyzine may affect the results of determination of 17-hydrocorticosteroids in urine.

Hydroxyzine counteracts the pressor effect of adrenaline.

When used in rats, hydroxyzine antagonized the anticonvulsant effects of phenytoin.

Cimetidine at a dose of 600 mg divided into 2 doses per day caused an increase in the concentration of hydroxyzine in the blood serum by 36% and a decrease in the maximum concentration of the cetirizine metabolite by 20%.

Hydroxyzine is a CYP2D6 inhibitor (enzyme release rate constant (Ki): 3.9 µmol; 1.7 µg/ml) and in high doses can lead to drug interactions with CYP2D6 substrates (metoprolol, propafenone, timolol, amitriptyline, clomipramine, desipramine , imipramine, paroxetine, haloperidol, risperidone, thioridazine, aripiprazole, codeine, dextromethorphan, duloxetine, flecainide, mexiletine, ondansetron, tamoxifen, tramadol, venlafaxine).

Hydroxyzine at a concentration of 100 μmol does not have an inhibitory effect on uridine diphosphate (UDP)-glucuronyltransferase isoforms 1A1 and 1A6 in human liver microsomes. It inhibits cytochrome P450 isoforms 2C9/C10, 2C19 and 3A4 at plasma concentrations exceeding the maximum (IC50 (mean concentration required to achieve half maximum inhibition): 103-140 µmol; 46-52 µg/ml). Therefore, it is unlikely that hydroxyzine can disrupt the metabolism of drugs that are substrates for these enzymes.

The cetirizine metabolite at a concentration of 100 µmol does not have an inhibitory effect on liver cytochrome P450 (1A2, 2A6, 2C9/C10, 2C19, 2D6, 2E1 and 3A4) and isoforms of UDP-glucuronyltransferase.

Hydroxyzine is metabolized by alcohol dehydrogenase and CYP3A4/5.

An increase in the concentration of hydroxyzine in the blood can be expected when it is used simultaneously with drugs that are inhibitors of these enzymes (telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole and some HIV protease inhibitors, including atazanavir, indinavir, nelfinavir, ritonavir, saquinavir, lopinavir/ritonavir, saquinavir/ritonavir and tipranavir/ritonavir). However, when only one metabolic pathway is inhibited, the effect can be partially compensated by other metabolic pathways.

Panic attacks. Difficulties in diagnosis.

People suffering from the symptoms of panic attacks usually do not know where to turn. They visit the offices of a therapist, cardiologist, endocrinologist, psychiatrist, psychologist, but doctors do not detect any disturbances in the functioning of the body. Of course, it is advisable to undergo all possible examinations and pass all the necessary tests in order to exclude the development of serious physiological abnormalities. However, if, in the end, they tell you that you are absolutely healthy, but anxiety, tachycardia, insomnia and other symptoms continue to torment you, then most likely you suffer from panic disorder, which means the problem lies in a disruption of the autonomic nervous system , which can only be identified by an experienced neurologist-vegetologist.

Some patients with signs of panic attacks are diagnosed with vegetative-vascular dystonia (VSD) and told that they will have to live with such symptoms all their lives, alleviating them with medications: antidepressants and tranquilizers.

“I went to all the doctors because there were a lot of symptoms: my heart, shortness of breath, blood pressure, my stomach, bones, muscles ached, I felt constant anxiety. At first, rare panic attacks grew into a daily norm. The neurologist prescribed Coaxil, but the pills made me feel worse. I drank Coaxil for three months and barely got off it. Then the therapist prescribed me adaptol. It made me feel better, but only while I was drinking it, and as soon as I stopped drinking, everything started all over again. Everything was useless until I learned from friends about the “Clinical Center for Autonomic Neurology”,” patient, Arthur (46 years old).

The deep misconception that VSD and panic attacks cannot be treated can be dispelled if you visit a doctor who specializes specifically in disorders of the autonomic nervous system. Panic attacks can be treated and diagnosed! The main thing is to know where and how this can be done.

Atarax - for nerves and mental disorders

The scourge of the 21st century is stress. And to it anxiety, excitement, neuroses, panic attacks, somatic manifestations (urticaria, skin itching, allergic dermatitis, eczema), sleep disturbance. It would seem that there’s nothing wrong with it, just rest and everything will pass. But if it doesn’t go away, gets worse and disrupts the usual rhythm of life, then it’s time to see a doctor. If we mean exclusively drug treatment, then the specialist will most likely write a prescription for the anxiolytic (tranquilizer) Atarax, which is allowed even for children from one year of age.

Figure 1 - Stress is the real scourge of the 21st century

The main active component - hydroxyzine - has a calming, anti-allergenic, analgesic, antispasmodic effect, and also increases concentration, improves attention and cognitive functions. If anxiety is pronounced, and chronic insomnia is also associated with it, then Atarax, or rather hydroxyzine, relieves anxiety, normalizes sleep, strengthening and increasing its duration, and reduces the frequency of awakenings at night. The drug is able to relax skeletal muscles, as well as smooth muscles. All this is due to the effect of Atarax on certain areas of the subcortical zones of the brain.

The drug is absorbed into the gastrointestinal tract, after which it quickly enters the systemic circulation. That is why the effect of taking Atarax is noticeable within 15-30 minutes.

If you take Atarax for a long time, then addiction or dependence on the drug will not develop. This means that he does not have “withdrawal syndrome”.

Indications

Indications for use of the drug are:

• relief of psychomotor agitation, tension, irritability in mental, neurological, somatic diseases;
• symptomatic treatment of withdrawal syndrome that occurs against the background of chronic alcoholism;
• anxiety;
• providing a sedative effect during premedication;
• therapy for itchy skin.

Why and why Atarax needs to be taken is determined by the attending physician. As a rule, taking Atarax is provoked by diagnosed skin diseases, which are accompanied by severe skin itching.

Contraindications

Atarax should not be taken if a person has the following diseases or conditions:

• pregnancy;
• childbirth;
• lactation period;
• porphyria;
• intolerance or hypersensitivity to the components of the drug;
• high sensitivity to cetirizine, piperazine derivatives, as well as ethylenediamine or aminophylline;
• angle-closure glaucoma;
• impaired absorption of glucose and galactose;
• hereditary galactose intolerance.

Figure 2 - Pregnant women are contraindicated to use Atarax

Atarax is used with caution in the following cases:

• myasthenia gravis;
• prostatic hyperplasia;
• difficulty defecating and urinating;
• dementia;
• increased intraocular pressure;
• predisposition to arrhythmia and seizures.

Side effects

Since Atarax is a drug that affects the central nervous system, it can sometimes cause suppression of certain functions or paradoxical stimulation. Also, when taking it, negative reactions from the body may occur:

• From the cardiovascular system: blood pressure rarely decreases, heart rate increases.
• From the point of view: decreased clarity of vision, impaired accommodation.
• From the gastrointestinal tract: a feeling of dry mouth, rarely - vomiting, nausea, problems with intestinal motility and, as a result, constipation.
• From the immune system: hypersensitivity, rarely anaphylactic shock may develop.
• From the urinary system: urine retention is rarely possible.
• From the respiratory system: rarely - bronchospasm and suffocation.
• Neurological disorders: drowsiness, headache, insomnia, dizziness, rarely – convulsions.
• Mental disturbances are rare: agitation, disorientation, and hallucinations are possible.
• Skin: itching, rash, rarely - swelling.
• General disorders: weakness, fever, fatigue.

How to take Atarax

At the pharmacy, Atarax can be purchased in two forms - a solution for intramuscular injection and tablets for oral administration. The dosage is selected by the attending physician and depends on the clinical picture of the disease, symptoms, nature of the course and the patient himself, or rather his individual reaction of the body to Atarax therapy.

Figure 3 - How to take Atarax correctly

Atarax in ampoules:

Premedication

• children: 1 mg/kg body weight 1 hour before surgery, if necessary, the dose can be administered at night before anesthesia;
• adults: 50–200 mg 1 hour before surgery, if necessary, the same dose can be administered the night before anesthesia.

Symptomatic treatment of itching

• children 1–6 years old: 1–2.5 mg/kg per day in several doses;
• children over 6 years old: 1–2 mg/kg per day in several doses;
• adults: at the beginning of treatment - 25 mg 1 time / day, if necessary, increase the dose to 25 mg 4 times / day. In this case, the maximum dose should not exceed 300 mg per day and 200 mg at a time.

Symptomatic treatment of anxiety: morning and afternoon - 12.5 mg, at night - 25 mg (total daily dose - 50 mg).

If the need arises, the doctor can increase the daily dose to 300 mg (maximum value). But if the patient has a history of renal or liver failure, or if the patient is elderly, then the dose is reduced.

Atarax tablets:

Reception during premedication and for symptomatic treatment of itching coincides with the recommendations when using Atarax injection solution.

Anxiety

• The daily dose for adults is 50 mg and, if necessary, can be increased to 300 mg. A quarter of the daily dose is taken in the morning during the day, and all that remains is taken before bed.

If the medicine is used by patients with a history of renal or liver failure, as well as people in older age groups, dosage adjustment (reduction) may be required.

Compatibility with other drugs

A separate issue when taking Atarax is its interaction with other medications. Thus, barbiturates, tranquilizers, opioid analgesics, ethanol-containing drugs, sleeping pills and any other drugs that depress the central nervous system, when taken simultaneously with Atarax, enhance their effects. That is, lethargy, indifference, drowsiness and other effects will appear several times brighter and stronger. But if it is still necessary to take everything together, then the doctor monitoring the patient will draw up a dosage regimen and select an individual dosage for each drug.

Figure 4 - Compatibility of other drugs with Atarax

The combination of Atarax + MAO inhibitors, anticholinergics is not recommended. Atarax is able to inhibit the action of epinephrine (adrenaline) and suspend the anticonvulsant effect of phenytoin.

Atarax has a destructive effect on the metabolism of substrate drugs for uridine diphosphate and glucuronyl transferase.

If you drink Cimetidine and Atarax at the same time, the concentration of hydroxyzine in the blood plasma will increase, but on the contrary, the concentration of metabolites will decrease.

As for cardiac glycosides, atropines, antihypertensive drugs, antiallergic drugs, Atarax does not in any way affect their functionality; the pharmacological effect provided.

However, it is worth remembering that it is better not to take drugs whose side effects indicate possible arrhythmia with Atarax. When they are mixed, there is a risk of prolongation of the QT interval and the development of ventricular tachycardia of the “pirouette” type.

Atarax during pregnancy and during breastfeeding

Atarax should not be taken during pregnancy, childbirth and lactation. Hydroxyzine penetrates the placenta and negatively affects the unborn baby. Since Atarax relaxes the smooth muscles of the uterus, preventing it from contracting as desired, this can disrupt the course of labor. When breastfeeding, Atarax enters the child's body through mother's milk, and this is prohibited for children who are not yet one year old.

Atarax and alcohol

Figure 5 - Drinking alcohol is prohibited when taking Atarax

During therapy with Atarax, drinking alcohol is prohibited, as alcohol enhances the effect of the drug and provokes adverse reactions. That is, the central nervous system is depressed, the state of intoxication increases, blood pressure decreases, and allergic reactions appear. With all this, there is a high risk of severe intoxication of the body, which can lead to death.

Atarax for neuroses and panic attacks

Neuroses are a fairly common diagnosis. This is a reversible neuropsychic disorder, which is provoked by constant stress, chronic fatigue, tension and anxiety. Neuroses are often accompanied by panic attacks. A panic attack is a state of sudden and extremely intense attack of fear or anxiety. Refers to neurotic diseases.

For such conditions, the doctor may prescribe Atarax. The main purpose of this tranquilizer is to calm and relieve anxiety. The product must be used strictly as prescribed by the doctor in the prescribed dosage and regularity. Atarax suppresses the activity of certain areas of the brain, relieving tension and panic attacks.

Analogues of Atarax

In the pharmacy you can find the following analogues of Atarax: Hydroxyzine, Phenazepam, Grandaxin, Anvifen.

Figure 6 - Analogues of Atarax

Remember that the prescription of an analogue or replacement of one drug with another is made exclusively by the attending physician, who can correlate the nature of the disease, the desired effect of taking the drug, contraindications, adverse reactions and dosage.

Atarax is sometimes compared to Phenibut. But this is not entirely true.

Atarax or Phenibut?

Phenibut is a nootropic drug that improves cognitive abilities and has a mild tranquilizing effect. This drug effectively relieves anxiety, psycho-emotional stress, and improves sleep. But Atarax is a tranquilizer, most often used to relieve itching, reduce anxiety and psychomotor agitation.

Panic attacks. Modern diagnostic methods.

Only a qualified neurologist-vegetologist can diagnose panic disorder, which manifests itself as panic attacks, identify its symptoms and prescribe optimal treatment.

At the initial examination, the vegetarian doctor must examine the patient’s normal reflexes, his muscular system, sensory organs, cognitive functions (memory, speech, perception), assess the general psycho-emotional state of the patient, taking into account all his complaints in order to collect a complete picture of the disease.

Next, there are several methods for diagnosing autonomic nervous disorder. One of them is the study of heart rate variability.

The patient performs a simple load: first he lies on his back, and after a few minutes he gets to his feet. In this way, we simulate a standard everyday situation when the minimum load is placed on our body. During this time, sensors attached to the patient's chest record the rhythm of his heart, and the doctor then compares the changes in rhythm in both positions. Such a study shows how adapted the human body is to the usual minimum load, which our autonomic nervous system normally copes with every day without the slightest difficulty.

How it works?

In a healthy state, our body responds adequately to any “stress”, any load (mental, physical, emotional). Therefore, when a healthy person gets up, the sympathetic part of the autonomic nervous system is activated in his body and the hormone adrenaline is produced, which means the heartbeat quickens. When a person lies down, his body should normally be in the mood for rest and relaxation. At the physiological level, this manifests itself as follows: the parasympathetic department of the autonomic nervous system becomes active and the hormone acetylcholine is released, which extinguishes the activity of adrenaline, and a phase of relaxation and replenishment of the body’s reserves begins.

But in patients with symptoms of panic attacks, an abnormal change in heart rhythms is observed: that is, when a person lies down, his pulse quickens and becomes faster and faster. That is, when a person gives his body the command to tune in to rest, the body understands the opposite - and prepares to run a short distance race. This is why people with disorders of the autonomic nervous system so often cannot sleep at night and never feel rested and alert.

Thus, the doctor concludes that the harmonious functioning of the sympathetic and parasympathetic parts of the nervous system is disrupted. This means you can move on to the next stage of the examination.

Among the innovative methods for diagnosing panic disorder are studies of the autonomic nervous system using infrared thermography. In an infrared image, a thermal imager clearly shows in which nodes (ganglia) of the autonomic nervous system the work is disrupted. It is with these vegetative nodes that the neurologist-vegetologist will subsequently work.

“Serious scientific research over the last decade has shown the high reliability and reliability of thermography. This allows this method to be used in medical practice to make a diagnosis in complex cases,” James Mercer, Professor, President of the European Thermography Society (EAT).

After treatment, you can take a repeat infrared photo, in which you will notice progress from the completed course. Areas with abnormal temperatures (bright red or dark blue) will change color in the image because their temperature regime is closer to normal.

Anti-anxiety effectiveness of Atarax

Sometimes anxiety is natural, adequate, and useful. Everyone feels anxious, restless or stressed in certain situations, especially if they have to do something unusual or prepare for it. For example, giving a speech in front of an audience or passing an exam. A person may feel anxious when walking down an unlit street at night, or when lost in a strange city. This type of anxiety is normal and even useful, as it prompts you to prepare a speech, study the material before an exam, and think about whether you really need to go out at night all alone. In other cases, anxiety is unnatural, pathological, inadequate, harmful. It becomes chronic, constant and begins to appear not only in stressful situations, but also for no apparent reason. Then anxiety not only does not help the person, but, on the contrary, begins to interfere with him in his daily activities. The line between a “normal” stress response and a pathological anxiety disorder is often quite blurred, and it is difficult for a person to know when to seek professional help. These subsyndromal anxiety disorders are the most difficult to diagnose and often remain untreated, while having an extremely negative impact on the quality of life of the patient and those around him. It is believed that treatment options should be considered when anxiety about everyday events is beyond the patient's control. The following disorders may also be a reason for prescribing therapy: nervousness, fussiness, impaired concentration, irritability, sleep disturbance, symptoms of autonomic dysfunction. The main approaches to the treatment of anxiety disorders are: • psychotherapy • pharmacotherapy For treatment purposes, you can use simple relaxation methods (muscle relaxation, calm breathing, distraction). Friendly and encouraging conversation also helps improve the condition. The main groups of drugs for the treatment of anxiety disorders: • Benzodiazepine tranquilizers • Antidepressants: – selective serotonin reuptake inhibitors, – tricyclic antidepressants • Neuroleptics • Non-benzodiazepine tranquilizers Benzodiazepines – quickly relieve sleep disorders and anxiety symptoms. Among the disadvantages of treatment with benzodiazepines, the following should be mentioned: “recoil” syndrome (rapid resumption or transient increase in symptoms after discontinuation of the drug), the risk of addiction and the formation of drug dependence, impaired cognitive functions (attention, concentration, memory), and impaired coordination. Therefore, drugs of the benzodiazepine group should not be taken for more than 2–4 weeks. Tricyclic antidepressants are powerful drugs that effectively relieve all anxiety and depressive symptoms (affecting both physical and mental manifestations of anxiety) and sleep disorders. Can be used for long-term treatment and prevention of anxiety. Tricyclic antidepressants have more pronounced side effects (dry mucous membranes, constipation, cardiovascular disorders, transient cognitive impairment). This worsens tolerability and increases the list of contraindications for their use in the treatment of anxiety, especially in patients with concomitant somatic diseases. Selective serotonin reuptake inhibitors are relatively safe, have a minimal range of side effects, are not addictive, and therefore can be used as long-term maintenance treatment. Their relative disadvantage is the long “waiting” period before the onset of the clinical effect of the drug (from 2 to 4 weeks). In addition, antidepressants in this group have side effects such as increased appetite and weight gain, nausea, loose stools, constipation, sweating, sleep disturbances, and sexual functions (libido and orgasm). In some cases, a positive effect in the treatment of anxiety is achieved with the use of antipsychotics. Typically, small doses of these drugs are used. However, when antipsychotics are prescribed, weakness, decreased blood pressure, menstrual irregularities, weight gain, colostrum secretion, and decreased libido may occur. Finally, international recommendations list another drug for the treatment of anxiety – hydroxyzine (Atarax). It is characterized by a rapid onset of effect, absence of addiction and drug dependence, does not impair cognitive functions, and has antipruritic and antiemetic effects. Hydroxyzine is neither a benzodiazepine nor a phenothiazine. The non-benzodiazepine anxiolytic Atarax (hydroxyzine) is a derivative of diphenylmetane, an antagonist of histamine H1 receptors. Hydroxyzine has been successfully used in a variety of areas of medicine: as a means of controlling tobacco smoking [1]; in pediatric dentistry [2]; for its intended purpose – for the treatment of anxiety neurosis (even in the era of the existence of such a nosological form) and for “mild” depression [3]; for behavioral and learning disorders in children [4]. Due to its antihistamine properties, hydroxyzine was used in allergology, to treat itching [5], and for urticaria pigmentosa (mastocytosis) in children [6]; in oncology [7]; in burn patients [8], in narcology [9] and in many other conditions. Recently, there has been interest among researchers in the use of hydroxyzine in patients with generalized anxiety disorder (GAD). The prevalence of this pathology and the associated burden of social consequences in the current scientific literature appear to be quite significant. According to one review [E.G. Starostina. Generalized anxiety disorder and anxiety symptoms in general medical practice. Rus. honey. magazine 2004; 12, 22 (222): 1277], with reference to numerous foreign works, “GAD is among the top ten diseases with the greatest temporary disability and according to this indicator is on the same level with ischemic heart disease, diabetes, joint diseases, peptic ulcer disease, and among mental disorders – with depression or even ahead of it.” In a double-blind, placebo-controlled study for the treatment of generalized anxiety disorder [10], the anxiolytic activity of Atarax at a dose of 50 mg (in 3 doses of 12.5 mg in the morning and afternoon plus 25 mg in the evening) was shown, which was manifested in a statistically significant, rapid and a significant reduction in anxiety symptoms already at the end of the 1st week of treatment, which persisted for another 1 week after cessation of treatment (n=110; course duration 4 weeks; Hamilton scale score - A). In this case, there was no phenomenon of “rebound” or return of anxiety. In another double-blind multicenter study [11], in which, along with placebo control, the benzodiazepine drug Bromazepam was also used, it was shown that hydroxyzine used for 3 months was statistically significantly different from placebo and was as effective as the comparison drug . Moreover, with benzodiazepine, side effects of severe drowsiness were observed twice as often as with hydroxyzine (n = 334; dose of hydroxyzine 50 mg/day in 3 divided doses; bromazepam - 6 mg/day in 3 divided doses; improvement on the Hamilton-A scale >50 %; p<0.03 at the end of the 6th week and p<0.001 - after 12 weeks; the number of patients who responded to treatment: 40% at the 6th and 60% at the 12th week, respectively). Another study [12] showed the effectiveness of Atarax (50 mg in 3 doses), comparable to that of the control buspirone (20 mg in 3 doses), with a statistically significant difference between Atarax and placebo on the 28th day of treatment (p <0.015) . There was no rebound phenomenon with abrupt withdrawal of both drugs (n=244; age 18–65 years). Another advantage of hydroxyzine is that, unlike benzodiazepines, it does not depress cognitive abilities [13] (triple crossover, double-blind clinical trial; comparing a single dose of 50 mg of hydroxyzine with a single dose of 2 mg of lorazepam and placebo; n = 9; healthy volunteers; 3-day interval before cross-over; assessment of cognitive functions 2-5 hours after taking comparator drugs). Some studies have shown a positive effect of hydroxyzine on cognitive function [14] (comparison with lorazepam; double-blind multicenter clinical trial; n = 30; GAD, Atarax 100 mg in 3 divided doses, lorazepam 4 mg in 3 divided doses; Beck score 28 -th day of treatment). Unlike lorazepam, with the same anxiolytic activity, hydroxyzine restored cognitive function to normal limits. Similar results were obtained in another, less evidence-based study - an open RCT [A.E. Bobrov et al. Journal neurol. and psychiatrist. them. S.S. Korsakov. 1988; 2] outpatients with GAD; (n=50). The course of treatment is 4 weeks, plus 2 weeks of follow-up. Features of Atarax - rapid onset of action, good tolerability, lack of dependence and depression of the central nervous system, make it an alternative drug to benzodiazepines in children and adolescents. In a study conducted at the Children's Psychiatry Center [15], Atarax was prescribed for various forms of mental illness in children and adolescents with symptoms of anxiety, irritability and insomnia-type sleep disorders, and its effectiveness was assessed. The study included 50 patients aged 5 to 18 years with various forms of mental illness, who were undergoing outpatient observation and treatment at the Children's Psychiatry Center. At the end of the 4th week of therapy, there was a decrease in the manifestations of anxiety and various fears noted earlier - falling asleep in the dark, staying at home in the absence of parents, fears of animals, noise of household appliances. In one case, a 5-year-old boy could stay at home with a nanny without his parents - a pronounced affective reaction was previously noted. In addition, all patients' sleep improved already in the second week of therapy, tearfulness, moodiness, and irritability were reduced. Simultaneously with the reduction of anxiety, the mood improved in 7 patients with a mixed anxious and depressive reaction caused by an adaptation disorder and with a mixed anxiety and depressive disorder, which was associated not with the direct antidepressant effect of Atarax, but with the comorbid dependence of anxiety and depression: anxiety was reduced - depression went away. Hydroxyzine (Atarax) has its obvious advantages over benzodiazepine anxiolytics in the treatment of anxiety disorders; it does not produce “rebound” phenomena, does not depress cognitive function and does not cause pathological dependence. References 1. Turle G. An investigation into the therapeutic action of hydroxyzine/Atarax in the treatment of nervous disorders and the control of tobacco–habit. Brit J Psychiat 1958; 104: 82 rub. 33. 2. Lang L. An evaluation of the efficacy of hydroxyzine (atarax–vistaril) in controlling the behavior of child patients. J–Dent–Child 1965; 32, 4: 253–8) 3.R.Middlefell, K.Edwards Hydroxyzine/Atarax in the relief of tension associated with anxiety neurosis and mild depressive states. Brit J Psychiat 1959; 105:792–4. 4. Segal L, Tansley A. A clinical trial with Hydroxyzine (Atarax) on a group of maladjusted educationally subnormal children.J Mental–Science; Br J Psychiat from 1963; 1957; 103:677–81. 5. Rhoades R, Leifer K, Cohan R, Wittig H. Suppression of histamine-induced pruritus by three antihistaminic drugs. J Allergy Clin Immunol, 1975 Mar.; 55, 3: 180–5. 6. Kettelhut B, Berkebile C, Bradley D, Metcalfe D. A double-blind, placebo-controlled, crossover trial of ketotifen versus hydroxyzine in the treatment of pediatric mastocytosis. J Allergy Clin Immunol 1989 May; 83, 5: 866–70) 7. Broder L, Lean N, Hilsenbeck S. A randomized blinded clinical trial comparing delta–9–tetrahydrocannabinol (THC) and hydroxizine (HZ) as antiemetics (AE) for cancer cancer (CT). PROC–AM–ASSOC–CANCER–RES; 1982; 23: 514. 8. Vitale M, Fields–Blache C, Luterman. A Severe itching in the patient with burns. J burn care & rehabilitation 1991; 12, 4: 330–3. 9. Kaim S, Klett C, B. Rothfeld. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Agressologie: revue internationale de physio-biologie et de pharmacologieappliquees aux effets de l'agression, 1968; 9, 2: 305–8. 10. Ferreri M, Hantouche T, M. Billardon. Interet de l'hydroxizynedans des troubles d'anxiete generalalisee: etude controlee en double aveugle versus placebo. L'encephale 1994; 20: 785–91. 11. Llorka P. et al. Efficiency and safety of hydroxysyne in the treatment of generalized anxiety disorder: a 3–month double–blind study. J Clin Psychiatry 2002; 63:1020–7. 12. Lader Scotto J. A multicenter double–blind comparison of hydroxizine, buspirone and placebo in patient with generalized anxiety disorder. Psychopharmacology 1998; 139:402–6. 13. De Brabander A, Deberdt W. Effect of hydroxizyne on attention and memory. Human Psychopharmacology 1990; 357–62. 14. Samuelian J, Billardon M, Guillou N. Retentissmentsur les functions cognitives de deuxtraitmentsanxiolitiques chez des patients souffrantd'anxietegeneralisee. L'encephale 1995; 21: 147 15. Rezakov A.A. Experience of using hydroxyzine (atarax) in children and adolescents. “PHARMIndex-Practik” issue 10; 2006, pp. 37–39

Panic attacks symptoms and treatment

To successfully treat panic attacks, an integrated approach is required; one of the modern treatment methods is complex physiotherapy. The treatment is aimed at the root cause of the disorder, which is rooted in the physiological disruption of the body. Psychotherapy can also be used as a method of treating panic attacks, but only as an auxiliary link. In some cases, a psychotherapist can alleviate the condition and reduce the severity of panic neurosis.

One of the clinics in Moscow that specializes directly in disorders of the autonomic nervous system is the Clinical Center for Autonomic Neurology. The clinic’s doctors have extensive experience working with panic attacks: they know how their symptoms manifest themselves and what treatment will be optimal in a given case. As part of a comprehensive physiotherapy course, you can be offered:

— undergo a course of intravenous laser therapy

— infrared laser therapy

— magnetic therapy

— as well as a course of color pulse correction of suprasegmental autonomic disorders (color therapy)

All methods are aimed at working directly with damaged vegetative nodes.

The targeted effect on the nerve nodes in its effect on the body is reminiscent of acupuncture in oriental medicine (acupuncture), but the action of the laser is much more accurate and is based on science, and not on ancient intuitions, especially since it is supported by thermal imaging images that show the localization of the vegetative node in the human body accurate to the millimeter.

“I underwent 2 courses of acupuncture with symptoms of panic attacks. After the first course, which lasted a month, I felt better - I just sighed. But a month later I had to return. Another month after the second course, my body completely returned to its previous deplorable state. The effect faded away again. Acupuncture gave me only temporary relief. The effect of the laser was incomparably more effective,” patient Alexander (43 years old).

For most patients, it is enough to undergo one course of comprehensive physical therapy to feel significantly better, and after a recovery period that lasts from 4 to 6 months, to completely get rid of all symptoms of panic attacks. In more advanced cases, several courses may be required. However, noticeable improvements are noticeable after the first treatment session.

“During laser therapy sessions, I felt relaxed and even fell asleep. After the first sessions, the anxiety noticeably subsided and my head cleared. Panic attacks after completing the course of treatment became rare and short-lived. There was one case of exacerbation in the subway, but the doctor warned me that this was possible during the recovery period. I happily completed the second course of treatment a year later and now I feel even better than when I didn’t have panic attacks yet,” patient Sergei (34 years old).

Drug therapy

Certain medications can help reduce some of the symptoms of a panic attack. If the patient’s brain has a disturbance in the exchange of neurotransmitters, the balance of the processes of excitation and inhibition, then they are prescribed much more than in milder cases.

At the first stage, medications relieve the attack, and then restore the functioning of various brain systems. They are able to eliminate the panic state altogether, or weaken it.

1. Tranquilizers are prescribed at the very beginning of treatment and not for long, as they cause addiction. These drugs extinguish the severity of the attack, stabilize the autonomic system, and normalize sleep.
2. Antidepressants require caution - you need to be careful about their contraindications, so the selection is strictly individual. It is interesting that similar products from different manufacturers can have different effects on the patient.
3. Antipsychotics are used extremely rarely - only if panic disorder cannot be cured with other medications, as well as in the presence of a personality disorder or metabolic disorders in the brain. In addition, they are very difficult to find.
4. Neurometabolic drugs are very active, so they are used strictly in courses and administered in the presence of a doctor. They allow you to reduce the doses of other psychotropic drugs.

It is necessary to emphasize once again that all of the above medications are prescribed personally. The doctor should pay special attention to their effect on the patient, especially in the first days, monitor the intake, cancel and re-prescribe in case of adverse events.