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In the last section, we discussed undiagnosed depression and when depression leads to addiction.
In this section, we will discuss panic and depression. This will include panic disorder; panic attacks and pregnancy; and panic vs. depression, which comes first? If you are already familiar with these disorders, you might use this section as a review.
As you may know, pregnancy is a period of heightened anxiety in a woman’s life. No matter how confident they may be, many women are anxious about embarking upon motherhood. Some women may be fearful that their baby could be born with some kind of physical problem or deformity, or they may simply fear the pain of labor and delivery.
♦ Panic Disorder
To complicate matters, these attacks can occur with or without agoraphobia, the fear and avoidance of places where escape or assistance might be difficult or embarrassing. People can actually fear and avoid many spaces, open or not, from bridges and tunnels to airplanes and movie theaters. For those who are agoraphobic, a panic attack might be triggered either by being in the place or situation that is feared or by the anticipation of having to be in such a place or situation.
Without agoraphobia, a panic attack may come on without any obvious stimulus at all. This lack of obvious stimulus can be even more frightening, as it was for Jada, who had never experienced one until she was 28 years old and twelve weeks pregnant. Jada’s husband, Rob, was in Europe on business when she awakened in the middle of the night drenched in sweat with severe heart palpitations, acute shortness of breath, and the feeling that her chest was being crushed.
Three weeks later, while Jada was at work preparing a difficult cost analysis for a client and feeling overwhelmed by all the figures in front of her, her vision suddenly blurred, she became dizzy, and she thought she was about to faint. Jada had to leave work and return home, a safe place where no one would see how anxious she was. This time, Jada knew she wasn’t having a heart attack. Subsequently, she came to see me, and I treated her with cognitive behavior therapy to help her cope with what she now realized were panic attacks.
♦ Panic Attacks During Pregnancy
Unlike depression, symptoms of panic do not creep up silently. Rather, they arrive like a bolt from the blue and cannot be overlooked or ignored. Rob described one of Jada’s panic attacks this way, "Jada was in the kitchen peeling vegetables. One minute she was happy as a lark, humming to herself, and the next minute she was shaking all over. Her face turned red and her pupils dilated until they were huge. She was bending over, holding her chest, and I just thought, ‘Oh my God, it’s another panic attack.’"
I have found that many women do not experience relief from panic attacks during pregnancy. If anything, some remain the same while others grow worse, but only a very few of them become better. It is generally accepted that those who experience panic attacks during pregnancy are at increased risk for postpartum symptoms.
♦ Panic vs. Depression, Which Comes First?
Celeste, a Native American, was admitted to the hospital because of uncontrollable high blood pressure during her pregnancy. Celeste was in the hospital for more than a week without ever disclosing to any of her caregivers that she’d been having eight to ten panic attacks a day. In fact, Celeste hid her symptoms very well until a nurse went to check on her one night and found Celeste sitting up in bed meditating.
When I saw Celeste the following day, I started her on a low dose of antidepressant medication in addition to the blood pressure medications she was already taking and to which she had not responded. Celeste remained in the hospital for another three weeks, after which she was discharged with her panic attacks substantially diminished.
In Celeste’s case, the high blood pressure and panic attacks occurred as two separate problems, and the connection between the two still remains unclear. In my practice, however, I very frequently see them occur in conjunction with one another, and once the panic attacks are treated, the blood pressure often returns to normal. Celeste has stopped drinking coffee, exercises regularly, and continues to take her medication.
Do you have a Jada or a Celeste? Might she benefit from hearing this section in your next session?
In the next section, we will continue our discussion of anxiety. This will include untreated anxiety, when a child is truly at risk, and ghosts in the nursery.
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