Stress slowly ratchets panic up, up, up

BROWN U. (US) — When people with panic disorders face a stressful event, like losing a job, they can suffer from steadily increasing anxiety for weeks or even months.

The findings, published online in the Journal of Affective Disorders, suggest that families and therapists should remain vigilant.

“We definitely expected the symptoms to get worse over time, but we also thought the symptoms would get worse right away,” says Ethan Moitra, a postdoctoral researcher, working with Martin Keller, professor of psychiatry and human behavior at Brown University.

“If they have the event and they are not feeling much different then maybe the vigilance on the individual’s part decreases somewhat,” Keller says. “With the knowledge we have, you may need to stay vigilant for three months or maybe longer. This is something you have to watch for.”

The research also shows that panic symptoms do not seem to increase in advance of stressful life events, even if they are predictable, such as a divorce becoming official.

The study is based annual assessments of 418 adults with panic disorder or panic disorder with agoraphobia, who were enrolled in the Harvard/Brown Anxiety Research Project (HARP) between 1998 and 2004. Volunteers were asked detailed, standardized questions about important events in their lives and their levels of anxiety.

A statistical analysis of the results found that for stressful life events in the categories of work, such as a demotion or layoff, or friends/family/household, such as a family argument, panic symptoms that had meandering severity before the event increased steadily but gradually for at least 12 weeks afterward.

Stressful events in seven other categories, such as crime/legal or deaths did not seem to affect panic symptoms at all.

While the findings about the effect of some stressful life events on symptoms of people already diagnosed with panic disorder are new, other researchers have connected stress to panic attacks before. Stressful events are associated with the onset of panic disorder in the vast majority of cases, Moitra says.

A possible biological explanation for the association is that stressful life events might exacerbate an underlying proclivity in people with panic disorder to perceive oncoming bouts of hyperventilation, which in turn lead to panic responses.

While some stressful events have proven to be associated with changes in panic symptom levels, more research is needed to determine what kind of causal role stressful events may have, Moitra says.

“This may be one of those reasons why panic disorders can get worse.”

The National Institutes of Health funded the research.

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