Lifestyle changes to help alleviate panic disorder

One of the challenges in treating panic disorder is that it has many manifestations and varied symptoms. The disorder itself is characterized by recurring episodes of sudden, uncontrollable fear or panic. These episodes are usually made more frightening by cardiovascular symptoms (such as shortness of breath, heart palpitations, or chest pain), nausea or other forms of gastrointestinal distress, and neurological problems such as faintness and trembling.

Given that panic disorder affects the lungs and gut as well as the brain, it’s no wonder that many people wonder whether certain lifestyle changes might help to alleviate symptoms. It’s a good question.

After all, panic disorder is chronic, so patients must find ways not only to deal with the acute phase — the actual panic attacks and the first months afterwards — but also to develop strategies to minimize or prevent future panic attacks and ease the anxiety that comes from anticipating an attack.

The research strongly suggests that smoking cigarettes and drinking coffee can both aggravate symptoms of panic disorder — but for different reasons.

Smoking interferes with breathing and reduces oxygen flow to the brain. The theory is that the brain misinterprets the smoker’s labored breathing and resulting lack of oxygen as a threat of suffocation. The automatic physiological response is more rapid breathing and faster pumping of the heart. In people who are susceptible to anxiety, the brain mistakes these responses as signs of panic — and the result may be a panic attack.

With caffeine, on the other hand, it’s the stimulant effect that promotes anxiety. Caffeine can set off a panic attack in someone who is susceptible by activating the sympathetic nervous system, which mediates the body’s response to stress or danger. (Often this is referred to as the “fight or flight” response.)

Many clinicians therefore recommend that patients with panic disorder (and other types of anxiety disorders) not smoke tobacco and eliminate, or at least minimize, consumption of coffee and other caffeinated beverages and foods. It’s also wise to avoid over-the-counter medications that contain caffeine, such as some weight loss aids and “daytime” cold medications.

The research is less clear about whether aspartame, a sugar substitute sold under the brand names NutraSweet and Equal, might also aggravate panic disorder. The theory is that phenylalanine, one of two amino acids in aspartame, may act in the brain in a way that exacerbates anxiety and mood, and perhaps trigger a panic attack in someone who is vulnerable.

Although there is no solid evidence providing a link, people who have panic disorder or other types of anxiety disorders, and who consume a lot of aspartame, may wish to switch to sucralose (Splenda) as a precaution. It’s also wise to limit consumption of diet sodas which contain aspartame.

Of course, it’s also important to remember that everyone is different. Your own reactions to certain foods will be different from those experienced by someone else. But if you notice you are more anxious after drinking a diet Cokes or a strong cup of coffee, then it may be time to consider making a change — or at least cutting back. And it’s always a good idea to give up cigarette smoking, for all the obvious health reasons.

Have you ever suffered a panic attack after drinking caffeine? What’s your view about the possible link between aspartame and anxiety?

Dr. Michael W. Kahn is an Assistant Professor in the Department of Psychiatry at Harvard Medical School, and is medical Director of Ambulatory Psychiatry at the Beth Israel Deaconess Medical Center in Boston.

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