Welcome to you Stuff you should Know from House Stuff Works dot com. Hey, and welcome to the podcast. I'm Josh Clark. There's Child's w Chuck Bryant, and Jerry Stuff you should know. Yep, Wide Spread Panic. Did you see that video which one there was a dude this was just like two days ago that went up on stage and attacked the band. Oh no, I didn't see that. Yeah, and they've got the whole thing and it was during one of the really repetitive droning parts of a song. And uh, I haven't seen an explanation but that there was. I went to the Widespread Panic Facebook thing because there was a big thread about people talking about it, and I just said, Hero, did you really hate people gang filing me? Going Hero, that's hilarious danger Stroll. I thought it was pretty funny. He attacked the members of the band, yeah, like physically, and I couldn't quite the drummer and he was upset, and I don't know if that part of the song made him snap, but it was definitely one of those repetitive thank thank you, it's like stop. But he was at the show, so that'd be weird unless he went there to attack them. Yeah, that's probably the bath salts maybe, so, so we're not talking about that kind of panic. That's more a psychotic break. And this is not widespread at all. It's very individualized panic, it is. But it turns out people suffering from this is kind of widespread. How about that? So it fits a little bit sure. Instead, Um, we're talking about panic attacks and the combination of panic attacks or the culmination of panic attacks that can lead to something called panic disorder, and it is a sucky mental condition that about two point eight percent of Americans, which is a pretty significant amount of people. Yeah, that's that's more than bipolar, which we've covered in schizophrenia, Yeah, and o c D, which we well, we've covered all three of this. Yeah. Um, so that's a pretty significant amount of people who suffer from panic disorder. Right, But that's different than just plain old panic attacks. Even though to have panic disorder you have to have panic attacks, but if you have panic attacks, you don't necessarily have panic disorder exactly. And I've had two experiences which I'll talk about at some point through the show, not personally, but Emily had a panic attack once and uh friend in college had a panic attack a roommate and neither one of them have panic disorders. It was just an isolated incident. Yeah, so apparently that's I don't know if commons the right word, but people do have panic attacks and they but they they that might be the only one they ever have for their entire lives, hope, which makes the whole thing kind of mysterious. And we should say like science does not know what exactly is going on here. That's some theory, but there's there's no there's no way to predict what's happening now even know if it's genetic or what environmental. Well, they finally isolated a gene last year, Uh, I guess and go and talk about that. Now in December they isolated the gene and you know, genes are always so boring with their names, unless it's a Simmons. That's right. The n k r T three uh they think may be responsible um because its presence appears to cause an over estimation of fear and danger in an overactivation of the hippocampus and amygdala. So basically, if you have this gene, you're gonna exaggerate your fear overall. But it's not like they're saying they prove that's the cause. But that is a good step in scientifically in the right direction. That's a huge step, because I mean that does sound very much like what a panic attack is. A panic attack is where you experience a very pronounced sense of fear and basically your fight or flight symptoms response and really, from what I can understand, your flight response. Yeah, like you're not in a position to fight or freeze because you know now these days it's fight, flight or freeze. Really yeah, I don't think I knew that. Yeah, there's a third option now, um like kind of oh no, wait, those aren't options sets a sequence, right, This is these are options. So when you're confronted with danger. Nick Thune, our buddy, the comedian, dude, have you seen his hand of fit ads? Yeah, those are awesome. I was like, that's Nick Thune and he's on like Miss America. Yeah. The first thing I always think about is good for you cash those checks baby. Uh yeah. He has that funny bit on stop dropping rolling, like they they needed to continue that, like keep rolling. He's like, that's kind of key. Don't stop dropping roll because you'll be consumed by fire. You need to keep rolling. Right until you get to a door. Yeah, it's very funny stuff. So this is a little different fight flight or freeze? Yeah? What what's freeze factor in? Like you just freeze up and toast? Yeah, at least beneficial of all of the these adaptations to danger. But basically, when you're when you're confronted with danger, you can either fight, fly, or freeze. That makes total sense. I don't know why freeze was never in there to begin with, because so many people freeze. They just added on the last couple of years. I think I'm a flyer or a freezer for sure. It depends. I don't know if do you think there's a personality type? Oh boy, I don't know. Um, you know, don't you think it's possibly like just what your body chemistry happens to be doing? Right then? No? I think some people are more inclined to fight for sure. Okay, Well, with panic attacks, you're flying like that's your only that's your jam right there. Um, and you're experiencing it in the exact same way that somebody's coming to mug you or has pulled a knife on you and you're running away, or there's a lion chasing you. Accept This is the key to panic attack. There is no lion, there is no mugger, there's no knife, there's no discernible reason for you to be experiencing this sudden onset of crippling fear. Um. But you're experiencing it nonetheless, that's right. No, no tangible thing happening right in that moment. So when you come out of it, and these things can they peak within about ten minutes, but these the symptoms can last for an hour more. Um. When you come out of it, you're like, I don't ever want that to happen again. The place that this just happened to, say, the park, I'm never going back to because now I associated with this because what you're doing when you experience fear, you're learning to stay away from something. So whether you want to or not, you've just been conditioned to fear the place that you just were because you had a panic attack. Um. And then lastly, you think possibly you're crazy, yeah, or having a heart attack. Yeah that's uh. Both both of the my wife and my friend both thought they were having heart attacks, which is super scary. And we'll get the difference later on. But um, I guess we should talk about just some of the initial symptoms of a panic attack. The old d s M Diagnostic and Statistical Manual Mental Disorders lists, Uh, it looks like about ten symptoms and if you have at least four of these, you may be having a panic attack, which is heart pounding, shaking, dizziness, sweating, choking, feeling nausea, shallow or short breath, chest pain, numbness or tingling chills, and hot flashes, feeling of unreality, feeling like you're going crazy, or feeling like you're about to die. You got four of those, you're having a panic attack, yes, Um. And if you have four panic attacks within four weeks, or you have one panic attack and then fear having another panic attack for about a month or so, then you can be die diagnosed with what's called panic disorder. So, uh, if you listen to our fear podcast, which was a really good one, UM, it's kind of the same as a panic attack. UM. We covered your Your autonomic nervous system is what maintains all the functions in your body, the involuntary functions in your body, that is, and it's gonna take signals from your central nervous system. It's gonna regulate your organs. That's why you don't have to tell your heart to beat or your kid needs to work. It's all your pancreas to secrete stuff. That's right. It's your autonomic nervous system. And it has two parts, the sympathetic and parasympathetic. And your parasympathetic controls like I said, your your heart beat and stuff like that. You're the normal aspect. Yeah, it's just right. Yeah, that balance that we all seek that we don't know we're seeking. And then the sympathetic is if you have that fight or flight, if you become excited, uh in any way, really, that's when that's gonna kick in. Yeah. It's like normal gear and then high gear. Yeah, but it's not always fear, you know, just any kind of excitement. Right, you could be super happy, it could be sexual arousal. That's all your sympathetic nervous system, right, And those two components make up the autonomic nervous system, which it kind of switches from one to the other depending on your state of arousal. Right, that's right. Um, But when fear has aroused you, um, your sympathetic nervous system kicks into high gear. Um. And adrenaline is released, which is a huge factor in causing the symptoms of a panic attack. Like you you start breathing very heavily and shallowly, um, your pupils dilate you. Uh. We always used to say if you're digesting food, you stop doing that. Basically, all of your energy is transferred over to either fighting or flying, and in the case of a panic attack, is transferred over to get you to be able to run away as fast as possible. Yeah, which can be a little scary, but in a real fear situation, if in danger, your parasympathetic nervous system is going to kick in and calm you down. But that is not what happens, uh, in the case of a panic attack, which is really perplexing. So let's recap this. A panic attack is when you experience this incredibly intense fear, so much so that you run away but there's nothing there to be afraid of. And then and then, to make everything a million times worse, your parasympathetic nervous system doesn't kick in and calm you down like it would under normal circumstances, so you get to experience this horrible thing even longer. That's right, and after this break, we are going to get into some of the potential causes of panic attacks. All right, So, like I said before, breaking news from December last year, they think they've isolated a gene. Previous to that, they've some research has said it could be genetic because identical twins experience it more than fraternal twins. But it's always been sort of up in the air. They's been contradictions as well the genetic basis. They think it's also possibly epigenetic or environmental like um. Apparently one study found that a lot of people who have panic disorder had some sort of traumatic incident happened in their childhood. My friend from college did, Is that right? So they're thinking like possibly it had some sort of effect and set up like a time bomb for later on in life. Yeah, the stored uh feelings that maybe you've never dealt with about some traumatic event are gonna they're gonna rear their head at some point in your life in some way. Yeah, Or it just rearranged the neural output in your brain so that one day you're just set up when everything is just right, that chemistry is flooding your brain in a certain way, and then Bam, it comes out of nowhere, you have a panic attack. Yeah. Another theory is that they think if you have an over active fear system, like you've basically have been scared too much in life, or you're a scared person, then it's just gonna make it a hair trigger for something to set it off, which makes a lot of sense. I think it could be a combo with a lot of things as usual. Yeah. I wonder though, what what it will end up being that if we'll find that there is one thing that that leads to this predictably like built up, but then there's the actual trigger. Yeah, and that's another thing too. So they don't know what triggers these things. They do know that a panic attack. Being worried about having a panic attack can actually trigger a panic attack. Absolutely. I feel so bad for people a panic disorder. This is like a terrible affliction because you do become very much afraid that you're going to have another panic attack. So that can set off a panic attack, but it also can set off a code morbidity called agoraphobia, where you are afraid to leave your house, but you're also afraid to be alone. And I read this, um this article that was from the eighties seven, and they were saying, like, the the freudis the Freudists, followers of Sigmund Freud. We're saying, um, oh, well, clearly, if you're in a gooraphobic you don't want to go outside because that's where sexual desire is, and you don't want to be alone because you're worried that you will like abuse yourself, So agoraphobia. And everybody went boom, sit down and shut up. Yeah, and um, so nowadays they have realized that agoraphobia is almost almost exclusively the result of panic disorder. Yeah, and it's because you you fear the place that you had a panic attack, so you don't want to go there again. And then maybe it happened again at the grocery store, so you don't want to go there, and it happened. You don't want to be alone, but you don't want to be around strangers, so you into your family members and now all of a sudden, you're not living your life anymore. Yeah, you're developing phobias because of your panic attacks in your association with them. Like if you're on an elevator and you have a panic attack, you're not getting on an elevator again, you've just developed a phobia for elevators, and so all of a sudden, you're not going to be working at a place where you might normally work because you have to take the elevator to to get there. Or do you develop a love of stairs? Right? But then what if you're you don't like confined spaces at all, like a stairwell either. Yeah you ever been locked in the stairwell here at the building? Yeah? I mean you just walk down however many flights until you're at the lobby. Oh, you can get out down there? Yes, okay, yeah, yeah, you're not actually locked in, you just have to walk all the way down to Usually just call you and say lee. Another theory is that when you're super tired, um and overworked was when a lot of times when these are set off, your brain is producing sodium lactate or c O two and when those increase, your brain uh says you know what, I think you're suffocating, and so I'm going to send a signal to get you a lot more oxygen. And I found this uh really sad case of this woman, a university student who died from a severe asthma attack like three days ago. Uh, and she had had a history of asthma, and then told the medics that she was going through like final exams and she had been having panic attacks uh for in the weeks like proceeding. So breathing is a huge part of panic attacks. And as evidenced by her, if you have asthma, it's can be deadly, which is super super scary and sad. Yeah. Um. Then one other I guess there's a neurological basis they believe for people who have panic attacks. People who suffer from panic disorder tend to have fewer serotonin receptors and apparently also UM gabba which helps us get to sleep. It's called a gamma immuno beautyic acid. Let's call it gabba gabba. Um. Those two have some sort of role in UM panic disorder. Like you don't have enough serotonin and your body is not producing enough gabba, you may be prone to panic disorder. Uh. They you know, there isn't like a specific type of person that necessarily gets a panic attack. It can happen to anyone, but um, usually it happens if you're you're in your twenties. Although they say kids can get it as well have a panic attack or a disorder. Um, twice as many women have a panic disorder developed one as men, which is pretty interesting. Um. And like you said, just the fear like having had one before, that fear can lead to more. So it's very cyclical, yes. And you know, um that one paper from seven. I can't tell if it was arguing in favor of panic disorder being like an evolutionary adaptation and like possibly beneficial, or if they were saying, like some people think this, can you believe this? But they were. One of the points that this guy made was well, twice as many women have panic disorders as men, So clearly it's an evolutionary adaptation because women wouldn't have had to have gone as far away from camp while they were gathering food as men. For men couldn't stand to have a panic attack, or they couldn't, it wouldn't be an adaptation for men, it would be for women. Plus women can't run as fast when they have kids to carry, so they need to be on alert a little more. It's just smelled like bunk bunk. That was a big year for bunk. Yeah. Um, if you do have a panic disorder. You may have a hard time getting your family to understand it. UM. Sometimes they overreact and think it's like way more severe than it is. UM. Sometimes they underreact and say, uh, you know, it's all in your head, like just calm down. UM. But either way it's saying, boy, you're nuts or you just need to relax. Neither one of those is going to help out the loved one. Chill out, there's no lion. One thing I've learned in arguments and fights with my wife is and I'm boilerning this early on is saying telling someone to relax never causes someone to relax. It's like the worst thing you can do if something's heated is to say just relax. That's just gonna ramp it up. So that's my advice for couples out there in any relationship. Really good, Thank you. UM. There is a silverlying to all this in that panic disorder is actually highly treatable. It's the treatments that they've come up with are pretty successful, and we will talk about those treatments right after this. All right, So you mentioned that they are treatable. They have found success rates through medication and therapy, which seemed to be about the same as far as how affective they are between sixty and of the time. That's pretty good. Yeah, that's not bad at all. So that's the good news. So there's three. There's three UM typical methods of treatment UM antidepressants, anti anxiety, pills, and therapy. And you might use them, you know, independent of what another in conjunction with one another. I also saw beta blockers. Some people use beta blockers to treat them, but they're not quite sure what's going on with that. I've used those before live performances. Those are the ones I read about that UM, you gave me one, and I was like a useless worm. Yeah, it didn't affect me like that. I I was, I just like totally lost my personality. I wasn't nervous, but I didn't do anything. Well, I've gotten used to live performing now, so I don't need them anymore. But I got that to from apparently a bunch of musicians, like in symphonies and stuff use And I was like, well, if first chair of Violinist, if it's good for them to give me some beta blockers. But it worked for me. But like I said, I'm over all that. I enjoy being on stage. Now. So with s SR eyes, which is what you moved on too from beta blockers, right, No, I'm not on it. So with SSR eyes, UM, those are selective serotonin reuptake inhibitors, and they do exactly what they sound like. You've got a bunch of serotonin receptors in your brain. If you have panic disorder, you may have fewer serotonin receptors in your brain. Serotonin is a neurotransmitter that helps basically stabilize your mood by either causing a neuron to fire or inhibiting a neuron to fire in this really beautiful, perfectly balanced chemical reaction. Right, So if you have a few of these receptors the normal, you're going to be comparatively out of balanced. What an SSR I, an antidepressant, does is it allows the serotonin to kind of stay in your synaps is a little longer than as normal, so that you are releasing a little more serotonin than you would under normal circumstances. And it's proven pretty effective for UM for panic disorder. Yeah, I mean, they'd work wonders for a lot of people for a lot of reasons, UM, but not everyone. And they can cause a lot of negative side effects. Uh. So obviously, you know, work with your doctor on a program, and it takes them a little while, like two to four weeks to begin working. Uh for a panic attack. Um, an anti anxiety drug like xan x might be a little more effective because that is immediately hits you. It is a tranquilizer benzodiazepine, right yeah, and it's um, you know, the zanex is going to help chill you out immediately, but you can get hooked on those things pretty quick. Yeah, and they're dangerous to quit cold turkey and um, yeah, it's it's not the best thing to go to xanex a lot. Well, yeah, they say that you should, um basically if you if you undertake an ssr I regimen, you can conceivably stay on it for years. If you undertake anti anxiety or benzo diazepine regimen, like it shouldn't last for more than a couple of weeks or month from what I understand, because of the dependency. And again, you want to like really do all of this with like a um qualified competent doctor's assistants, not a doctor's assistant, doctor's assistant. It depends if it's a qualified competent doctor's assistant who can write prescriptions, who trust go for it, that's true. Uh. And then there's therapy of course, the old CBT cognitive behavioral therapy, which we've talked about a bunch, but um, that is Uh, they're gonna sort of the processes is gonna play out like this. They're gonna teach you out your panic disorder, which is a big step. If you understand something, uh, you can overcome it more easily. I think they're gonna monitor you and you're gonna self monitor and record your symptoms and when they happen and why they happen, what the circumstance was. Breathing, like we mentioned, is a huge part of it. Um, anything from meditation to just regular breathing exercises which will give you some tips on that in a minute too, are going to help you out. And then the old exposure two uh situations. Then this is once you've rethought, like your what your approach is going to be, Like here's your new outlook and now here's a situation that might give you a panic attack. How do you feel? Yeah, or like if you had a panic attack and an elevator, like they may tell you to imagine you're in an elevator. Your therapy might progress until you're actually in an elevator and you're chilling out. And the hope is that if if you can undergo exposure therapy to that degree, it will get you over your panic attacks in general. Another aspect of it, Chuck, is rethinking, uh, and that is basically accepting the fact that you have panic attacks. Apparently if you can say I'm having a panic attack or I have panic attacks and you acknowledge it to yourself and to other people, it immediately turns down the volume on the whole thing. Yeah, I noticed some similarities and uh, someone guiding through someone through an LSD trip and guiding someone through a panic attack. It's interesting. A lot of it is like understanding, like I am having an acid trip, I am not having a good time. It's the same thing as I'm having a panic attack and this is no good And if I understand that, then I can calm down more easily and keeping it in just lead you to freak out more exactly. Um, So that's CBT cognitive behavioral therapy and um, if you if you undergo therapy and you're still suffering from panic attacks. The apparently being discouraged as a a real problem with people with panic disorder because you can still suffer them even if you're doing everything right. Um, and so a lot of people have learned to cope, and there's some pretty common coping techniques for a panic disorder. And like you said, the heart of the whole thing is breathing. Like when you suffer a panic attack, you start breathing shallowly and quickly, and um, you can hyperventilate. What you want to do is breathe from your diaphragm and that you can actually practice this in the times when you're not having a panic attack. Yeah, if you're a singer, you know how to breathe with your diaphragm. But if you're not, what you can do is lie down on your back, put some pillows on your head and knees, and um, put a hand on your stomach and a hand on your chest, and then practice breathing, uh, and making your hand on your stomach move without the hand on your chest moving and then tap the hand on your stomach while you make a circle with a hand on your chest. When you're really advanced. Wow, it's pretty impressive. Uh. And then another thing you can do is just literally like put a weight on your stomach and make sure to heavy like a book. Yeah, like a nice something that you can see going up and down when you're breathing with your diaphragm, that's right. Um, And you want to just kind of breathe in the good exhale the bad. Yeah, Like I'm having a panic attack. This will pass, you know, this will subside. This is a temporary feeling. That's what you should be saying to yourself. And if you're a person who's like out in public and you see somebody having a panic attack, you basically want to do the same thing that they're trying to do for themselves. You want to remain calm. You want to tell them that it's going to be over with pretty soon, that everything's okay, they have nothing to fear. Um. Yeah, you don't want to tell them to chill out, though. Uh. Guiding someone through relaxation is different than saying chill out, by the way, right, very different. Uh. They do recommend that you, um, if you have a problem with with attacks in general, or if you have a disorder, you should exercise a lot. You should practice Um, they don't call it meditation, but that's really what it is, is deep breathing and relaxation. It's called mindfulness these days, isn't it. I don't know. I think that's what they call it, because meditation turns people off, right, guess interesting? Uh cut cut out the caffeine and sugar and nicotine. Yeah, that's not gonna help you at all, Uh doing all those things. Uh. And you know, if this stuff is stuff that's building up inside of you, which it often is, learn how to express yourself a little more and um and talk about your issues. Um. I know that in both of my cases. My buddy in college, it was during finals week and I had gone to bed and my roommate and another dude had were out in the living room staying up, and one of them came and woke me up and he's like, dude, he's having a heart attack. He's having a heart attack. And um, I didn't know anything about panic attacks. So we took him the hospital, of course, and that's all it was. It was a panic attack. He calmed down. I think, um, I think it might have given him something there. I met some sort of medication to calm him down. Probably Benzo. Yeah, probably like a good shot in the arm of that stuff. And he was like, I'm fine. Right With Emily's case, she had been under a lot of stress and was and driving back from Akron, Ohio to Atlanta. I think she went to get I think she had to get some furniture or something. So she was in a truck, like a moving truck, had been drinking caffeine like crazy, like she does, and um, basically, uh started to have trouble breathing on the highway going like e d down the highway and had to pull over. Called me, and you know, I calmed her down. I was like, all right, now, let's get back on the road. See how you do. She got back on the highway and immediately freaked out again. And Uh, I flew to Cincinnati and went to a hotel and drove her home. Yeah, I mean there was really no choice at that point. Uh. You know, when it's your wife, you Plus, it was a good opportunity to get on the white horse, you know, and right in and save the day. I think everyone loves those opportunities, you know. And it's and I've always also wanted to run to the airport, like give me a one way ticket this somewhere I have time for your body scan. Pretty much. That's how it happened. So she checked herself into a hotel and I went there and had some nice Cincinnati Skyline chili, and then the next morning we hit the road. Yeah, that was good, and she hasn't had one since then, despite like, uh, you know, she she has a lot of anxiety just as a human, but um, no panic attacks. So I definitely have seen the things I saw in this article and both of them, whether it was during finals, like the things going on in her life at the time, we're super stressful. I think the trigger was she doesn't like see great at night or in the rain when she's driving, and I think all these things compounded, um and just played out to where she felt like she's having a heart attack, and so did my friend. But I guess we should mention that there are some tailtale signs of a heart attack. Yeah, that's a big yeah, that you can recognize the difference, because you don't want to actually be having a heart attack and be like it's just a panic. Just breathe, just breathe while you're dying. Um. Here are a few tips from the American heart association. Pressure in the center of your chest that persists longer than a couple of minutes, or goes away then returns, shortness of breath, pain in the arm or upper body. You might feel nauseous or faint. And of course, if you're ever in doubt, call because, like you said, you don't want to be having a heart attack thinking it's will subside, there will be a guy in your face. Well to say the last exactly, Uh, If you want to know more about panic attacks and panic disorder, type either one of those sets of words into the search part how stuff works and it'll bring up this article. And since I said that it's time for a listener mail, I call this basement fear. Hey, guys, I know most listeners know your podcasts great for learning and entertainment, but I found another purpose distraction from stress induced irrational fears. This sounds familiar. We were just talking about this kind of thing. Oh yeah, And I didn't even realize that when I picked this out. How about that serendipity. Um, I grew up in a house with a creepy, gross basement where we did laundry, and it never bothered me. My fiance James, and I recently moved into a house with a non creepy and non gross basement. But I think the stress of planning a wedding is getting to me because when I need to go down into the basement to do laundry, I nearly have a panic attack imagining a person lurking in the basement. I've started playing an episode of Stuff You Should Know on my iPhone and carrying it in my pocket when I need to go down to the basement, stay back Spirit exactly, so we literally accompanied her into the basementch I think is hysterical. I am busy enough enjoying your humor and information that I don't get us overwhelmed by this irrational fear. I think it may even be waning now, so I continue to make myself go down into the basement and see that my fear is not really based in any reality at all. Uh. That's CBT, that's exposure therapy boom. Also before this weird basement, if you're popped up, I long called you guys my cleaning crew because I listened to episodes while doing my chores. And that is from Kelsey in Kansas City, Kansas, not Kansas City, Missouri, Missouri. And uh, Kelsey, good luck with that, and just don't look behind that door over near the washing machine. That's very helpful. Just getting Kelsey, there's nothing down there, and just take us with you. Well, we will protect you because spirits don't like us. The podcast is coming from inside the house. If you want to get in touch with Chuck or me, you can tweet to us at s y s K podcast. You can join us on Facebook dot com, slash stuff you Should Know. You can send us an email to Stuff Podcast at how stuff Works dot com and has always joined us at our home on the web, Stuff you Should Know dot com. For more on this and thousands of other topics, is it how stuff Works dot com.

Welcome to you Stuff you should Know from House Stuff Works dot com. Hey, and welcome to the podcast. I'm Josh Clark. There's Child's w Chuck Bryant, and Jerry Stuff you should know. Yep, Wide Spread Panic. Did you see that video which one there was a dude this was just like two days ago that went up on stage and attacked the band. Oh no, I didn't see that. Yeah, and they've got the whole thing and it was during one of the really repetitive droning parts of a song. And uh, I haven't seen an explanation but that there was. I went to the Widespread Panic Facebook thing because there was a big thread about people talking about it, and I just said, Hero, did you really hate people gang filing me? Going Hero, that's hilarious danger Stroll. I thought it was pretty funny. He attacked the members of the band, yeah, like physically, and I couldn't quite the drummer and he was upset, and I don't know if that part of the song made him snap, but it was definitely one of those repetitive thank thank you, it's like stop. But he was at the show, so that'd be weird unless he went there to attack them. Yeah, that's probably the bath salts maybe, so, so we're not talking about that kind of panic. That's more a psychotic break. And this is not widespread at all. It's very individualized panic, it is. But it turns out people suffering from this is kind of widespread. How about that? So it fits a little bit sure. Instead, Um, we're talking about panic attacks and the combination of panic attacks or the culmination of panic attacks that can lead to something called panic disorder, and it is a sucky mental condition that about two point eight percent of Americans, which is a pretty significant amount of people. Yeah, that's that's more than bipolar, which we've covered in schizophrenia, Yeah, and o c D, which we well, we've covered all three of this. Yeah. Um, so that's a pretty significant amount of people who suffer from panic disorder. Right, But that's different than just plain old panic attacks. Even though to have panic disorder you have to have panic attacks, but if you have panic attacks, you don't necessarily have panic disorder exactly. And I've had two experiences which I'll talk about at some point through the show, not personally, but Emily had a panic attack once and uh friend in college had a panic attack a roommate and neither one of them have panic disorders. It was just an isolated incident. Yeah, so apparently that's I don't know if commons the right word, but people do have panic attacks and they but they they that might be the only one they ever have for their entire lives, hope, which makes the whole thing kind of mysterious. And we should say like science does not know what exactly is going on here. That's some theory, but there's there's no there's no way to predict what's happening now even know if it's genetic or what environmental. Well, they finally isolated a gene last year, Uh, I guess and go and talk about that. Now in December they isolated the gene and you know, genes are always so boring with their names, unless it's a Simmons. That's right. The n k r T three uh they think may be responsible um because its presence appears to cause an over estimation of fear and danger in an overactivation of the hippocampus and amygdala. So basically, if you have this gene, you're gonna exaggerate your fear overall. But it's not like they're saying they prove that's the cause. But that is a good step in scientifically in the right direction. That's a huge step, because I mean that does sound very much like what a panic attack is. A panic attack is where you experience a very pronounced sense of fear and basically your fight or flight symptoms response and really, from what I can understand, your flight response. Yeah, like you're not in a position to fight or freeze because you know now these days it's fight, flight or freeze. Really yeah, I don't think I knew that. Yeah, there's a third option now, um like kind of oh no, wait, those aren't options sets a sequence, right, This is these are options. So when you're confronted with danger. Nick Thune, our buddy, the comedian, dude, have you seen his hand of fit ads? Yeah, those are awesome. I was like, that's Nick Thune and he's on like Miss America. Yeah. The first thing I always think about is good for you cash those checks baby. Uh yeah. He has that funny bit on stop dropping rolling, like they they needed to continue that, like keep rolling. He's like, that's kind of key. Don't stop dropping roll because you'll be consumed by fire. You need to keep rolling. Right until you get to a door. Yeah, it's very funny stuff. So this is a little different fight flight or freeze? Yeah? What what's freeze factor in? Like you just freeze up and toast? Yeah, at least beneficial of all of the these adaptations to danger. But basically, when you're when you're confronted with danger, you can either fight, fly, or freeze. That makes total sense. I don't know why freeze was never in there to begin with, because so many people freeze. They just added on the last couple of years. I think I'm a flyer or a freezer for sure. It depends. I don't know if do you think there's a personality type? Oh boy, I don't know. Um, you know, don't you think it's possibly like just what your body chemistry happens to be doing? Right then? No? I think some people are more inclined to fight for sure. Okay, Well, with panic attacks, you're flying like that's your only that's your jam right there. Um, and you're experiencing it in the exact same way that somebody's coming to mug you or has pulled a knife on you and you're running away, or there's a lion chasing you. Accept This is the key to panic attack. There is no lion, there is no mugger, there's no knife, there's no discernible reason for you to be experiencing this sudden onset of crippling fear. Um. But you're experiencing it nonetheless, that's right. No, no tangible thing happening right in that moment. So when you come out of it, and these things can they peak within about ten minutes, but these the symptoms can last for an hour more. Um. When you come out of it, you're like, I don't ever want that to happen again. The place that this just happened to, say, the park, I'm never going back to because now I associated with this because what you're doing when you experience fear, you're learning to stay away from something. So whether you want to or not, you've just been conditioned to fear the place that you just were because you had a panic attack. Um. And then lastly, you think possibly you're crazy, yeah, or having a heart attack. Yeah that's uh. Both both of the my wife and my friend both thought they were having heart attacks, which is super scary. And we'll get the difference later on. But um, I guess we should talk about just some of the initial symptoms of a panic attack. The old d s M Diagnostic and Statistical Manual Mental Disorders lists, Uh, it looks like about ten symptoms and if you have at least four of these, you may be having a panic attack, which is heart pounding, shaking, dizziness, sweating, choking, feeling nausea, shallow or short breath, chest pain, numbness or tingling chills, and hot flashes, feeling of unreality, feeling like you're going crazy, or feeling like you're about to die. You got four of those, you're having a panic attack, yes, Um. And if you have four panic attacks within four weeks, or you have one panic attack and then fear having another panic attack for about a month or so, then you can be die diagnosed with what's called panic disorder. So, uh, if you listen to our fear podcast, which was a really good one, UM, it's kind of the same as a panic attack. UM. We covered your Your autonomic nervous system is what maintains all the functions in your body, the involuntary functions in your body, that is, and it's gonna take signals from your central nervous system. It's gonna regulate your organs. That's why you don't have to tell your heart to beat or your kid needs to work. It's all your pancreas to secrete stuff. That's right. It's your autonomic nervous system. And it has two parts, the sympathetic and parasympathetic. And your parasympathetic controls like I said, your your heart beat and stuff like that. You're the normal aspect. Yeah, it's just right. Yeah, that balance that we all seek that we don't know we're seeking. And then the sympathetic is if you have that fight or flight, if you become excited, uh in any way, really, that's when that's gonna kick in. Yeah. It's like normal gear and then high gear. Yeah, but it's not always fear, you know, just any kind of excitement. Right, you could be super happy, it could be sexual arousal. That's all your sympathetic nervous system, right, And those two components make up the autonomic nervous system, which it kind of switches from one to the other depending on your state of arousal. Right, that's right. Um, But when fear has aroused you, um, your sympathetic nervous system kicks into high gear. Um. And adrenaline is released, which is a huge factor in causing the symptoms of a panic attack. Like you you start breathing very heavily and shallowly, um, your pupils dilate you. Uh. We always used to say if you're digesting food, you stop doing that. Basically, all of your energy is transferred over to either fighting or flying, and in the case of a panic attack, is transferred over to get you to be able to run away as fast as possible. Yeah, which can be a little scary, but in a real fear situation, if in danger, your parasympathetic nervous system is going to kick in and calm you down. But that is not what happens, uh, in the case of a panic attack, which is really perplexing. So let's recap this. A panic attack is when you experience this incredibly intense fear, so much so that you run away but there's nothing there to be afraid of. And then and then, to make everything a million times worse, your parasympathetic nervous system doesn't kick in and calm you down like it would under normal circumstances, so you get to experience this horrible thing even longer. That's right, and after this break, we are going to get into some of the potential causes of panic attacks. All right, So, like I said before, breaking news from December last year, they think they've isolated a gene. Previous to that, they've some research has said it could be genetic because identical twins experience it more than fraternal twins. But it's always been sort of up in the air. They's been contradictions as well the genetic basis. They think it's also possibly epigenetic or environmental like um. Apparently one study found that a lot of people who have panic disorder had some sort of traumatic incident happened in their childhood. My friend from college did, Is that right? So they're thinking like possibly it had some sort of effect and set up like a time bomb for later on in life. Yeah, the stored uh feelings that maybe you've never dealt with about some traumatic event are gonna they're gonna rear their head at some point in your life in some way. Yeah, Or it just rearranged the neural output in your brain so that one day you're just set up when everything is just right, that chemistry is flooding your brain in a certain way, and then Bam, it comes out of nowhere, you have a panic attack. Yeah. Another theory is that they think if you have an over active fear system, like you've basically have been scared too much in life, or you're a scared person, then it's just gonna make it a hair trigger for something to set it off, which makes a lot of sense. I think it could be a combo with a lot of things as usual. Yeah. I wonder though, what what it will end up being that if we'll find that there is one thing that that leads to this predictably like built up, but then there's the actual trigger. Yeah, and that's another thing too. So they don't know what triggers these things. They do know that a panic attack. Being worried about having a panic attack can actually trigger a panic attack. Absolutely. I feel so bad for people a panic disorder. This is like a terrible affliction because you do become very much afraid that you're going to have another panic attack. So that can set off a panic attack, but it also can set off a code morbidity called agoraphobia, where you are afraid to leave your house, but you're also afraid to be alone. And I read this, um this article that was from the eighties seven, and they were saying, like, the the freudis the Freudists, followers of Sigmund Freud. We're saying, um, oh, well, clearly, if you're in a gooraphobic you don't want to go outside because that's where sexual desire is, and you don't want to be alone because you're worried that you will like abuse yourself, So agoraphobia. And everybody went boom, sit down and shut up. Yeah, and um, so nowadays they have realized that agoraphobia is almost almost exclusively the result of panic disorder. Yeah, and it's because you you fear the place that you had a panic attack, so you don't want to go there again. And then maybe it happened again at the grocery store, so you don't want to go there, and it happened. You don't want to be alone, but you don't want to be around strangers, so you into your family members and now all of a sudden, you're not living your life anymore. Yeah, you're developing phobias because of your panic attacks in your association with them. Like if you're on an elevator and you have a panic attack, you're not getting on an elevator again, you've just developed a phobia for elevators, and so all of a sudden, you're not going to be working at a place where you might normally work because you have to take the elevator to to get there. Or do you develop a love of stairs? Right? But then what if you're you don't like confined spaces at all, like a stairwell either. Yeah you ever been locked in the stairwell here at the building? Yeah? I mean you just walk down however many flights until you're at the lobby. Oh, you can get out down there? Yes, okay, yeah, yeah, you're not actually locked in, you just have to walk all the way down to Usually just call you and say lee. Another theory is that when you're super tired, um and overworked was when a lot of times when these are set off, your brain is producing sodium lactate or c O two and when those increase, your brain uh says you know what, I think you're suffocating, and so I'm going to send a signal to get you a lot more oxygen. And I found this uh really sad case of this woman, a university student who died from a severe asthma attack like three days ago. Uh, and she had had a history of asthma, and then told the medics that she was going through like final exams and she had been having panic attacks uh for in the weeks like proceeding. So breathing is a huge part of panic attacks. And as evidenced by her, if you have asthma, it's can be deadly, which is super super scary and sad. Yeah. Um. Then one other I guess there's a neurological basis they believe for people who have panic attacks. People who suffer from panic disorder tend to have fewer serotonin receptors and apparently also UM gabba which helps us get to sleep. It's called a gamma immuno beautyic acid. Let's call it gabba gabba. Um. Those two have some sort of role in UM panic disorder. Like you don't have enough serotonin and your body is not producing enough gabba, you may be prone to panic disorder. Uh. They you know, there isn't like a specific type of person that necessarily gets a panic attack. It can happen to anyone, but um, usually it happens if you're you're in your twenties. Although they say kids can get it as well have a panic attack or a disorder. Um, twice as many women have a panic disorder developed one as men, which is pretty interesting. Um. And like you said, just the fear like having had one before, that fear can lead to more. So it's very cyclical, yes. And you know, um that one paper from seven. I can't tell if it was arguing in favor of panic disorder being like an evolutionary adaptation and like possibly beneficial, or if they were saying, like some people think this, can you believe this? But they were. One of the points that this guy made was well, twice as many women have panic disorders as men, So clearly it's an evolutionary adaptation because women wouldn't have had to have gone as far away from camp while they were gathering food as men. For men couldn't stand to have a panic attack, or they couldn't, it wouldn't be an adaptation for men, it would be for women. Plus women can't run as fast when they have kids to carry, so they need to be on alert a little more. It's just smelled like bunk bunk. That was a big year for bunk. Yeah. Um, if you do have a panic disorder. You may have a hard time getting your family to understand it. UM. Sometimes they overreact and think it's like way more severe than it is. UM. Sometimes they underreact and say, uh, you know, it's all in your head, like just calm down. UM. But either way it's saying, boy, you're nuts or you just need to relax. Neither one of those is going to help out the loved one. Chill out, there's no lion. One thing I've learned in arguments and fights with my wife is and I'm boilerning this early on is saying telling someone to relax never causes someone to relax. It's like the worst thing you can do if something's heated is to say just relax. That's just gonna ramp it up. So that's my advice for couples out there in any relationship. Really good, Thank you. UM. There is a silverlying to all this in that panic disorder is actually highly treatable. It's the treatments that they've come up with are pretty successful, and we will talk about those treatments right after this. All right, So you mentioned that they are treatable. They have found success rates through medication and therapy, which seemed to be about the same as far as how affective they are between sixty and of the time. That's pretty good. Yeah, that's not bad at all. So that's the good news. So there's three. There's three UM typical methods of treatment UM antidepressants, anti anxiety, pills, and therapy. And you might use them, you know, independent of what another in conjunction with one another. I also saw beta blockers. Some people use beta blockers to treat them, but they're not quite sure what's going on with that. I've used those before live performances. Those are the ones I read about that UM, you gave me one, and I was like a useless worm. Yeah, it didn't affect me like that. I I was, I just like totally lost my personality. I wasn't nervous, but I didn't do anything. Well, I've gotten used to live performing now, so I don't need them anymore. But I got that to from apparently a bunch of musicians, like in symphonies and stuff use And I was like, well, if first chair of Violinist, if it's good for them to give me some beta blockers. But it worked for me. But like I said, I'm over all that. I enjoy being on stage. Now. So with s SR eyes, which is what you moved on too from beta blockers, right, No, I'm not on it. So with SSR eyes, UM, those are selective serotonin reuptake inhibitors, and they do exactly what they sound like. You've got a bunch of serotonin receptors in your brain. If you have panic disorder, you may have fewer serotonin receptors in your brain. Serotonin is a neurotransmitter that helps basically stabilize your mood by either causing a neuron to fire or inhibiting a neuron to fire in this really beautiful, perfectly balanced chemical reaction. Right, So if you have a few of these receptors the normal, you're going to be comparatively out of balanced. What an SSR I, an antidepressant, does is it allows the serotonin to kind of stay in your synaps is a little longer than as normal, so that you are releasing a little more serotonin than you would under normal circumstances. And it's proven pretty effective for UM for panic disorder. Yeah, I mean, they'd work wonders for a lot of people for a lot of reasons, UM, but not everyone. And they can cause a lot of negative side effects. Uh. So obviously, you know, work with your doctor on a program, and it takes them a little while, like two to four weeks to begin working. Uh for a panic attack. Um, an anti anxiety drug like xan x might be a little more effective because that is immediately hits you. It is a tranquilizer benzodiazepine, right yeah, and it's um, you know, the zanex is going to help chill you out immediately, but you can get hooked on those things pretty quick. Yeah, and they're dangerous to quit cold turkey and um, yeah, it's it's not the best thing to go to xanex a lot. Well, yeah, they say that you should, um basically if you if you undertake an ssr I regimen, you can conceivably stay on it for years. If you undertake anti anxiety or benzo diazepine regimen, like it shouldn't last for more than a couple of weeks or month from what I understand, because of the dependency. And again, you want to like really do all of this with like a um qualified competent doctor's assistants, not a doctor's assistant, doctor's assistant. It depends if it's a qualified competent doctor's assistant who can write prescriptions, who trust go for it, that's true. Uh. And then there's therapy of course, the old CBT cognitive behavioral therapy, which we've talked about a bunch, but um, that is Uh, they're gonna sort of the processes is gonna play out like this. They're gonna teach you out your panic disorder, which is a big step. If you understand something, uh, you can overcome it more easily. I think they're gonna monitor you and you're gonna self monitor and record your symptoms and when they happen and why they happen, what the circumstance was. Breathing, like we mentioned, is a huge part of it. Um, anything from meditation to just regular breathing exercises which will give you some tips on that in a minute too, are going to help you out. And then the old exposure two uh situations. Then this is once you've rethought, like your what your approach is going to be, Like here's your new outlook and now here's a situation that might give you a panic attack. How do you feel? Yeah, or like if you had a panic attack and an elevator, like they may tell you to imagine you're in an elevator. Your therapy might progress until you're actually in an elevator and you're chilling out. And the hope is that if if you can undergo exposure therapy to that degree, it will get you over your panic attacks in general. Another aspect of it, Chuck, is rethinking, uh, and that is basically accepting the fact that you have panic attacks. Apparently if you can say I'm having a panic attack or I have panic attacks and you acknowledge it to yourself and to other people, it immediately turns down the volume on the whole thing. Yeah, I noticed some similarities and uh, someone guiding through someone through an LSD trip and guiding someone through a panic attack. It's interesting. A lot of it is like understanding, like I am having an acid trip, I am not having a good time. It's the same thing as I'm having a panic attack and this is no good And if I understand that, then I can calm down more easily and keeping it in just lead you to freak out more exactly. Um, So that's CBT cognitive behavioral therapy and um, if you if you undergo therapy and you're still suffering from panic attacks. The apparently being discouraged as a a real problem with people with panic disorder because you can still suffer them even if you're doing everything right. Um, and so a lot of people have learned to cope, and there's some pretty common coping techniques for a panic disorder. And like you said, the heart of the whole thing is breathing. Like when you suffer a panic attack, you start breathing shallowly and quickly, and um, you can hyperventilate. What you want to do is breathe from your diaphragm and that you can actually practice this in the times when you're not having a panic attack. Yeah, if you're a singer, you know how to breathe with your diaphragm. But if you're not, what you can do is lie down on your back, put some pillows on your head and knees, and um, put a hand on your stomach and a hand on your chest, and then practice breathing, uh, and making your hand on your stomach move without the hand on your chest moving and then tap the hand on your stomach while you make a circle with a hand on your chest. When you're really advanced. Wow, it's pretty impressive. Uh. And then another thing you can do is just literally like put a weight on your stomach and make sure to heavy like a book. Yeah, like a nice something that you can see going up and down when you're breathing with your diaphragm, that's right. Um, And you want to just kind of breathe in the good exhale the bad. Yeah, Like I'm having a panic attack. This will pass, you know, this will subside. This is a temporary feeling. That's what you should be saying to yourself. And if you're a person who's like out in public and you see somebody having a panic attack, you basically want to do the same thing that they're trying to do for themselves. You want to remain calm. You want to tell them that it's going to be over with pretty soon, that everything's okay, they have nothing to fear. Um. Yeah, you don't want to tell them to chill out, though. Uh. Guiding someone through relaxation is different than saying chill out, by the way, right, very different. Uh. They do recommend that you, um, if you have a problem with with attacks in general, or if you have a disorder, you should exercise a lot. You should practice Um, they don't call it meditation, but that's really what it is, is deep breathing and relaxation. It's called mindfulness these days, isn't it. I don't know. I think that's what they call it, because meditation turns people off, right, guess interesting? Uh cut cut out the caffeine and sugar and nicotine. Yeah, that's not gonna help you at all, Uh doing all those things. Uh. And you know, if this stuff is stuff that's building up inside of you, which it often is, learn how to express yourself a little more and um and talk about your issues. Um. I know that in both of my cases. My buddy in college, it was during finals week and I had gone to bed and my roommate and another dude had were out in the living room staying up, and one of them came and woke me up and he's like, dude, he's having a heart attack. He's having a heart attack. And um, I didn't know anything about panic attacks. So we took him the hospital, of course, and that's all it was. It was a panic attack. He calmed down. I think, um, I think it might have given him something there. I met some sort of medication to calm him down. Probably Benzo. Yeah, probably like a good shot in the arm of that stuff. And he was like, I'm fine. Right With Emily's case, she had been under a lot of stress and was and driving back from Akron, Ohio to Atlanta. I think she went to get I think she had to get some furniture or something. So she was in a truck, like a moving truck, had been drinking caffeine like crazy, like she does, and um, basically, uh started to have trouble breathing on the highway going like e d down the highway and had to pull over. Called me, and you know, I calmed her down. I was like, all right, now, let's get back on the road. See how you do. She got back on the highway and immediately freaked out again. And Uh, I flew to Cincinnati and went to a hotel and drove her home. Yeah, I mean there was really no choice at that point. Uh. You know, when it's your wife, you Plus, it was a good opportunity to get on the white horse, you know, and right in and save the day. I think everyone loves those opportunities, you know. And it's and I've always also wanted to run to the airport, like give me a one way ticket this somewhere I have time for your body scan. Pretty much. That's how it happened. So she checked herself into a hotel and I went there and had some nice Cincinnati Skyline chili, and then the next morning we hit the road. Yeah, that was good, and she hasn't had one since then, despite like, uh, you know, she she has a lot of anxiety just as a human, but um, no panic attacks. So I definitely have seen the things I saw in this article and both of them, whether it was during finals, like the things going on in her life at the time, we're super stressful. I think the trigger was she doesn't like see great at night or in the rain when she's driving, and I think all these things compounded, um and just played out to where she felt like she's having a heart attack, and so did my friend. But I guess we should mention that there are some tailtale signs of a heart attack. Yeah, that's a big yeah, that you can recognize the difference, because you don't want to actually be having a heart attack and be like it's just a panic. Just breathe, just breathe while you're dying. Um. Here are a few tips from the American heart association. Pressure in the center of your chest that persists longer than a couple of minutes, or goes away then returns, shortness of breath, pain in the arm or upper body. You might feel nauseous or faint. And of course, if you're ever in doubt, call because, like you said, you don't want to be having a heart attack thinking it's will subside, there will be a guy in your face. Well to say the last exactly, Uh, If you want to know more about panic attacks and panic disorder, type either one of those sets of words into the search part how stuff works and it'll bring up this article. And since I said that it's time for a listener mail, I call this basement fear. Hey, guys, I know most listeners know your podcasts great for learning and entertainment, but I found another purpose distraction from stress induced irrational fears. This sounds familiar. We were just talking about this kind of thing. Oh yeah, And I didn't even realize that when I picked this out. How about that serendipity. Um, I grew up in a house with a creepy, gross basement where we did laundry, and it never bothered me. My fiance James, and I recently moved into a house with a non creepy and non gross basement. But I think the stress of planning a wedding is getting to me because when I need to go down into the basement to do laundry, I nearly have a panic attack imagining a person lurking in the basement. I've started playing an episode of Stuff You Should Know on my iPhone and carrying it in my pocket when I need to go down to the basement, stay back Spirit exactly, so we literally accompanied her into the basementch I think is hysterical. I am busy enough enjoying your humor and information that I don't get us overwhelmed by this irrational fear. I think it may even be waning now, so I continue to make myself go down into the basement and see that my fear is not really based in any reality at all. Uh. That's CBT, that's exposure therapy boom. Also before this weird basement, if you're popped up, I long called you guys my cleaning crew because I listened to episodes while doing my chores. And that is from Kelsey in Kansas City, Kansas, not Kansas City, Missouri, Missouri. And uh, Kelsey, good luck with that, and just don't look behind that door over near the washing machine. That's very helpful. Just getting Kelsey, there's nothing down there, and just take us with you. Well, we will protect you because spirits don't like us. The podcast is coming from inside the house. If you want to get in touch with Chuck or me, you can tweet to us at s y s K podcast. You can join us on Facebook dot com, slash stuff you Should Know. You can send us an email to Stuff Podcast at how stuff Works dot com and has always joined us at our home on the web, Stuff you Should Know dot com. For more on this and thousands of other topics, is it how stuff Works dot com.