Panic Attacks Are a Fact of Life for Many : Health: The anxiety disorder dictates where they go, what they do. But treatment, including a recently approved new drug, often is effective.

Thousands of Americans are too afraid to get into their cars, shop at the mall or even venture out of the house, worried they’ll suffer a panic attack.

“It’s a horrible feeling,” said Ann, a 51-year-old Richmond real estate agent. “I feel like I’m losing control. I feel like the world around me doesn’t exist and I feel like I’m going to die.”

Ann, who asked that her last name be withheld, said the panic attacks began when she was about 8, but she was too afraid to tell anyone.

“I didn’t even tell my parents,” she said. “We’re very good at faking things. I didn’t know whether I was mentally unbalanced. People with panic attacks are good liars, good excuse-makers.”

Ann had trouble going to the beauty parlor or sitting through a Sunday church service. She started avoiding the places where she had the attacks, places where she felt closed in.

About 3 million people suffer from panic attacks, said Dr. William T. Riley, co-director of the Anxiety Disorders Clinic at the Medical College of Virginia.

“Most people have experienced at least one or two panic attacks in their lifetime,” he said. “For it to be something that we consider a disorder, that we need to treat, people need to experience about one a week.”

The symptoms often mimic a heart attack. They include chest pain, shortness of breath, dizziness, trembling and sweating, nausea and abdominal distress.

The disorder is known as agoraphobia when people start avoiding places where they experience the attacks.

Panic disorders seem to develop primarily in people in their 20s, Riley said. It can strike anywhere, anytime. Evidence suggests that people inherit a predisposition to panic attacks. Other factors indicate that outside stress contributes to the problem.

“A lot of the people who have panic disorders had problems with separation from mom and dad early on,” he said. “They had difficulty with being left at the baby-sitter, difficulty going to school by themselves.”

The attack can last 15 to 30 minutes, and more often than not, people can disguise the fact that they are having one.

“On the outside, all they’ll usually see in these folks is that they look hotter, more sweaty. They’ll shake a little bit and have some difficulty talking.

“A lot of time they can keep working or hold it together.”

The two most frequent things people with panic attacks avoid are driving and shopping malls.

“They’re real afraid of being trapped and having this panic attack happen in front of a bunch of people, where they can’t get out,” Riley said. “Malls are very crowded and there aren’t a lot of exits. They’re OK in a shopping center. They can get to the doors quick.”

Last month, the Food and Drug Administration approved the first medication for the treatment of panic disorders. Xanax, known generically as alprazolam, had been used to treat clinical anxiety and anxiety associated with depression.

The drug is manufactured by Upjohn Co. of Kalamazoo, Mich. Executives there said a biochemical malfunctioning in the brain is believed to be one of the causes of panic attacks. Xanax can block the attacks by interacting with several different systems in the brain.

Patients also must learn how to control their behavior, Riley said. They learn relaxation techniques, they learn how to talk themselves out of the episode. Then, they begin to try to tackle the things they’re most fearful of.

“If they’re fearful of driving because they started to have these panic attacks, we start working on the drive,” he said. “If they’re fearful of going to the mall, a first step may be nothing more than driving there, sitting in the parking lot for five minutes and going back home.”

Agoraphobics also attend support group sessions. For example, in Richmond about 700 people belong to Agoraphobics Building Independent Lives.

The treatment is effective about 70% to 80% of the time, Riley said.

Ann, who has been working closely with Riley, said she has gotten to the point where she can go to the grocery store, a discount store and even the beauty salon.

“I took my car through the carwash by myself two weeks ago,” she said. “I’m still having trouble with the interstates, because you can’t get off of them until the exits.”

Her most recent assignment was to drive the interstate a little each day.

“You take a little bit at a time,” she said. “If you do it without anxiety, you’ve really done something.”