Archive for October, 2006

"Dude, wait a minute, I can help you!"

Tuesday, October 31st, 2006

That’s what I wish I would have said.  So I’m feeling guilty for just sitting there.  "I’m coming out!" I heard in a deep, but anxious voice.  I turned to see a large man built like a linebacker pushing his way against the flow of people walking down the aisle of a 747 American Airlines flight heading to DFW from the New Jersey airport.  Then I heard the flight attendant say, "where are you going?"  He replied, "I’m not going, I’m scared."  My first impulse was to jump up and go after him – I knew I could help.  I didn’t.  But I should have at least given him my card and said, "call me, I can help you."  Maybe he would have said no thanks but that’s no excuse.  I should have offered.  Why?

I feel obligated to offer help when I see someone in distress and I have the knowledge and  ability to help.  For 30 years I have had a special interest in panic disorder and associated phobias.  Fear of flying associated with panic disorder is easy to treat of course.  I don’t know for sure that he had panic disorder.  He might have had an irrational fear that the plane might crash.  Patients with panic disorder are afraid they are going to have a panic attack which can be a form of claustrophobia.  Fear of panic attacks frequently causes panic because the individual gets so tense that they can’t breathe properly and the combination of increased muscle activity (metabolism) and shallow breathing cause CO2 levels in the blood (hence the brain) to go up and patients with panic disorder have a lower threshold of CO2 tolerance.  Everybody at some CO2 level will panic because the brain is hard wired to let us know if we are in a poorly ventililated place – basically the lower brain centers send the message – "get out of here or you’re going to die!"  This can be life saving under some circumstances – but panic attacks are a "false alarm". 

What the man leaving the plane needed was first to understand the physiology and cause of his symptoms.  Second, he needed to be offered Niravam (fast acting alprazolam that dissolves on the tongue), or sublingual Klonopin that would quickly calm him down, raise his stress tolerance level, and help him maintain control.  He might also have needed psychological support – at least for the first few minutes.

I can try to rationalize "it was none of my business" (cop out).  I could remind myself  "no good deed goes unpunished" (frequently true but cop-out) or I could think well at least he didn’t get gunned down – remember the poor guy in Florida?  (See previous blog).  Maybe he’ll go on line and end up on the Anxiety Disorders Association of America website, http://www.adaa.org/., where I’m listed as a resource.

If you or anyone you know suffers from fear of flying make sure to get the treatment needed.  There’s a lot of things we can’t do anything about, this isn’t one of them.   http://www.anxieties.com/home.htm

 

Can ADHD people go to college?

Monday, October 23rd, 2006

Question:  I have ADHD, and it is ruining my life.  I can’t function like everyone else.  I keep making appointments to see a therapist, but I never go.  I don’t want to do this anymore.  I want to go to college, but everyone I know says it’s not a good idea for ME.  Can ADHD people succeed in college?

- Stacy

Answer:  Being ADD doesn’t mean you can’t concentrate and be productive.  But it means it’s very difficult to do things you don’t have high interest in.

Therapy can help you understand your ADD and cope with it better in some ways.  But research overwhelmingly shows that medication is a much more effective treatment.

Stimulants like Adderall XR and Methylphenidate (Daytrana, Concerta, et al]) are the most effective treatment.  They “turn on the brain” and allow you to focus and do things well that are important but not necessarily interesting to you (like, unfortunately, a lot of college work).  Stimulants give ADD people control of their life by broadening their areas of functional capability.  Finding the right medication at the right dose is the first step.

In my practice of over 40 years, stimulants, especially Adderall XR, have been the medications that lead people to say things like, “My life has changed.  Things are easier.  My life is better.”  And they’re still saying it 1 year, 5 years, and 10 years later.

As far as your fears about college, I treated students at the University of Texas at Dallas for 15 years.  I saw many students go from barely passing to making all A’s once they got on the right medication.

I invite readers to comment on how a particular medication or combination of medications has changed their life.