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Women: More Panic Attacks in Midlife

Women's Role in Society Puts Them at Greater Risk

From the WebMD Archives

Sept. 22, 2003 -- After age 50, a woman is at high risk for panic attacks -- especially if she has faced stressful life events and health problems.

That's the finding from a new study in this week's Archives of Internal Medicine.

Panic attacks are a distinctive form of anxiety more common in women than men.

A full-blown panic attack is defined as an attack of sudden fear for no apparent reason, anxiety, or extreme discomfort.

However, whether panic attacks are more likely to happen in the menopausal years has never been studied, writes researcher Jordan W. Smoller, MD, ScD, a psychiatric researcher with Massachusetts General Hospital in Boston.

"To our knowledge, this study is the largest survey of the prevalence ... of panic attacks in postmenopausal women," Smoller adds.

Serious Life Events Trigger Panic Attacks

His study involved more than 3,000 women -- between age 50 and 79 -- who completed detailed questionnaires on an assortment of heart disease, respiratory, migraine, panic, and other symptoms; serious life events that occurred in the previous year; and limitations that panic attacks had on their lives.

Researchers found:

  • 18% had experienced panic attacks in the past six months.
  • 13% had full-blown panic attacks that impaired their social activities and daily lives.
  • 7% had limited-symptom panic attacks (rapid or irregular heartbeat only).
  • 14% of full-blown panic attacks. -- The majority happened to women between age 50 and 59.
  • Women were nearly three times more likely to have full-blown panic attacks if their income was less than $20,000 a year.
  • One-third of women who had full-blown panic attacks also suffered from depression symptoms and women with defined depression were also significantly more likely to suffer from full- blown panic attacks.
  • Women with emphysema, asthma, heart disease, migraines with aura, and thyroid problems were more likely to report full- blown panic attacks.
  • Stressful life events factored strongly in panic attacks. Women who had five or more events in the past year were seventimes more likely to have full-blown panic attacks.

A woman's marital status and education level did not make an appreciable difference in whether she had panic attacks or not. Also, whether she had taken hormone replacement therapy did not make a difference, Smoller reports.

Because some medical conditions produce symptoms similar to panic attacks -- and women may be misdiagnosed -- "we believe that the rates we observed may be a conservative estimate of panic in postmenopausal women," he writes.

Panic attacks and panic disorder often begin when women are in their 20s or 30s, but there may be a later peak between ages 45 and 54, Smoller writes. Panic Disorder in Older Women Ignored

"This is a great study; it's been very much needed," says Katherine Shear, MD, professor of psychiatry at the University of Pittsburgh School of Medicine, tells WebMD.

Indeed, "most studies have focused on panic in younger women, not those in menopause years," Shear tells WebMD. There's even been some confusion about whether very many older women experience panic attacks, she says.

This study also helps shed light on the relationship between panic and heart disease, says Shear. "Studies have linked panic and heart disease in men, but no one has ever looked at this in women. While this study doesn't quite establish a link, I think it does present good evidence."

"The same nervous system imbalances that trigger sudden death and heart disease may also trigger panic attack," Shear tells WebMD. "Mental stress and stressful life events are strongly associated with panic and with heart disease."

Doctors are not always good at diagnosing panic, she adds. "[Smoller's] study underscores that not only are panic attacks prevalent in post-menopausal women but they are also clinically significant. It is a serious mental illness."

Panic disorder is a major health problem, and "currently there are no funded National Institute of Mental Health studies of anxiety disorders in older women. It's a major deficiency in the field," says Shear. "This study is helping us draw attention to that fact."

Societal, not Hormonal

Doctors should indeed be looking more closely at their patients' symptoms, looking for signs of panic disorder, says Janet Pregler, MD, director of the Iris Cantor UCLA Women's Center.

After all, panic does not seem to be a hormonal disorder, Pregler points out. Even before girls start having periods, they show higher rates of anxiety disorders. That's a clear sign that hormones are not involved.

"More likely, it's the effects of stressful life events that women are exposed to, like abuse," Pregler tells WebMD. "Women's role in society may impact anxiety.

We've seen it in studies of monkeys and of people, that those who are more fearful of taking risk, who are not assertive, are more prone to panic disorder. We have to consider at what point does society put women at risk?"

While fewer women over age 60 reported panic attacks in Smoller's study, there may be reasons, Pregler adds. "They may not think it appropriate to mention it to their doctors. Or they may not realize what is happening when they have a panic attack."

Show Sources

SOURCES: Smoller, J. Archives of Internal Medicine, Sept. 22, 2003; vol 163. Katherine Shear, MD, professor of psychiatry, University of Pittsburgh School of Medicine. Janet Pregler, MD, director, Iris Cantor UCLA Women's Center.
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