New data question panic, suicide relation.

You've experienced the sensation before, but it never gets any easier. A sudden rush of fear courses through your body. Your heart beats wildly and pounds painfully against your chest. The room starts to spin and you feel like you might be going crazy. You're having another panic attack.

To top it off, these recurrent symptoms may also signal a heightened tendency to attempt suicide. A random national sample of adults suggested a few years ago that one in five persons reporting repeated panic attacks, also known as panic disorder, has also attempted suicide, a strikingly high rate comparable to that observed for persons with severe depression (SN: 11/4/89, p.293). But new evidence, published in the May AMERICAN JOURNAL OF PSYCHIATRY, points to a much weaker link between panic disorder and suicide attempts.

Five of 234 people treated only for panic disorder at two outpatient mental health clinics had attempted suicide or entertained serious thoughts about killing themselves, a rate of 2 percent, assert psychologist Steven Friedman of the State University of New York Health Science Center at Brooklyn and his colleagues. That number exceeds the 1 percent rate of suicide attempts among people with no psychiatric disorders but falls far short of the 20 percent rate associated with panic disorder in the national sample.

Several factors may account for the discrepant findings, Friedman's group contends. A history of other psychiatric disorders among individuals with panic disorder in the national sample may have magnified their distress to the point where they considered suicide, the researchers suggest. Participants in the national sample reported panic attacks for the previous six months but cited suicide attempts over their lifetimes, they note.

Data from the new study support this possibility. Among patients treated at the same two outpatient clinics, 14 of 59 suffering from panic disorder as well as borderline personality disorder had attempted suicide, a rate of 25 percent. Symptoms of the latter condition include emotionally volatile relationships, feelings that life is empty or chaotic, alcohol and drug abuse, and repeated suicidal threats.

In both the national and outpatient studies, women with panic disorder and histories of alcohol and drug abuse proved most likely to report at least one suicide attempt, the scientists add.

Panic disorder sufferers in the national sample may also have been unaware that treatments exist for their condition, thus stoking feelings of demoralization and helplessness that contribute to suicidal thoughts and actions, Friedman's group argues.

In the outpatient study, experienced clinicians at the two facilities reviewed intake interviews and medical charts of panic disorder patients admitted over the past decade. A majority of those treated reported thinking about death, but usually in connection with fears of dying experienced during a panic attack.

A similar review of outpatient records, reported in the September 1991 AMERICAN JOURNAL of PSYCHIATRY by psychiatrist Aaron T. Beck of the University of Pennsylvania Medical School in Philadelphia and his co-workers, identified only one previous suicide attempt among 151 people treated for panic disorder between 1985 and 1989.

Further studies must establish more firmly the conditions that may combine with panic disorder, such as borderline personality disorder, to increase an individual's tendency to attempt suicide, the researchers conclude.

Even if only a weak link exists between panic disorder and suicide attempts, the disorder causes much distress and a substantially decreased quality of life among an estimated 1.5 percent of the U.S. population at some time in their lives, the investigators maintain. Psychoactive medication and psychological treatment can often help to diminish panic symptoms (SN: 10/5/91,p.214).