Depression and Attention Deficit Disorder with Panic Attacks in an Adult Woman

"In these stories, the identities and locations have been changed to ensure client confidentiality.”

A 42-year old married woman presented with a three year history of panic attacks.  The attacks came over her in “waves,” and were characterized by typical signs of panic attacks including her feeling a flushing sensation in her face, feeling she would die, a rapid heartbeat, nausea and a sense of doom.  In addition, she developed excessive sleepiness, depression, crying spells, episodes of “feeling funny,” déjà vu, ringing in her ears and episodes where people “sound incoherent.”  Also, she suffered from headaches and a change in her sense of taste.

Past history was revealing that she had sustained three concussions when younger, that she had initially forgotten about, but remembered when closely questioned.  Following these concussions she had trouble sustaining attention, was easily distracted, and had difficulty completing her homework. Medical history was unremarkable.  Preliminary diagnosis was Panic Disorder with secondary Major Depression, possible Temporal Lobe Seizures and Attention Deficit Disorder as a result of the concussions.

Further psychiatric evaluation confirmed the presence of depression, panic attacks and Attention Deficit Disorder, but did not support a diagnosis of temporal lobe seizures. The client was initially placed on Effexor 75 mg and Clorazopam 1 mg twice-a-day.  After one month the Clorazopam was tapered and discontinued and the Effexor was increased up to 300 mgs at bedtime. Within five weeks time, her panic attacks had disappeared, her energy level had increased, her depression had improved dramatically, and there was a complete absence of déjà vu, headaches, and feelings of unreality or lapses of consciousness.  She described that she felt like “eighty percent of my old self.”  Of particular interest was the fact that her “temporal lobe symptoms” disappeared along with the symptoms of depression and panic. The addition of Ritalin helped her to improve her ability to concentrate and sustain attention and focus, and she then felt like “ninety percent of my old self.”

Psychotherapy assisted her in resolving long standing problems with low self-esteem and provided her with tools to help her better organize her life.