Treatment of panic disorder: a personal experience

Editor’s note:

Garry McDonald is one of Australia’s best known comedians. He has successfully overcome problems with panic disorder which at one stage threatened his career.

AP: How did you realise you had a problem?

GM: I have been an anxious person for many years, but did not know what the problem was. In 1992 I became severely stressed when the director of a play I was appearing in announced that it would be presented to an audience after only 10 days of rehearsals. This was too soon for me to cope with and I just wanted to run away. As it turned out I had no need to panic. Rehearsals got so far behind that only Act 1 was presented to the invited audience, and my character only appeared in Act 2.

AP: How was your life affected?

GM: I had a low opinion of myself. I became fearful of not reaching the standard that people expected of me in a performance, or the standards I had set for myself. My mind was racing with negative thoughts and I was afraid of making a fool of myself.

When I was having an attack, I would become tongue-tied and stammer. My sleep was reduced. I could feel like this for days.

Worrying about having another attack made me change some of my activities. Anxiety made me want to avoid going to parties. I was worried that I would be boring. If I went to a party, I almost immediately had to go into the toilet because of my anxiety.

AP: Did the people around you realise there was a problem or did they just expect you to ‘pull yourself together’?

GM: People expect you to perform. They do not expect you to throw in the towel. I was having trouble standing up for what I knew was right for me. At one stage someone threatened to sue me if I did not perform as they wanted.

AP: When did you seek help?

GM: Although I had some psychological therapy, my breakdown was a real wake-up call. In 1993 I descended into depression. I felt ashamed and unable to concentrate. Suicidal thoughts really frightened me. Although I felt dreadful, by evening I was able to manage to pull together some kind of a performance in my show, then I would spiral down again.

Somebody made me go and talk to my general practitioner. I remember sitting in the gutter waiting to see the doctor. I was then referred for a psychiatric opinion.

AP: What treatment did you have?

GM: My depression was treated with drugs such as dothiepin and moclobemide.

For my anxiety I have had alprazolam and buspirone. The problem with these drugs is that they suppress the problem. They hold down your anxiety, they do not make the problem go away.

Buspirone caused me a few problems. It made me disinhibited and I would say strange things at the most inappropriate times.

AP: Which was the most effective treatment?

GM: Bronwyn Fox sent me a copy of her book ‘Anxiety attack: don’t panic’.* Reading that book was a revelation. For the first time I realised that I had a recognised disorder. This was a huge turning point and I arranged to see a specialist in the disorder.

I had eight sessions of cognitive behaviour therapy. This was very effective and taught me how to recognise and challenge my negative thoughts.

The skills you learn in cognitive behaviour therapy can be used to reduce relapses. About 18 months after my therapy I began to feel frantic and nervous again.

I was reassured that this was just a temporary setback. After just one visit to the specialist I was again able to control my thoughts. I now try to practise these skills all the time.

AP: How could health professionals be more helpful?

GM: Telling the patient that they have panic disorder is not enough. You need to describe the symptoms to the person. They will be greatly relieved that their symptoms are being recognised. Providing an information leaflet, which includes a list of typical symptoms, can also be helpful.

The person should be reassured that there is a very successful treatment, but it requires their co-operation. There is no magic pill. If the patient is referred, it is important that they are seen by someone skilled in cognitive behaviour therapy.

AP: What would you advise people with similar symptoms to do?

GM: Australians have a tendency to put themselves down. This can result in people with anxiety blaming themselves and not doing anything about it. If people cannot function because of panic they need to go and see a specialist in anxiety disorders.

People have to be willing to work for themselves as part of cognitive behaviour therapy. Once they have learned the technique, people will realise that it works quickly and with practice they will be able to master their fears.

They should not expect to jump straight to their goal. With cognitive behaviour therapy, the journey to that goal is just as important as the outcome. Making your own discoveries on the way is empowering.

People should be aware that if they have had panic disorder for 20 years it is likely to recur. If they keep practising how to challenge worrying thoughts they will retain control.

Cognitive behaviour therapy has given me a sense of being stronger because I am looking after myself without the need for drugs.

* Melbourne: Longman Cheshire; 1993. Currently out of print.