Clinical Cases

Panic Attacks in a Woman of 44

Written by Petr Zacharias

Homeopath Petr Zachariáš shares a case of panic attacks in a woman of 44. Faces flushes from excitement and fear something will happen were among the symptms leading to the simillimum.

1st visit, 6. 3. 2021

A woman, 44, suffers from anxiety and panic attacks occurring several times a day. She uses Lexaurin. The first panic attack appeared in 2010, without any apparent cause. When the first panic attack came, she was just expecting a carpet cleaner and was nervous, anxious that everything must be tidy before he arrives. Suddenly, she developed a sensation of constriction in her throat, she could not breathe and started trembling.

Some time later, she found out that her husband had been unfaithful to her, and she was greatly disappointed; she confirms that she still harbours that disappointment.

The biggest aggravation occurred in May 2018 when she became unwell at work (she got up from her chair to go and get something, went back and suddenly developed a sudden weakness that forced her to sit down. After a few minutes, the weakness subsided but ever since, she has been suffering from flushes of heat to the face with red cheeks and anxiety.

At first, there were waves of anxiety but gradually, she got to the point where she feels anxious all the time. The anxieties escalate into panic attacks several times a day, during which her face and especially cheeks flush with heat.

Her cheeks burn and flush when she is nervous as well. She is constantly nervous, anxious, has fears, feels tingling in her hands and head, and a burning sensation in his cheeks. Since her condition got worse (2018), she haas been much more tired and keeps yawning frequently.

Panic attacks currently occur several times a day with the following symptoms: feeling of anxiety in her throat and chest, a sensation of heat in the cheeks, tingling in the head, cold hands, internal trembling and fear that something bad is going to happen to her.

Observation: she cannot hold a line of conversation – she keeps digressing from the question and it is necessary to ask the same thing repeatedly to wrestle out an answer.

Seven years ago, she had a contraceptive implant introduced. She says she had not noticed any psychological changes after it was implanted. She wakes up after about 5 hours of sleep and then cannot fall asleep again for an hour, most often waking up around 3AM.

She also suffers from migraines above her right eye, about once a month; now that she receives vitamin C and calcium infusions, the migraines are much better. They started in her thirties after having children (her mom suffered from migraines all her life).

The headaches concentrate in the area of the right eye, typically progressing into such severity that she feels as if the top of her head would fly off (the last such migraine was 3 months ago).

For a long time, she cannot bear tight clothes around her neck (2).

She suffers from asthma ever since she was small, and she uses Symbicort.

She does not enjoy life as much as she used to.

Case analysis:

In cases of panic attacks, it is very important to ask about the possible etiology, especially if the onset of the attacks is temporally clearly defined. Argentum nitricum was the first remedy I thought of concerning a possible etiology.

The reason was that the first panic attack occurred in a situation where the patient felt anticipation and anxiety (before a visit from carpet cleaners). However, in 2018, when the most severe aggravation occurred, the patient did not recall anything that could have triggered such a severe exacerbation of the panic attacks. For this reason (as we do not know the etiology with certainty), we have to work with symptoms alone in this case.

In terms of symptoms, it is important to consider the course of the panic attacks and the problems that occur together with these attacks. For example, if we have a patient who suffers from panic attacks, eczema and insomnia, the first remedy we think of is Kali arsenicosum.

If panic attacks combine with severe depression, Helleborus is one of the first drugs we need to consider. If panic attacks are combined with neurological problems, we think of Argentum nitricum, Agaricus and Stramonium.

In some cases, the course of panic attacks are so specific that it may point us directly to the simillimum. In most cases, however, the course itself is not so specific (i.e., the symptoms arising during the attack itself are covered by multiple remedies).

If this is the case, the range of possible remedies can be narrowed down using patient’s symptoms in other areas, especially if such symptoms in other areas occur during (or in association with) panic attacks. Here, such symptoms include flushes of heat in the face, which are described by the patient as very intensive and are accompanied by a burning sensation in the cheeks.

As this symptom stands out above the others in its intensity and first appeared at the same time as the worsening of the panic attacks, we can be sure that, together with the panic attacks, it belongs to the so-called uppermost layer of symptoms.

In other words, panic attacks and hot flushes are the most important symptoms in this case. The development of both these symptoms in this intensity is associated with a single period; however, we have been unable to identify any etiology. The question, then, is whether there is a remedy with the combination of panic attacks and facial flushing as a keynote. And there is one – Amylenum nitrosum.

Although the patient has a personal history of disappointment that still persists, there is no association between the disappointment and the development or worsening of panic attacks because the attacks started before this disappointment. However, as she has not got over it yet, it must be included in the analysis.

Amylenum nitrosum was, therefore, the remedy that occurred to me in the second place and thanks to the combination of aforementioned symptoms, it was a serious candidate for simillimum. Let’s have a look at all the important symptoms now and repertorize the case; then, as always, we will differentiate among the remedies.

Intensive symptoms:

  1. Ailment from anticipation
  2. Ailment from disappointment
  3. Panic attacks
  4. Fear that something bad would happen
  5. Flushes of heat in the face, worse when agitated
  6. Frequent yawning
  7. Waking around 3 AM
  8. Cannot bear tight clothing around her neck
  9. Digressing from the questions

Combined symptoms:

  1. Anxiety and flushes of heat

Repertorization in the RADAR software with the Synthesis 9.1 repertory

Repertorization is performed using the technique Sum of symptoms and degreesintensity is considered)

Differential diagnosis:

Arsenicum album is one of the most important remedies in patients with anxiety and panic attacks. In most such cases, it comes out on top in the repertorization. However, none of the patient’s symptoms are keynotes of Arsenicum, nor is the combination of anxiety and flushes of heat in the face.

Lycopodium cannot be confirmed as none of the patient’s symptoms are its keynotes.

Phosphorus is a very important remedy in patients with both anxiety and panic attacks; moreover, the fear that something bad would happen is its keynote. However, hot flushes in the face in association with anxiety and emotional turmoil, which are the most intensive symptoms in this case, are not a typical (keynote) feature of Phosphorus.

Pulsatilla cannot be confirmed as none of the patient’s symptoms is its keynote.

Ignatia comes into consideration whenever we can see the etiology of disappointment and a feeling of constriction in the throat. The constriction in the throat, although we have not included it in the repertorization, is one of the symptoms that come on during panic attacks, and is a keynote of Ignatia. However, although Ignatia is an important remedy for problems resulting from disappointment, it does not have as strong anxiety as the one our patient feels.

Sulphur is an important remedy for hot flushes (not only) in menopause. With Sulphur, however, the flushes are not combined with panic attacks, and the patient who needs this remedy feels the heat during flushes predominantly in the temples and feet.

Kali carbonicum awakens 4-5 hours after falling asleep or between 2-4 AM. Both these symptoms are keynotes of Kali carbonicum. However, the anxiety in Kali carbonicum does not reach the intensity of panic attacks and this remedy does not cover the flushing combined with anxiety, either.

Mercurius solubilis cannot be confirmed as none of the patient’s symptoms are its keynotes.

Calcarea carbonica is an important remedy in patients with panic attacks, especially if their development is preceded by overwork. During a panic attack, however, Calcarea’s strongest symptom is the fear of going crazy. Calcarea carbonica has shaking during panic attacks, similar to Gelsemium, Phosphorus and Argentum nitricum, as well as hot flushes, which may be associated with anxiety in Calcarea. Although this connection is not a keynote of Calcarea, the remedy covers it and, for that reason, must be considered.

Sepia cannot be confirmed as none of the patient’s symptoms are its keynotes.

Amylenum nitrosum is a remedy of which severe anxiety attacks (panic attacks) together with severe local hot flushes in the upper body and face are a keynote combination. This remedy is very similar to Lachesis, but, unlike Lachesis, it has a strong fear of something bad happening (especially during a panic attack).

Like Lachesis, this remedy has flushing and the aversion to tight clothes around the neck (although not as intensive as Lachesis). Also, although it is not present in this case, jealousy is in the picture of both these remedies. The frequent yawning that the patient speaks of is a keynote and confirmatory symptom of Amylenum nitrosum.

Lachesis is an important remedy in flushes of heat, which are also its keynote symptom. The flushes of heat are, however, always felt all over the body in Lachesis while in Amylenum nitrosum, they are always felt locally, e.g. in the chest or face.

Lachesis corresponds to the style of speech (jumping from one topic to another), which is its keynote, just like the aversion to tight clothes around her neck. On the other hand, Lachesis does not have panic or anxiety attacks with fear of something bad happening in its picture.

Selection of the remečdy, potency and dosage

Amylenum nitrosum is the only remedy that can be confirmed at the same time, its keynotes are the main symptoms of the case. I prescribed it at a single split dose at the potency of 200C.

Prescription: Amylenum nitrosum 200C in a single split dose

1st follow-up 8. 5. 2021 – 8 weeks after taking the remedy:

One week after taking the remedy, the patient experienced severe psychological deterioration, which began to improve a few days later, together with her sleep. However, the headaches got worse over the long term, they occur every 2 weeks now and the pain lasts for 3 days. Her last migraine was 10 days ago and she took a caffeine analgesic for it.

Anxiety is 80% better, sleep improved by about 50% and she has not had to take Lexaurin once.

She felt (and still feels) generally much better and enjoys her life much more but after taking the caffeine-containing medication for migraine, her condition got somewhat worse again. She feels, however, still much better than before the homeopathic treatment.

Since she took the caffeine analgesic 10 days ago, the pain on the top of her head has got worse (she has pain with a feeling that the top of her head would “fly off” every day); the headaches are accompanied by a waving sensation (which she did not have as often before) and tingling in the face.

Analysis of first follow up

The initial aggravation after taking the remedy followed by an improvement of the main psychological complaints, sleep and energy is a great reaction indicating that the treatment runs in line with Hering’s Laws. This is further underlined by the aggravation of older symptoms (migraine headaches).

There has been, however, a partial relapse after taking the caffeine-containing analgesic, after which the general condition got somewhat worse and new symptoms have appeared (constant headache combined with waving sensation).

This type of pain on the vertex combined with the sensation as if the top of the head would fly off is a keynote of the remedy Cimicifuga, which has also a similar rocking sensation in its picture. However, as the patient feels generally better than before the treatment, it is possible that the complaints will disappear spontaneously. For this reason, I propose to wait for 7-10 days more and to evaluate the development after that time.

Prescription: wait

2nd follow-up 17. 5. 2021 – 9 days after the last follow-up – e-mail:

“Hello Peter, I am sending the information about our school patient as we agreed.

She is generally much better now, the pressure on the top of her head regressed and the sensation of the top of the head flying off disappeared completely. Since the last migraine 2 weeks ago, she has not had severe headaches anymore.

All in all, she says that she finally enjoys every day, feels joy over ordinary things and nothing ails her. You can hear even from her voice that she is full of energy, I have not seen her like this for a long time now… She asked me to give you a huge Thank you!

Analysis of the 2nd follow-up:

The reaction we see means that the organism managed to renew the balance on its own. As the patient feels better in all aspects and has no complaints, we have to wait without repeating the remedy.

Prescription: wait


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About the author

Petr Zacharias

Petr Zacharias is the founder and main teacher at the Prague College of Classical Homeopathy. He studied with George Vithoulkas at the IACH and has conducted seminars with Dr. A. U. Ramakrishnan, Dr. S. K. Banerjea, Dr. Jorgos Kavouras and Erik van Woensel.

1 Comment

  • Hi Petr,

    Your case analysis is so very careful and detailed with fine tuning from comparative materia medica. Thank you.

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