Q&A: Panic Attacks, Anxiety, and Concussion

Q&A: Panic Attacks, Anxiety, and Concussion

Raymond Pan, MD, clinical psychiatrist with the UPMC Sports Medicine Concussion Program and an assistant professor of psychiatry at the University of Pittsburgh, answers questions about treating panic attacks and anxiety that are brought on by any type of concussion.


Q: Why would a person experience panic attacks after sustaining a concussion?

A: People who suffer a concussion have various symptoms, such as dizziness, balance issues, nausea, sensitivity to their surroundings, and so forth. Basically, they don’t feel like themselves, so they worry that this is their “new normal” and they’ll never feel better ever again. Many of these folks have no history of psychiatric problems so this is entirely new to them. This feeling and worry is what causes panic attacks and anxiety.

Since the patients don’t feel like themselves, they can’t fulfill their obligations like caretaking in the home, or for athletes, their sports performance suffers, so anxiety ensues. A professional athlete who suffers a concussion may feel like this is an excuse for their team to cut them, and if they’re cut, they worry about how they’ll support their family. This can all build up and cause panic attacks.

It is not an absolute, but the more highly functional an individual typically is, the more likely they are to be the most anxious. They are used to performing at a high level, so the symptoms caused by having a concussion affect them more.


Q: What are some symptoms of having anxiety and panic attacks?

A: Anxiety is the most common psychiatric disorder, though not the most commonly treated behavior because people don’t seek treatment for it. However, concussion patients at the UPMC Sports Medicine Concussion Program can be evaluated for anxiety while undergoing treatment for their concussion.

Patients with anxiety who are prone to panic attacks may experience the following symptoms:

  • Anxious mood
  • Depressed mood
  • Dizziness
  • Headaches
  • Inability to concentrate
  • Insomnia
  • Irritability
  • Memory loss
  • Mood swings
  • Nausea
  • Noise and light sensitivity
  • Stuttering
  • Tinnitus, or ringing in the ears
  • Vestibular problems

A concussion can affect your baseline of anxiety and make it worse. However, the baseline can improve if you’re treated. And the good news is, if symptoms get better through concussion treatment, the patient will feel less anxiety.


Q: How do you treat panic attacks and anxiety that are brought on by a concussion?

A: I can prescribe medication to treat the symptoms of anxiety. I also do psychological counseling and I suggest that my patients see a psychologist as well. Many concussion patients come from out of town so I go to the concussion clinic at the UPMC Rooney Sports Complex to make it easier for them to see a psychiatrist. Many of these patients don’t have a psychiatric history and no family history of psychiatric problems. Most are gifted athletes and high functioning individuals who need some help working through the anxiety brought on by not feeling well due to the concussion.

Along with my colleagues at the clinic, I encourage my patients to exercise moderately, go to vestibular and physical therapies, and do normal activities of daily living such as going to the grocery store. Psychiatric medication reduces the acute symptoms of anxiety, such as helping the patient not feel so emotionally drained.

My patients worry they’ll never feel better so I have to educate them that it’s a process and it can take a while to recover from a concussion. If they do their exercises, go to social functions, go out to eat, go to the busy mall, and not just sleep on their couch all day, they’ll ease their symptoms and start to feel better.


Q: What kind of support is needed to help a patient work through the anxiety brought on by a concussion?

A: Support is key. Things you’re used to doing quickly take you longer and take more effort. So, having support from family and friends is really important. If a college student must take a break from classes to recover, having parents who tell them, ‘it’s okay, we’ll have you at home for a while,’ or ‘we’ll help you get into another college,’ can be really important. Or if a mother with a concussion isn’t able to take her children to the bus stop, she’ll need a family member or friend to help them.

For professional athletes, there’s the team, the agent, and the athlete’s family. The athlete may worry that the team will cut them and they won’t be able to support their family. They can’t participate in team activities so they’re isolated from their colleagues. So again, emotional support from loved ones is incredibly helpful. This is often the first brush with failure for these folks so they need outside support to get them through.


Q: Why choose the UPMC Sports Medicine Concussion Program for your care?

A: It’s a team approach. Concussion symptoms are linked closely with physical symptoms that need to be addressed. The fact that I am in the same building with the physical therapists and other neuropsychologists definitely helps so we can all talk about the concussion treatment plans for each patient. By having all these specialists working together, hopefully our patients can get better faster. It’s essentially a “one stop shop” for concussion care.