Question. My husband is depressive, on medication and seeing a psychiatrist. When he’s in the “pit” he becomes incredibly needy. He has frequent panic attacks and yells for me to come help him each time he has one – sometimes three or four times an hour. He is on medication and seeing a psychiatrist. I can handle this over the short term, but the problem is I’m returning to a full-time job next week. The last time he was in this state he called me between five and ten times a day, putting my job in jeopardy. He’s also spoken of suicide, and I’m wondering how he will cope if I tell him not to call me at work.

Answer. I sympathize with your situation. From your description, your husband either has an extremely severe form of panic disorder or a very dependent and “clingy” way of dealing with his anxiety – or a combination of the two scenarios. I think it is important that you discuss the situation with his psychiatrist. Someone having 3-4 panic attacks per hour despite vigorous treatment is not within the expected level of control for the disorder.

You don’t say what medication he’s taking, but I would certainly take another look at them. If his psychiatrist isn’t willing to do so, I would obtain a second opinion from an expert in panic disorder (PD). Start by seeking a referral from a medical school-based department of psychiatry.

Secondly, you don’t say if your husband has received cognitive-behavioral therapy (CBT). I believe this is an essential part of managing severe panic disorder, and would urge you to explore this with the psychiatrist. Do not accept general forms of relaxation therapy or supportive therapy – the therapist must be an expert in cognitive-behavioral therapy. A good behavioral psychologist would be my first pick.

If your insurance would cover it, your husband might benefit from some sort of day program. It doesn’t sound like sitting around at home is a good idea for him. Frankly, if he has spoken of suicide recently, I would take that very seriously, and let his psychiatrist know. He should NOT be “home alone” if he is strongly suicidal. When you got to work, I’d recommend that you arrange in advance a number of times in the day when you will call him. I would advise against responding to non-scheduled calls from him – to do so will only reinforce his neediness.

On the other hand, it is neither wise nor appropriate to punish a cry for help (from someone who is suicidally depressed) by ignoring it – so if this is really the case, your husband shouldn’t be at home alone. You may want to contact the Anxiety Disorders Association of America for more information about panic disorder, or call the Panic Disorder Info Hotline at NIMH. Good luck.

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