Laura Duffy, M.D. is an Attending Psychiatrist at California Pacific Medical Center in San Francisco who was recently referred a patient with panic disorder whose anxiety was triggered in an unusual way.

“My patient is a man in his 30s, quite successful professionally, who had no obvious past psychiatric history other than a questionable history of subclinical generalized anxiety disorder. Several months ago he was at a party where he drank some beers and took a “Yellow Jacket,” which is a street name for ephedra [Ed. Note: ephedra is an herbal product used for weight loss and energy stimulation which has been implicated in the deaths of several professional and amateur athletes, most recently in the death of Baltimore Orioles pitcher Steve Bechler, who died of heat exhaustion]. The night of the party, he went to sleep normally, but the next day while in a cab he suffered a full scale panic attack, which terrified him so much he went to an emergency room, where he was diagnosed with anxiety and dehydration. He was fine for two weeks, then at a social event was chatting with someone who said he had taken ephedra once, and my patient immediately had another panic attack. He began to have anticipatory anxiety, became hyperaware of his heart rate, and eventually was started on Zoloft by his primary care physician, and was referred to me. I diagnosed him with panic disorder, and have maintained him on Zoloft 75 mg per day and Klonipin 0.5 mg b.i.d., with near complete resolution of his anxiety.”