Advertisement

The Biology of Panic Disorder

  • Jeremy D. Coplan
  • Laszlo A. Papp
  • Jack M. Gorman
Chapter
Part of the The Depressive Illness Series book series (DISS, volume 4)

Abstract

The burgeoning amount of knowledge recently accumulated about the biology of panic disorder with or without agoraphobia (termed collectively PD) may prompt concern for falling into the “blind men feeling the elephant” trap. A plethora of biochemical compounds capable of inducing panic and other severe anxiety states not only supports a biological component in panic disorder, but also tests our definitions of clinical panic states. We are presented the challenge of differentiating primary pathogenesis from secondary and less specific changes in a complex interplay of biological systems.

Keywords

Panic Disorder Panic Attack Metabolic Alkalosis Sodium Lactate Locus Ceruleus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alpert NR, Root WS: Relationship between excess respiratory metabolism and utilization of intravenously infused sodium racemic lactate and sodium L(-)lactate. Am J Physiol 1954; 177: 455–462.PubMedGoogle Scholar
  2. Asnis GM, Friedman JH, Van Praag HM, et al: Noradrenergic dysfunction in panic disorder. Presented at the 143rd Annual Meeting of the American Psychiatric Association, May 1990, New York.Google Scholar
  3. Ballenger JC, Burrows GD, Dupont RL, et al: Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. Arch Gen Psychiatry 1988; 45 (5): 413–422.PubMedCrossRefGoogle Scholar
  4. Blier P, de Montigny C, Chaput Y: Modifications of the serotonin system by antidepressant treatments: Implications for the therapeutic response in major depression. J Clin Psychopharmacol 1987; 7:6s: 24s-35s.Google Scholar
  5. Carr DB, Sheehan DV, Surman OS, et al: Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy. Am J Psychiatry 1986; 143: 483–494.PubMedGoogle Scholar
  6. Carr DB, Fishman SM, Systrom D, et al: Carbon dioxide in panic disorder and premenstrual normals. Proceedings Annual meeting of the American Psychiatric Association, Chicago, 1987.Google Scholar
  7. Charney DS, Heninger GR, Breier A: Noradrenergic function in panic anxiety. Arch Gen Psychiatry 1984; 41: 751–763.PubMedCrossRefGoogle Scholar
  8. Charney DS, Heninger GR: Noradrenergic function and the mechanism of action of antianxiety treatment: I. The effect of long-term alprazolam treatment. Arch Gen Psychiatry 1985; 42: 458–467.PubMedCrossRefGoogle Scholar
  9. Charney DS, Heninger GR: Noradrenergic function and the mechanism of action of antianxiety treatment, II: the effect of long-term imipramine treatment. Arch Gen Psychiatry 1985; 42: 475–481.Google Scholar
  10. Charney DS, Henbinger GR: Abnormal regulation of noradrenergic function in panic disorders. Arch Gen Psychiatry 1986; 43: 1042–1055.PubMedCrossRefGoogle Scholar
  11. Cohen ME, White PD: Life situations, emotions and neurocirculatory asthenia. Psychosom Med 1951; 13: 335–337.PubMedGoogle Scholar
  12. Coryell W, Noyes R Jr, Schlechte J: The significance of HPA axis disturbance in panic disorder. Biol Psychiatry 1989; 25: 989–1002.PubMedCrossRefGoogle Scholar
  13. Crowe RR, Noyes R, Pauls DL, et al: A family study of panic disorder. Arch Gen Psychiatry 1983; 40: 1065–1069.PubMedCrossRefGoogle Scholar
  14. Crowe RR, Noyes R, Wilson AF, et al: A linkage study of panic disorder. Arch Gen Psychiatry 1987; 44: 933–937.PubMedCrossRefGoogle Scholar
  15. Crowe RR, Noyes R, Persico AM: Pro-opiomelanocortin (POMC) gene excluded as a cause of panic disorder in a large family. J Affective Disord 1987; 12: 23–27.CrossRefGoogle Scholar
  16. Crowe RR, Noyes R, Samuelson S, et al: Close linkage between panic disorder and alpha-haptoglobin excluded in 10 families. Arch Gen Psychiatry 1990; 47 (4): 377–380.PubMedCrossRefGoogle Scholar
  17. Dager SR, Rainey JM, Kenny MA, et al: Central nervous system effects of lactate infusion in primates. Biol Psychiatry 1990; 27 (2): 193–204.PubMedCrossRefGoogle Scholar
  18. den Boer JA, Westenberg HG, Kamerbeek WD, et al: Effect of serotonin uptake inhibitors in anxiety disorders; a double-blind comparison of clomipramine and fluvoxamine. Int J Clin Psychopharmacol 1987; 2 (1): 21–32.CrossRefGoogle Scholar
  19. Eriksson E, Humble M: Serotonin in psychiatric pathophysiology. In: Pohl R, Gershon S (Eds.), The Biological Basis of Psychiatric Treatment, Progress in Basic Clinical Pharmacology, Basel: Karger, 1990, Vol. 3, 66–119.Google Scholar
  20. Evans L, Kenardy J, Schneider P, et al: Effect of a selective serotonin uptake inhibitor in agoraphobia with panic attacks. Acta Psychiatr Scand 1986; 73: 49–53.PubMedCrossRefGoogle Scholar
  21. Fontaine R, Breton G, Dery R, et al: Temporal lobe abnormalities in panic disorder: An MRI study. Biol Psychiatry 1990; 27: 304–310.PubMedCrossRefGoogle Scholar
  22. Fyer AJ, Liebowitz MR, Gorman JM, et al: Lactate vulnerability of remitted panic patients. Psych Res 1985; 14: 143–148.CrossRefGoogle Scholar
  23. Gershon MD, Tamir H: Serotonectin and the family of proteins that bind serotonin. Biochem Pharmacol 1983; 33 (20): 3115–3118.CrossRefGoogle Scholar
  24. Gloger S, Grunhaus L, Gladic D, et al: Panic attacks and agoraphobia: low dose clominpramine treatment. J Clin Psychopharmacol 1989; 9 (1): 28–32.PubMedCrossRefGoogle Scholar
  25. Gold PW, Loriaux DL, Roy A: Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing’s disease. Pathophysiologic and diagnostic implications. New Eng J Med 1986; 314: 1329–1335.PubMedCrossRefGoogle Scholar
  26. Gorman JM, Liebowitz MR, Fryer AJ, et al: Lactate infusions in obsessive-compulsive disorder. Am J Psychiatry 1985; 142 (7): 864–866.PubMedGoogle Scholar
  27. Gorman JM, Cohen BS, Liebowitz MR, et al: Blood gas changes and hypophos-phatemia in lactate induced panic. Arch Gen Psychiatry 1986; 43: 1067–1075.PubMedCrossRefGoogle Scholar
  28. Gorman JM, Liebowitz MR, Fyer AJ, et al: An open trial of fluoxetine in the treatment of panic attacks. J Clin Psychopharmacol 1987; 7: 329–332.PubMedCrossRefGoogle Scholar
  29. Gorman JM, Fyer MR, Goetz R, et al: Ventilatory challenge studies of patients with panic disorder. Arch Gen Psychiatry 1988; 45 (1): 31–39.PubMedCrossRefGoogle Scholar
  30. Gorman JM, Battista D, Goetz RR, et al: A comparison of sodium bicarbonate and sodium lactate infusion in the induction of panic attacks. Arch Gen Psychiatry 1989; 46: 145–150.PubMedCrossRefGoogle Scholar
  31. Gorman JM, Liebowitz MR, Fyer AF, et al: A neuroanatomical hypothesis for panic disorder: Am J Psychiatry 1989; 146 (2): 148–161.PubMedGoogle Scholar
  32. Gorman JM, Goetz RR, Dillon D, et al: Sodium D-lactate infusion of panic disorder patients. Neuropsychopharmacology 1990; 3 (3): 181–189.PubMedGoogle Scholar
  33. Griez E, Lousberg H, van den Hout MA, et al: CO2 vulnerability in panic disorder. Psychiatry Res 1987; 2: 87–95.CrossRefGoogle Scholar
  34. Grosz HJ, Farmer BB: Pitts’ and McCulre’s lactate anxiety study revisited. Br J Psychiatry 1972; 120: 415–418.PubMedCrossRefGoogle Scholar
  35. Hamik A, Peroutka SJ: 1-(m-Chlorophenyl)piperazine (mCPP) interactions with neurotransmitter receptors in the human brain. Biol Psychiatry 1989; 25: 569–575.PubMedCrossRefGoogle Scholar
  36. Heninger GR, Charney DS, Price LH: Alpha-2 Adrenergic receptor sensitivity in depression. Arch Gen Psychiatry 1988; 45: 718–726.PubMedCrossRefGoogle Scholar
  37. Insel TR, Ninan PT, Aloi J, et al: A benzodiazepine receptor-mediated model of anxiety. Arch Gen Psychiatry 1984; 41: 741–750.PubMedCrossRefGoogle Scholar
  38. Kahn RS, Westenberg HG, Verhoeven WM, et al: Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; A double-blind comparison of 5-hydroxytryptophan, clomipramine and placebo. Int J Clin Psychopharmacol 1987; 2: 33–45.CrossRefGoogle Scholar
  39. Kahn RS, Wetzler S, Van Praag HM, et al: Behavioral indication of serotonergic supersensitivity in panic disorder. Psychiatry Res 1988; 25: 101–104.PubMedCrossRefGoogle Scholar
  40. Kellner C, Roy-Byrne PP: Computed tomography and magnetic resonance imaging in panic disorder. In: Ballenger J (Ed.) Neurobiology of Panic Disorder, New York: Wiley-Liss, 1990.Google Scholar
  41. Kelly D, Mitchell-Heggs N, Shean D: Anxiety and the effects of sodium lactate assessed clinically and physiologically. Br J Psychiatry 1971; 119: 129–1411.PubMedCrossRefGoogle Scholar
  42. Klein DF: Delineation of two drug responsive anxiety syndromes. Psychopharma-cology 1964; 5: 397–408.CrossRefGoogle Scholar
  43. Klein DF: Possible respiratory abnormalities in panic disorder. Presented at the American College of Neuropsychology, Hawaii, 1985.Google Scholar
  44. Klein DF, Papp LA, Gorman JM: Acetazolamide as a control for CO2-induced panic. Am J Psychiatry 1990; 147: 677–678.PubMedGoogle Scholar
  45. Krystal JH, Southwick SM, Charney DS: Yohimbine effects in PTSD. Presented at the 143rd Annual Meeting of the American Psychiatric Association, May 1990, New York.Google Scholar
  46. Lader MH, Ron M, Petursson H: Computed axial brain tomography in long term benzodiazepine users. Psychol Med 1984; 14: 203–206.PubMedCrossRefGoogle Scholar
  47. Liebowitz MR, Fyer AJ, Gorman JM, et al: Lactate provocation of panic attacks: 1 Clinical and behavioral findings. Arch Gen Psychiatry 1984; 41: 764–770.PubMedCrossRefGoogle Scholar
  48. Liebowitz MR, Fyer AJ, Gorman JM, et al: Specificity of lactate infusions in social phobia versus panic disorder. Am J Psychiatry 1985; 142 (8): 947–950.PubMedGoogle Scholar
  49. Loosen PT, Prange AT: Serum thyrotropin response to thyrotropin-releasing hor-mone in psychiatric patients: A review. Am J Psychiatry 1982; 139: 405–415.PubMedGoogle Scholar
  50. Lum LC: Hyperventilation and anxiety states. J R Soc Med 1981; 74: 1–4.Google Scholar
  51. Mathew RJ, Wilson WH: Caffeine induced changes in cerebral circulation. Stroke 1985; 16: 814–817.PubMedCrossRefGoogle Scholar
  52. Mathew RJ, Wilson WH, Tant S: Responses to hypercarbia induced by acetazola-mide in panic disorder patients. Am J Psychiatry 1989; 146: 996–1000.PubMedGoogle Scholar
  53. Mathew RJ, Wilson WH: Cerebral blood flow in anxiety and panic. In: Ballenger J (Ed.) Neurobiology of Panic Disorder, New York: Wiley-Liss, 1990.Google Scholar
  54. McGrath P, Stewart J, Harrison W, et al: Lactate infusions in patients with depression and anxiety. Psychopharmacol Bull 1985; 21 (3): 555–558.PubMedGoogle Scholar
  55. Middleton HC: An enhanced hypotensive response to clonidine can still be found in patients with panic disorder despite psychological treatment. J Anxiety Disord 1990; 4: 213–219.CrossRefGoogle Scholar
  56. Milc-Emil J, Brunstein MM: Drive and timing components of ventilation. Chest 1976; 70 (1,suppl): 131–133.CrossRefGoogle Scholar
  57. Nordahl TE, Semple WE, Gross M, et al: Cerebral glucose metabolic differences in patients with panic disorder. Neuropsychopharmacology 1990; 3 (3): 261–272.PubMedGoogle Scholar
  58. Norman TR, Kimber NM, Judd FK, et al: Platelet tritiated-H-rauwolscine bind-ing in patients with panic attacks. Psychiatry Res 1987; 22: 43–48.PubMedCrossRefGoogle Scholar
  59. Noyes R Jr, Anderson DJ, Clancy J, et al: Diazepam and propanolol in panic disorder and agoraphobia. Arch Gen Psychiatry 1984; 41: 287–292.PubMedCrossRefGoogle Scholar
  60. Noyes R, Crowe RR, Harris EL, et al: Relationship between panic disorder and agoraphobia: A family study. Arch Gen Psychiatry 1986; 43: 227–232.PubMedCrossRefGoogle Scholar
  61. Nutt DJ: Altered central alpha-2 sensitivity in panic disorder. Arch Gen Psychiatry 1989; 46: 165–169.PubMedCrossRefGoogle Scholar
  62. Ott J: Estimation of the recombination fraction in human pedigrees: Efficient computation of the likelihood for human linkage studies. Am J Hum Genet 1974; 26: 588–597.PubMedGoogle Scholar
  63. Pauls DL, Noyes R, Crowe RR: The familial prevalence in second-degree relatives of patients with anxiety neurosis (panic disorder). Affect Disord 1979; 1: 279–285.CrossRefGoogle Scholar
  64. Pile A: The role of alpha 2-adrenoceptors in the mechanism of action of antidepressant drugs. Pol J Pharmacol Pharm 1987; 39 (6): 691–713.Google Scholar
  65. Pitts FN, Allen RE: In: Biochemical Induction of Anxiety, edited by Fann WE, Karacan I, Pokorny AD, Williams I (Eds.), New York: SP Medical and Scientific, 1979, 125–140.Google Scholar
  66. Pitts FN, McClure JN: Lactate Metabolism in Anxiety Neurosis. New Engl J Med 1967; 277: 1329–1336.PubMedCrossRefGoogle Scholar
  67. Pohl R, Yeragani VK, Balon R, et al: The jitteriness syndrome in panic disorder patients treated with antidepressants. J Clin Psychol 1988; 49: 100–104.Google Scholar
  68. Rainey JM Jr, Pohl RB, Williams M, et al: A comparison of lactate and isoproterenol anxiety states. Psychopathology 1984; 17 (Suppl 1): 74–82.PubMedCrossRefGoogle Scholar
  69. Redmond DE, Jr, Huang YH: Current Concepts 2. New evidence for a locus ceruleus-norepinephrine connection with anxiety. Life Sci 1979; 25 (26): 2149–2162.PubMedCrossRefGoogle Scholar
  70. Reiman EM, Raichle ME, Robins E, et al: The application of positron emission to-mography to the study of panic disorder. Am J Psychiatry 1986; 143: 469–477.PubMedGoogle Scholar
  71. Reiman EM, Raichle ME, Robins E, et al: Neuroanatomical correlates of lactate-induced anxiety attack. Arch Gen Psychiatry 1989; 46: 493–500.PubMedCrossRefGoogle Scholar
  72. Roy-Byrne PP, Uhde TW, Rubinow DR, et al: Reduced TRH and prolactin responses to TRH in panic disorder. Am J Psychiatry 1986; 143: 503–507.PubMedGoogle Scholar
  73. Roy-Byrne PP, Uhde TW, Post RM, et al: The corticotropin-releasing hormone stimulation test in patients with panic disorder. Am J Psychiatry 1986; 143: 896–899.Google Scholar
  74. Roy-Byrne PP, Cowley DS, Grenblatt DJ, et al: Reduced benzodiazepine sensitivity in panic disorder. Arch Gen Psychiatry 1990; 47 (6): 534–538.CrossRefGoogle Scholar
  75. Sandberg DP, Harrison W, Gorman JM, et al: Sodium lactate vulnerability in premenstrual dysphoria. Proceedings ACNP Puerto Rico, 1987.Google Scholar
  76. Sanderson WS, Rapee RM, Barlow DH: The influence of an illusion of control on panic attacks induced via inhalation of 5.5% Carbon Dioxide-enriched air. Arch Gen Psychiatry 1989; 46 (2): 157–164.PubMedCrossRefGoogle Scholar
  77. Schmauss C, Krieg JC: Enlargement of cerebrospinal fluid space in long-term benzodiazepine abusers. Psychol Med 1987; 17: 869–873.PubMedCrossRefGoogle Scholar
  78. Siever SJ, Uhde TW: New studies and perspectives on the noradrenergic receptor system in depression: effects of the alpha-2 adrenergic agonist clonidine. Biol Psychiatry 1984; 19: 131–156.PubMedGoogle Scholar
  79. Spier SA, Tesar GE, Rosenbaum JF, et al: Treatment of panic disorder with clonazepam. J Clin Psychol 1986; 47: 238–242.Google Scholar
  80. Stavraki C, Vargo B: The relationship of anxiety and depression: a review of the literature. Br J Psychiatry 1986; 149: 7–16.CrossRefGoogle Scholar
  81. Svensson TH, Usdin T: Feedback inhibition of brain noradrenaline neurons by tricyclic antidepressants: alpha-receptor mediation. Science 1978; 202: 1089–1091.PubMedCrossRefGoogle Scholar
  82. Targum SD, Marshall LE: Fenfluramine provocation of anxiety in patients with panic disorder. Psychiatry Res 1989; 28: 295–306.PubMedCrossRefGoogle Scholar
  83. Targum SD: Differential responses to anxiogenic challenge studies in patients with major depressive disorder and panic disorder. Biol Psychiatry 1990; 28: 21–34.PubMedCrossRefGoogle Scholar
  84. Torgersen S: Genetic factors in anxiety disorders. Arch Gen Psychiatry 1983; 40 (10): 1085–1089.PubMedCrossRefGoogle Scholar
  85. Torgersen S: Twin studies in panic disorder. In: Ballenger J (Ed.) Neurobiology of Panic Disorder, New York: Wiley-Liss, 1990.Google Scholar
  86. Uhde TW, Kellner CH: Cerebral ventricular size in panic disorder. J Affect Disord 1987; 12: 175–178.PubMedCrossRefGoogle Scholar
  87. Uhde TW, Stein MB, Vittone BJ, et al: Behavioral and physiologic effects of short-term and long-term administration of clonidine in panic disorder. Arch Gen Psychiatry 1989; 46: 170–177.PubMedCrossRefGoogle Scholar
  88. Uhde TW: Caffeine provocation of panic: A focus on biological mechanisms. In: Ballenger JD (Ed.), Neurobiological Aspects of Panic Disorder, New York: Alan R Liss, 1990, 219–242.Google Scholar
  89. Westenberg HGM, den Boer JA: Serotonin function in panic disorder: effect of 1–5-hydroxytryptophan in patients and controls. Psychopharmacology 1989; 98: 283–285.PubMedCrossRefGoogle Scholar
  90. Whitwam JG, Doffin J, Triscott A, et al: Stimulation of the peripheral chemore-ceptors with sodium bicarbonate. Br J Anesth 1976; 48: 853–857.CrossRefGoogle Scholar
  91. Woods SW, Charney DS, Lake J, et al: Carbon dioxide sensitivity in panic anxi-ety. Arch Gen Psychiatry 1988; 43: 900–909.CrossRefGoogle Scholar
  92. Woods SW, Charney DS, Silver JM, et al: Benzodiazepine receptor antagonist effects in panic disorder. Presented at the 141st Annual Meeting of the American Psychiatric Association; May 1988; Montreal, Canada.Google Scholar
  93. Woods SW, Koster K, Krystal JH, et al: Effects of yohimbine on regional cerebral blood flow in patients with panic disorders. Soc Neurosci Abstr 1988; 14: 47.Google Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Jeremy D. Coplan
    • 1
  • Laszlo A. Papp
    • 1
  • Jack M. Gorman
    • 1
  1. 1.Biological Studies UnitNew York State Psychiatric Institute and College of Physicians and Surgeons of Columbia UniversityNew YorkUSA

Personalised recommendations

Cite chapter

Buy options