Panic Disorder: Research Findings

Introduction

 "Beginning with the study of Pitts and McClure, who described the panicogenic activity of sodium lactate, the experimental induction of panic attacks with different challenges has been used to characterize the neurobiology of anxiety." 

Ströhle A.

Max-Planck-Institut für Psychiatrie, München

  This quote is from Ref. 1. Various theories have been proposed to explain this result. Klein (2) proposed a suffocation false alarm theory. My own theory is different from that. My own theory is that there is too much lactate in the brain in panic disorder. When the problem is made worse by lactate infusion, the body triggers a legitimate alarm system. Klein's theory does make some sense. In a suffocation situation the lactate would rise. Oxygen is needed for proper mitochondrial function.

  Needless to say there are also psychological theories for panic disorder.

Klein's Theory

  Klein's theory is that the brain has a suffocation alarm system. This part of the theory is probably true. This would make sense from an evolutionary point of view. The species would benefit from such a system. However, there is no lack of oxygen in panic disorder. Something else has gone wrong. The lactate is high, but for another reason. Therefore Klein feels that it is a false alarm. 

  However, in asthma there can be a real lack of oxygen. Therefore it is interesting that some people with asthma have had anxiety problems.

  Fear is discussed in Ref. 3. Other substances can also cause panic attacks, which may cast some doubt on Klein's theory (4). Refs. 5-12 present more information on these subjects. I find it interesting that psychotropic drugs have been given to dogs (11).

Carbon Dioxide Inhalation

  Another problem with Klein's theory is that panic attacks can be induced by carbon dioxide inhalation (13). This suggests a suffocation alarm theory based on carbon dioxide in the brain. If Klein's theory were correct, then there would have to be two suffocation alarm systems. This is possible, but why would they both be needed?

Confirmations

  Unlike many other endeavors in psychiatry, the induction of panic attacks by lactate has been amply confirmed (14). The induction of panic by carbon dioxide inhalation has also been confirmed (15). These are solid medical facts. But what do they mean? My view is that the carbon dioxide results represent a legitimate suffocation alarm. However, in mitochondrial disorders such as MELAS the lactate is high but the oxygen is normal. The reason the lactate is high is that in MELAS the mitochondria are abnormal. This is a very serious disease with psychiatric symtoms.

  Also there have been reports of high lactate in schizophrenia by a Detroit group. These were confrmed by a Moscow group. This probably means mitochondrial dysfunction in schizophrenia. There also could be mitochondrial dysfunction in panic disorder and in other anxiety disorders such as phobias. The lacate probably causes the anxiety.

  The Detroit group, led by Frohman & Gottlieb, felt that the excess lactate was caused by excessive amino acids entering the cell. Excessive amino acids entered the cell because of an unknown toxin in the blood.

Dager

  Dager and his group have investigated the brain in psychiatric disorders using magnetic resonance spectroscopy (16). This article is very useful because it is available free full text at Pubmed Central.

Conclusions

  An excess of lactic acid could cause the brain to be more acid than usual (17). This is seen in MELAS, where the LA stands for lactic acidosis.

  But what are the treatments? Ref. 18 explains some treatments including orthomolecular psychiatry. Unfortunately some drugs can cause panic attacks including the illegal drug yohimbine. Both Ref. 18 and 19 are available free full text on the Internet. Ref. 19 provides more information on psychiatry.

References

1. [Experimental provocation of panic attacks as a human experimental model for anxiety] Ströhle A. Nervenarzt. 2003 Sep;74(9):733-9. Review. German.

2. Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry. 1993;50:306–17.

3. LeDoux J. Fear and the brain: where have we been, and where are we going? Biol Psychiatry. 1998;44:1229–38.

4. Lee YJ, Curtis GC, Weg JG, Abelson JL, Modell JG, Campbell KM. Panic attacks induced by doxapram. Biol Psychiatry. 1993;33:295–7.

5. Lydiard RB. Increased prevalence of functional gastrointestinal disorders in panic disorder: clinical and theoretical implications. CNS Spectr. 2005;10:899–908.

6. Nascimento I, et al. Psychiatric disorders in asthmatic outpatients. Psychiatry Res. 2002;110:73–80.

7. Panksepp J. Affective neuroscience: The foundations of human and animal emotions. New York: Oxford University Press; 1998.

8. Perna G, Bertani A, Politi E, Colombo G, Bellodi L. Asthma and panic attacks. Biol Psychiatry. 1997;42:625–30.

9. Preter M, Klein DF. Panic disorder and the suffocation false alarm theory: current state of knowledge and further implications for neurobiologic theory testing. In: Bellodi L, Perna G, editors. The Panic Respiration Connection. Milan: MDM Medical Media; 1998.

10. Roy-Byrne PP, Craske MG, Stein MB. Panic disorder. Lancet. 2006;368:1023–32.

11. Scott JP. Effects of psychotropic drugs in separation distress in dogs. Amsterdam. Proc IX Congress ECNP Exc Med.1974.

12. Shavitt RG, Gentil V, Mandetta R. The association of panic/agoraphobia and asthma. Contributing factors and clinical implications. Gen Hosp Psychiatry. 1992;14:420–3.

13. Sinha SS, Coplan JD, Pine DS, Martinez JA, Klein DF, Gorman JM. Panic induced by carbon dioxide inhalation and lack of hypothalamic-pituitary-adrenal axis activation. Psychiatry Res. 1999;86:93–8.

14. Liebowitz MR, Fyer AJ, Gorman JM, Dillon D, Appleby IL, Levy G, Anderson S, Levitt M, Palij M, Davies SO, et al. Lactate provocation of panic attacks. I. Clinical and behavioral findings. Arch Gen Psychiatry. 1984 Aug;41(8):764–770.

15. Griez E, Zandbergen J, Pols H, de Loof C. Response to 35% CO2 as a marker of panic in severe anxiety. Am J Psychiatry. 1990 Jun;147(6):796–797.

16. Research applications of magnetic resonance spectroscopy to investigate psychiatric disorders. Dager SR, Corrigan NM, Richards TL, Posse S. Top Magn Reson Imaging. 2008 Apr;19(2):81-96. Review.

17. Friedman SD, Mathis CM, Hayes C, Renshaw P, Dager SR. Brain pH response to hyperventilation in panic disorder: preliminary evidence for altered acid-base regulation. Am J Psychiatry. 2006;163(4):710–5.

18. www.associatedcontent.com/article/2255365/depression_research_including_treatments.html

19. www.associatedcontent.com/article/2245331/affective_illnesses_organic_theories.html