 |
|
Sympathetic Activity in Patients With Panic Disorder at Rest, Under Laboratory Mental Stress, and During Panic Attacks
Dominic J. C. Wilkinson, BMedSci;
Jane M. Thompson, MBBS;
Gavin W. Lambert, PhD;
Garry L. Jennings, MD;
Rosemary G. Schwarz, MBBS, FRANZCP;
Don Jefferys, PhD;
Andrea G. Turner;
Murray D. Esler, MBBS, PhD
Arch Gen Psychiatry. 1998;55:511-520.
Background The sympathetic nervous system has long been believed to be involved in the pathogenesis of panic disorder, but studies to date, most using peripheral venous catecholamine measurements, have yielded conflicting and equivocal results. We tested sympathetic nervous function in patients with panic disorder by using more sensitive methods.
Methods Sympathetic nervous and adrenal medullary function was measured by using direct nerve recording (clinical microneurography) and whole-body and cardiac catecholamine kinetics in 13 patients with panic disorder as defined by the DSM-IV, and 14 healthy control subjects. Measurements were made at rest, during laboratory stress (forced mental arithmetic), and, for 4 patients, during panic attacks occurring spontaneously in the laboratory setting.
Results Muscle sympathetic activity, arterial plasma concentration of norepinephrine, and the total and cardiac norepinephrine spillover rates to plasma were similar in patients and control subjects at rest, as was whole-body epinephrine secretion. Epinephrine spillover from the heart was elevated in patients with panic disorder (P=.01). Responses to laboratory mental stress were almost identical in patient and control groups. During panic attacks, there were marked increases in epinephrine secretion and large increases in the sympathetic activity in muscle in 2 patients but smaller changes in the total norepinephrine spillover to plasma.
Conclusions Whole-body and regional sympathetic nervous activity are not elevated at rest in patients with panic disorder. Epinephrine is released from the heart at rest in patients with panic disorder, possibly due to loading of cardiac neuronal stores by uptake from plasma during surges of epinephrine secretion in panic attacks. Contrary to popular belief, the sympathetic nervous system is not globally activated during panic attacks.
From the Human Neurotransmitter Research Laboratory, Baker Medical Research Institute, and the Alfred Heart Centre, Melbourne, Australia (Mr Wilkinson, Ms Turner, and Drs Thompson, Jennings, Esler, and Jefferys); the Department of Physiology, University of Göteborg, Göteborg, Sweden (Dr Lambert); and Melbourne Clinic, Melbourne, Australia (Dr Schwarz).
RELATED ARTICLE
Catecholamines and Pathogenesis in Panic Disorder
George R. Heninger
Arch Gen Psychiatry. 1998;55(6):522-523.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Elevated Brain Serotonin Turnover in Patients With Depression: Effect of Genotype and Therapy
Barton et al.
Arch Gen Psychiatry 2008;65:38-46.
ABSTRACT
| FULL TEXT
Panic and hypertension: brothers in arms through 5-HT?
Davies et al.
J Psychopharmacol 2007;21:563-566.
An overview of pheochromocytoma: history, current concepts, vagaries, and diagnostic challenges.
MANGER
Ann. N. Y. Acad. Sci. 2006;1073:1-20.
ABSTRACT
| FULL TEXT
The neuronal noradrenaline transporter, anxiety and cardiovascular disease.
Esler et al.
J Psychopharmacol 2006;20:60-66.
ABSTRACT
Single-unit analysis of sympathetic nervous discharges in patients with panic disorder
Lambert et al.
J. Physiol. 2006;570:637-643.
ABSTRACT
| FULL TEXT
Does Panic Disorder Increase the Risk of Coronary Heart Disease? A Cohort Study of a National Managed Care Database
Gomez-Caminero et al.
Psychosom. Med. 2005;67:688-691.
ABSTRACT
| FULL TEXT
Colon Motility During a Panic Attack
Hyman and Cocjin
Psychosom. Med. 2005;67:616-617.
ABSTRACT
| FULL TEXT
Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia
Gold et al.
Proc. Natl. Acad. Sci. USA 2005;102:8303-8308.
ABSTRACT
| FULL TEXT
Hyperadrenergic Postural Tachycardia Syndrome in Mast Cell Activation Disorders
Shibao et al.
Hypertension 2005;45:385-390.
ABSTRACT
| FULL TEXT
123I-Metaiodobenzylguanidine Myocardial Scintigraphy in Panic Disorder
Tanabe et al.
JNM 2004;45:1305-1308.
ABSTRACT
| FULL TEXT
Cardiac Sympathetic Nerve Biology and Brain Monoamine Turnover in Panic Disorder
ESLER et al.
Ann. N. Y. Acad. Sci. 2004;1018:505-514.
ABSTRACT
| FULL TEXT
A Historical Inquiry into the Appropriateness of the Term `Panic Disorder'
Papakostas et al.
History of Psychiatry 2003;14:195-204.
ABSTRACT
Dysautonomias: Clinical Disorders of the Autonomic Nervous System
Goldstein et al.
ANN INTERN MED 2002;137:753-763.
ABSTRACT
| FULL TEXT
Catechol O-Methyltransferase Genetic Polymorphism in Panic Disorder
Woo et al.
Am. J. Psychiatry 2002;159:1785-1787.
ABSTRACT
| FULL TEXT
Paroxysmal hypertension during a complex partial seizure
JARDINE et al.
J. Neurol. Neurosurg. Psychiatry 2001;71:132-133.
FULL TEXT
Kinins in humans
Duncan et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2000;278:R897-R904.
ABSTRACT
| FULL TEXT
|
