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Research Article| Volume 26, ISSUE 6, P612-622, October 1989

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Behavioral biochemical and neuroendocrine concomitants of lactate-induced panic anxiety

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      Abstract

      In a single-blind study using sodium lactate infusions to provoke panic attacks, 11 of 15 patients with panic disorder panicked with lactate. None of the 15 control subjects panicked during lactate administration. Before receiving lactate, higher preinfusion anxiety levels were present in the patient group as compared to controls. Preinfusion Acute Panic Inventory (API) scores were significantly higher in patients who panicked compared to nonpanicking patients. In addition, patients who panicked during lactate infusion showed a higher mean plasma MHPG level at baseline. During lactate infusion, however, no increase in plasma MHPG was seen in patients who panicked, nor in nonpanickers and controls. Several other biochemical and hormonal variables were measured. No single biochemical or neuroendocrine variable was found to correlate with lactate-induced panic attacks. It is argued that the baseline arousal level of patients with panic disorder may be increased, which renders these patients more vulnerable to panic attacks.
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      References

        • Ackerman SH
        • Sachar EJ
        The lactate theory of anxiety: A review and reevaluation.
        Psychosom Med. 1974; 36: 69-81
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR).
        APA, Washington, DC1987
        • Bloom G
        • Von Euler NS
        • Frankenhaeuser M
        Catecholamine excretion and personality traits in paratroop trainees.
        Acta Physiol Scand. 1963; 58: 77-89
        • Bonn J
        • Harrison J
        • Rees W
        Lactate induced anxiety: Therapeutic application.
        Br J Psychiatry. 1971; 119: 468-470
        • Cameron OG
        • Lee MA
        • Curtis GC
        • McCann DS
        Psychobiologic changes during ‘spontaneous’ panic.
        Psychosom Med. 1985; 47: 308
        • Carr DB
        • Sheehan DV
        Panic anxiety: A new biological model.
        J Clin Psychiatry. 1984; 45: 323-330
        • Carr DB
        • Sheehan DV
        • Surman OS
        • Coleman JH
        • Greenblatt DJ
        • Heninger GR
        • Jones KJ
        • Lcvine PH
        • Watkins WD
        Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy.
        Am J Psychiatry. 1986; 143: 483-494
        • 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
        • Charney DS
        • Heninger GR
        Abnormal regulation of noradrenergic function in panic disorders.
        Arch Gen Psychiatry. 1986; 43: 1042-1054
        • Charney DS
        • Heninger GR
        • Redmond DE
        Yohimbine induced anxiety and increased noradrenergic function in humans: Effects of diazepam and clonidine.
        Life Sci. 1983; 33: 19-29
        • Cowley DS
        • Hyde TS
        • Dager SR
        • Dunner DL
        Lactate infusions: The role of baseline anxiety.
        Psychiatry Res. 1987; 21: 169-179
        • Curtis GC
        • Cameron OG
        • Nesse RM
        The Dexamethasone Suppression Test in panic disorder and agoraphobia.
        Am J Psychiatry. 1982; 139: 1043-1046
        • Derogatis LR
        • Lipman RS
        • Covi L
        SCL-90: An outpatient psychiatric rating scale: Preliminary report.
        Psychopharmacol Bull. 1973; 9: 13-28
        • Dillon DJ
        • Gorman JM
        • Liebowitz MR
        • Fyer AJ
        • Klein DF
        Measurement of lactate-induced panic and anxiety.
        Psychiatry Res. 1987; 20: 97-105
        • Ehlers A
        • Margraf J
        • Roth WT
        • Taylor CB
        • Maddock RJ
        • Sheikh J
        • Kopell BS
        Lactate infusions and panic attacks: Do patients and controls respond differently?.
        Psychiatry Res. 1986; 17: 295-308
        • Faludi G
        • Kaskó M
        • Perényi A
        • Arató M
        • Frecska E
        The Dexamethasone Suppression Test in panic disorder and major depressive episodes.
        Biol Psychiatry. 1986; 21: 1008-1014
        • Fink M
        • Taylor M
        • Volavka J
        Anxiety precipitated by lactate.
        N Engl J Med. 1971; 289: 1429
        • Fuller RW
        Serotonergic stimulation of pituitary-adrenocortical function in rats.
        Neuroendocrinol. 1981; 32: 118-127
        • Garvey MJ
        • Tollefson GD
        • Orsulak PJ
        Elevations of urinary MHPG in depressed patients with panic attacks.
        Psychiatr Res. 1987; 20: 183-187
        • Gorman JM
        • Dillon D
        • Fyer AJ
        • Liebowitz MR
        • Klein DF
        The lactate infusion model.
        Psychopharmacol Bull. 1985; 21: 428-433
        • Gorman JM
        • Cohen BS
        • Liebowitz MR
        • Fyer AJ
        • Ross D
        • Davies SO
        • Klein DF
        Blood gas changes and hypophosphatemia in lactate-induced panic.
        Arch Gen Psychiatry. 1986; 43: 1067-1071
        • Grunhaus L
        • Flegel P
        • Haskett RF
        • Greden JF
        Serial Dexamethasone Suppression Tests in simultaneous panic and depressive disorders.
        Biol Psychiatry. 1987; 22: 332-338
        • Hoehn-Saric R
        • Merchant AF
        • Keyser ML
        • Smith VK
        Effects of clonidine on anxiety disorders.
        Arch Gen Psychiatry. 1981; 38: 1278-1282
        • Levin AP
        • Doran AR
        • Liebowitz MR
        • Fyer AJ
        • Gorman JM
        • Klein DF
        • Paul SM
        Pituitary adrenocortical unresponsiveness in lactate-induced panic.
        Psychiatry Res. 1987; 21: 23-32
        • Lieberman JA
        • Brenner R
        • Lesser M
        • Coccaro E
        • Borentsein M
        • Kane JM
        Dexamethasone Suppression Tests in patients with panic disorder.
        Am J Psychiatry. 1983; 140: 917-919
        • Liebowitz MR
        • Fyer AJ
        • McGrath P
        • Klein DF
        Clonidine treatment of panic disorder.
        Psychopharmacol Bull. 1981; 17: 122-123
        • Liebowitz MR
        • Fyer AJ
        • Appleby I
        • Levitt M
        • Gorman J
        • Dillon D
        • Levy G
        • Anderson S
        • Davies S
        • Palij S
        • Klein DF
        Lactate provocation of panic attacks.
        Psychopharmacol Bull. 1983; 19: 476-478
        • Liebowitz MR
        • Fyer AJ
        • Gorman JM
        • Dillon D
        • Appleby I
        • Levy G
        • Anderson S
        • Levitt M
        • Palij M
        • Davies S
        • Klein DF
        Lactate provocation of panic attacks. I. Clinical and behavioral findings.
        Arch Gen Psychiatry. 1984; 41: 764-770
        • Liebowitz MR
        • Gorman JM
        • Fyer AJ
        • Levitt M
        • Dillon D
        • Levy G
        • Appleby I
        • Anderson S
        • Palij M
        • Davies S
        • Klein DF
        Lactate provocation of panic attacks. 11. Biochemical and physiological findings.
        Arch Gen Psychiatry. 1985; 42: 709-719
        • Liebowitz MR
        • Gorman JM
        • Fyer A
        • Dillon D
        • Levitt M
        • Klein DF
        Possible mechanisms for lactate's induction of panic.
        Am J Psychiatry. 1986; 143: 495-502
        • Lingjaerde O
        Lactate-induced panic attacks: Possible involvement of serotonin reuptake stimulation.
        Acta Psychiatr Scand. 1985; 72: 206-208
        • Margraf J
        • Ehlers A
        • Roth WT
        Sodium lactate infusions and panic attacks: A review and critique.
        Psychosom Med. 1986; 48: 23-51
        • Meltzer HY
        • Uberkoman-Wüta B
        • Robertson A
        • Tricou BJ
        • Lowy M
        Enhanced serum cortisol response to 5-hydroxytryptophan in depression and mania.
        Life Sci. 1983; 33: 2541-2549
        • Mueller EA
        • Murphy DL
        • Sunderland T
        Neuroendocrine effects of M-chlorophenylpiperazine, a serotonin agonist, in humans.
        J Clin Endocrinol Metab. 1985; 61: 1179-1183
        • Pitts FN
        • McClure JN
        Lactate metabolism in anxiety neurosis.
        N Engl J Med. 1967; XX: 1329-1336
        • Pohl R
        • Ettedgui E
        • Bridges M
        • Lycaki H
        • Jimerson D
        • Kopin I
        • Rainey JM
        Plasma MHPG levels in lactate and isoproterenol anxiety states.
        Biol Psychiatry. 1987; 22: 1127-1136
        • Rainey JM
        • Frohman CE
        • Freedman RR
        • Pohl RB
        • Ettedgui E
        • Williams M
        Specificity of lactate infusion as a model of anxiety.
        Psychopharmacol Bull. 1984; 20: 45-49
        • Rifkin A
        • Klein DF
        • Dillon D
        • Levitt M
        Blockade by imipramine or desipramine of panic induced by sodium lactate.
        Am J Psychiatry. 1981; 138: 676-677
        • Roy-Byrne PP
        • Uhde TW
        • Post RM
        • Gallucci W
        • Chrousos GP
        • Gold PW
        The corticotropin-releasing hormone stimulation test in patients with panic disorder.
        Am J Psychiatry. 1986; 143: 896-899
        • Sheehan DV
        • Bao BCh
        • Claycomb JB
        • Surman OS
        • Bear L
        • Coleman J
        • Gelles L
        Panic attacks and the Dexamethasone Suppression Test.
        Am J Psychiatry. 1983; 140: 1063-1064
        • Sweeney DR
        • Maas JW
        • Heninger GR
        State anxiety, physical activity and urinary 3-methoxy-4-hydroxyphenethylene glycol excretion.
        Arch Gen Psychiatry. 1978; 35: 1418-1423
        • Thijssen JHH
        • Van den Berg JHM
        • Adlercreutz J
        The determination of cortisol in human plasma: Evaluation and comparison of seven assays.
        Clin Chem Acta. 1980; 100: 39-46
        • Van der Kar LD
        • Karteszi M
        • Bethea CL
        • Ganong WF
        Serotonergic stimulation of prolactin and corticosterone secretion is mediated by different pathways from the mediobasal hypothalamus.
        Neuroendocrinology. 1985; 41: 380-384
        • Villacres EC
        • Hollifield M
        • Katon WJ
        • Wilkinson CW
        • Veith RC
        Sympathetic nervous system activity in panic disorder.
        Psychiatr Res. 1987; 21: 313-321
        • Westenberg HGM
        • Klompmakers A
        • Lint L
        Determination of plasma MHPG by means of liquid chromatography.
        1988 (submitted for publication).
        • Wing JK
        • Cooper JE
        • Sartorius N
        The Measurement and Classification of Psychiatric Symptoms.
        Cambridge University Press, Cambridge, England1975
        • Woods SW
        • Charney DS
        • McPherson CA
        • Gradman AH
        • Heninger GR
        Situational panic attacks. Behavioral, physiologic, and biochemical characterization.
        Arch Gen Psychiatry. 1987; 44: 365-375
        • Woods SW
        • Charney DS
        • Goodman WK
        • Heninger GR
        Carbon dioxide: Induced anxiety. Behavioral, physiological and biochemical effects of carbon dioxide in patients with panic disorders and healthy subjects.
        Arch Gen Psychiatry. 1988; 45: 43-52
        • Yeragani VK
        • Balon R
        • Pohl R
        • Ortiz A
        • Weinberg P
        • Rainey JM
        Do higher preinfusion heart rates predict laboratory induced panic attacks.
        Biol Psychiatry. 1987; 22: 554-558
        • Yeragani VK
        • Pohl R
        • Rainey JM
        • Balon R
        • Ortiz A
        • Lyaki H
        • Gershon S
        Preinfusion heart rates and laboratory induced panic anxiety.
        Acta Psychiatr Scand. 1987; 75: 51-54
        • Yeragani VK
        • Pohl R
        • Balon R
        • Weinberg P
        • Berchou R
        • Rainey JM
        Preinfusion anxiety predicts lactate-induced panic attacks in normal controls.
        Psychosom Med. 1987; 49: 383-389