Background
A number of studies have shown that patients with panic disorder are more likely to
have panic attacks during carbon dioxide inhalation than are normal comparison subjects.
Some studies have shown that antipanic medications can reduce the anxiogenic response
to carbon dioxide, but none have shown if this is the case for cognitive behavioral
therapy or if successful treatment reduces the respiratory physiologic response to
carbon dioxide.
Methods
Twenty-five patients with panic disorder and 13 normal comparison subjects underwent
baseline testing with 5% and 7% carbon dioxide inhalation. The patients were then
retested after at least 12 weeks of treatment with either antipanic medication or
cognitive behavioral therapy. Comparison subjects were retested after a similar interval.
Results
Successful treatment resulted in lower panic rates, and reduced anxiogenic response.
Treatment had no effect, however, on the respiratory physiologic response.
Conclusions
There is dissociation in treatment response between the subjective and objective responses
to carbon dioxide inhalation in panic disorder patients, with the former but not the
latter showing positive change. We hypothesize that the strengthening of higher cortical
control over subcortical fear-related structures, whether via medication or cognitive
behavioral therapy treatment, results in less anxiety and fear in response to provoked
symptoms reminiscent of naturally occurring panic.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Panic and generalized anxiety disorders.Behav Ther. 1986; 15: 431-449
- The 35% CO2 hyperreactivity and clinical symptomatology in patients with panic disorder after 1 week of treatment with citalopram.J Clin Psychopharmacol. 2001; 21: 262-267
- The effect of one-week treatment with venlafaxine on 35% CO2 hyperreactivity in patients with panic disorder.J Clin Psychopharmacol. 2003; 23: 106-108
- Psychosocial bases of perceived exertion.Med Sci Sports Exerc. 1982; 14: 377-381
- 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
- Noradrenergic function and the mechanism of action of antianxiety treatment. II. The effect of long-term imipramine treatment.Arch Gen Psychiatry. 1985; 42: 473-481
- The measurement of lactate-induced panic and anxiety.Psychiatry Res. 1987; 20: 97-105
- Effects of the serotonin reuptake inhibitor fluvoxamine on yohimbine-induced anxiety in panic disorder.Psychiatry Res. 1993; 48: 119-133
- Anxiogenic effects of CO2 and hyperventilation in patients with panic disorder.Am J Psychiatry. 1994; 151: 547-553
- Effects of antipanic treatment on response to carbon dioxide.Biol Psychiatry. 1997; 42: 982-991
- Ventilatory physiology of patients with panic disorder.Arch Gen Psychiatry. 1998; 45: 31-39
- A neuroanatomical hypothesis of panic disorder.Am J Psychiatry. 2000; 157: 493-505
- Physiologic changes during carbon dioxide inhalation in patients with panic disorder, major depression and premenstrual dysphoric disorder.Arch Gen Psychiatry. 2001; 58: 125-131
- Hyperventilation, carbon dioxide sensitivity and panic disorder.Am J Psychiatry. 1993; 150: 1149-1157
- The diagnostic and substance specificity of carbon dioxide induced panic.Am J Psychiatry. 1993; 150: 250-257
- Antipanic drug moldulcation of 35% CO2 hyperactivity and short-term treatment outcome.J Clin Psychopharmacol. 2002; 22: 300-308
- Alprazolam predmedication and 35% carbon dioxide vulnerability in panic patients.Biol Psychiatry. 1996; 40: 913-917
- Attentuation of carbon dioxide induced panic after clonazepam treatment.Acta Psychiatr Scand. 1991; 84: 585-586
- Acute L-5-hydroxytryptophan administration inhibits carbon dioxide-induced panic in panic disorder patients.Psychiatry Res. 2002; 113: 237-242
- Sodium lactate vulnerability in panic.Am J Psychiatry. 1991; 148: 795-797
- Instructional set and physiological response to CO2 inhalation.Am J Psychiatry. 1999; 156: 745-748
- Carbon dioxide sensitivity in panic anxiety.Arch Gen Psychiatry. 1986; 43: 900-909
- Effects of alprazolam on cholecystokinin-tetrapeptide-induced panic and hypothalamic-pituitary-adrenal-axis activity.Neuropsychopharmacology. 2003; 28: 979-984
Article info
Publication history
Accepted:
August 9,
2004
Received in revised form:
July 27,
2004
Received:
March 3,
2004
Identification
Copyright
© 2004 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
