RESUMO
Thirty-one of 43 patients with panic disorder or agoraphobia with panic attacks and none of 20 normal controls panicked in response to infusions of sodium lactate. Before receiving lactate, patients showed higher heart rates than controls and also signs of hyperventilation. During lactate infusion, patients who did not panic, nevertheless, developed higher lactate and pyruvate levels and greater ionized calcium and pH changes than controls. Lactate-induced panic attacks were regularly accompanied by biological changes consistent with hyperventilation and central noradrenergic activation and irregularly by elevation of plasma norepinephrine and cortisol levels. Panic attacks were not associated with changes in epinephrine or calcium levels or pH. Baseline arousal increased the likelihood of panic during lactate infusion. It is hypothesized that lactate-induced panic primarily involves central noradrenergic discharge with inconsistent peripheral manifestations.
Assuntos
Transtornos de Ansiedade/induzido quimicamente , Medo/efeitos dos fármacos , Lactatos/administração & dosagem , Pânico/efeitos dos fármacos , Adulto , Agorafobia/sangue , Agorafobia/induzido quimicamente , Transtornos de Ansiedade/sangue , Nível de Alerta/efeitos dos fármacos , Cálcio/sangue , Epinefrina/sangue , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hidrocortisona/sangue , Concentração de Íons de Hidrogênio , Hiperventilação/induzido quimicamente , Infusões Parenterais , Lactatos/sangue , Ácido Láctico , Masculino , Norepinefrina/sangue , Sistema Nervoso Parassimpático/efeitos dos fármacosRESUMO
To assess the pharmacologic and phenomenologic comparability of lactate-induced and naturally occurring panic attacks, patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks were infused with 0.5M racemic sodium lactate before and after successful drug treatment. Lactate-induced and naturally occurring panic attacks were symptomatically similar. Following treatment, the patients' response to lactate did not differ from that of normal controls, whereas the pretreatment panic rate was much higher. These data suggest that lactate acts, by as yet unidentified mechanisms, to trigger the same panic attacks as occur spontaneously in vulnerable persons.
Assuntos
Transtornos de Ansiedade/induzido quimicamente , Medo , Lactatos , Pânico , Adulto , Agorafobia/induzido quimicamente , Agorafobia/diagnóstico , Agorafobia/tratamento farmacológico , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/tratamento farmacológico , Clonidina/uso terapêutico , Desipramina/uso terapêutico , Medo/efeitos dos fármacos , Feminino , Humanos , Imipramina/uso terapêutico , Lactatos/farmacologia , Ácido Láctico , Masculino , Pânico/efeitos dos fármacosRESUMO
Many clinical and theoretic attempts have been made to link anxiety disorders and the beta-adrenergic nervous system. Six patients with panic disorder, who had panic attacks produced by sodium lactate infusions, were given repeated lactate infusions that were immediately preceded by intravenous administration of propranolol hydrochloride. In all cases, propranolol pretreatment infusion failed to prevent panic attacks, anxiety, tachycardia, and increased systolic BP during the lactate infusion.
