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Serotonin and panic

Published online by Cambridge University Press:  03 January 2018

C. J. Bell  and
D. J. Nutt
C. J. Bell*
Affiliation:
Psychopharmacology Unit, University of Bristol, Bristol
D. J. Nutt
Affiliation:
Psychopharmacology Unit, University of Bristol, Bristol
*
Dr C. Bell, Psychopharmacology Unit, School of Medical Sciences, University of Bristol, Bristol BS8 1TD
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Abstract

Background

Tricyclic (TCA) and monoamine oxidase inhibitor (MAOI) antidepressants are effective in the treatment of panic disorder. Two selective serotonin reuptake inhibitors (SSRIs) have also been licensed in the UK for this indication and studies with three other SSRIs have recently been completed. These provide further evidence for the role of serotonin in panic.

Method

Review of clinical, animal and laboratory studies.

Results

SSRIs have been shown to be effective in the treatment of panic disorder. The reported rates of improvement of 60–70% of patients taking SSRIs are similar to those seen withTCAs and greater than placebo. Other serotonergic agents do not appear to be effective. Animal work and human studies including measures of 5-HT in plasma, cerebrospinal fluid and platelets, challenge paradigms and tryptophan depletion show that the relationship between 5-HT and anxiety is complex.

Conclusion

Clinical trials have shown that of all the serotonergic agents only the SSRIs are effective in panic disorder. They are as beneficial as the TCAs and seem to be better tolerated which may be particularly significant in view of the chronic nature of the condition. Serotonin plays a role in panic disorder and serotonergic dysfunction, however the results and evidence do not fit one theory alone. It is also likely that different brain regions and 5-HTreceptors are involved in specific ways.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 172 , Issue 6 , June 1998 , pp. 465 - 471
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

Bakish, D. McNair, N. V. P. Saxena, B. et al (1994) A double-blind comparison of fluvoxamine, imipramine and placebo in the treatment of out-patients with panic disorder. Neuropsychopharmacology, 10 (suppl. 3), 11s.Google Scholar
Black, D. W. Wesner, R. Bowers, W. et al (1993) A comparison of fluvoxamine, cognitive therapy and placebo in the treatment of panic disorder. Archives of General Psychiatry, 50, 44–50.CrossRefGoogle ScholarPubMed
Blier, P. de Montigny, C. & Chaput, Y. (1990) A role for the serotonergic system in the mechanism of action of antidepressant treatments; preclinical evidence. Journal of Clinical Psychiatry, 6 (suppl. 5), 5–12.Google Scholar
Charney, D. S. & Heninger, G. (1986) Serotonin function in panic disorder. Archives of General Psychiatry, 43, 1059–1065.CrossRefGoogle ScholarPubMed
Charney, D. S. Woods, S. W. Goodman, W. K. et al (1986) Drug treatment of panic disorder; the comparative efficacy of imipramine, alprazolam and trazadone. Journal of Clinical Psychiatry, 47, 580–586.Google Scholar
Charney, D. S. Woods, S. W. Goodman, W. K. et al (1987) Serotonin function in anxiety: II. Effects of the serotonin agonist m-CPP in panic disorder patients and healthy subjects. Psychopharmacology, 92, 14–24.CrossRefGoogle ScholarPubMed
Deakln, J. F. W. & Graeff, F. G. (1991) 5-HT and mechanisms of defence. Journal of Psychopharmacology, 5, 305–315.Google Scholar
De Beurs, E. van Balkom, A. Lange, A. et al (1995) Treatment of panic disorder with agoraphobia; comparison of fluvoxamine, placebo and psychological panic management combined with exposure and of exposure in vivo alone. American Journal of Psychiatry, 152, 683–691.Google ScholarPubMed
Delgado, P. L. Charney, D. S. Price, L. H. et al (1990) Serotonin function and the mechanism of antidepressant action. Reversal of antidepressant induced remission by rapid depletion of plasma tryptophan. Archives of General Psychiatry, 47, 411–417.CrossRefGoogle ScholarPubMed
Den Boer, J. Westenberg, H. & Kamerbeek, W. (1987) Effect of SSRIs in anxiety disorders; a double blind comparison of fluvoxamine and clomipramine. International Clinical Psychopharmacology, 2, 21–32.CrossRefGoogle ScholarPubMed
Den Boer, J. & Westenberg, H. (1988) Effect of a serotonin and noradrenaline uptake inhibitor in panic disorder: a double blind comparative study with fluvoxamine and maprotiline. International Clinical Psychopharmacology, 3. 59–74.CrossRefGoogle ScholarPubMed
Den Boer, J. & Westenberg, H. (1990) Serotonin function in panic disorder: a double blind placebo controlled study with fluvoxamine and ritanserin. Psychopharmacology, 102, 85–94.CrossRefGoogle ScholarPubMed
Dunbar, G. Steiner, M. Oakes, R. et al (1995) A fixed dose study of paroxetine (10 mg, 20 mg, 40 mg) and placebo in the treatment of panic disorder. European Neuropsychopharmacology, 5, 361.Google Scholar
Engelman, K. Lovenberg, W. Sjoerdsman, A. et al (1947) Inhibition of 5-HT synthesis by p-chlorophenylalanine in carcinoid syndrome. New England Journal of Medicine, 227, 1103–1108.Google Scholar
Evans, L. Kenardy, J. Schneider, P. et al (1986) Effect of a selective serotonin reuptake inhibitor in agoraphobia with panic attacks. Acta Psychiatrica Scandinavica, 73, 49–53.CrossRefGoogle ScholarPubMed
George, D. T. Nutt, D. J. Rawlings, R. R. et al (1995) Behavioural and endocrine responses to clomipramine in panic disorder patients with and without alcoholism. Biological Psychiatry, 37. 112–119.CrossRefGoogle ScholarPubMed
Goddard, A. W. Sholomskas, D. E. & Walton, K. E. (1994) Effects of tryptophan depletion in panic disorder. Biological Psychiatry, 36, 775–777.CrossRefGoogle ScholarPubMed
Graeff, F. G. (1990) Brain defense systems and anxiety. In Handbook of Anxiety, Vol. 3: The Neurobiology of Anxiety (eds M. Roth, G. D. Burrows & R. Noyes). pp. 307–354. Amsterdam: Elsevier.Google Scholar
Graeff, F. G. Zuardl, A. W. Gjimiglio, J. S. et al (1985) Effect of metergoline on human anxiety. Psychopharmacology, 86, 334–338.CrossRefGoogle ScholarPubMed
Graeff, F. G. Guimeras, T. S. & De Andrade, T. G. (1996) Role of 5-HT in stress, anxiety and depression. Pharmacology, Biochemistry and Behaviour, 54, 129–141.CrossRefGoogle ScholarPubMed
Hoehn-Saric, R. McLeod, D. R. & Hipsley, P. A. (1993) Effect of fluvoxamine on panic disorder. Journal of Clinical Psychopharmacology, 13, 321–326.CrossRefGoogle ScholarPubMed
Jenck, F. Martin, J. R. & Moreau, J. L. (1996) Animal models of panic disorder – emphasis on face and predictive validity. European Neuropsychopharmacology, 6 (suppl. 4), s22.01.CrossRefGoogle Scholar
Johnson, M. R. Lydiard, R. B. & Ballenger, J. C. (1995) Panic disorder: Pathophysiology and drug treatment. Drugs. 49, 328–344.CrossRefGoogle ScholarPubMed
Kahn, R. S. Wetzler, S. & van Pragg, H. M. (1988) Behavioural indications for receptor hypersensitivity in panic disorder. Psychiatry Research. 25, 101–104.CrossRefGoogle ScholarPubMed
Lecrubier, Y. Bakker, A. & The Collaborative Paroxetine Panic Study Investigators (1997a) A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Acta Psychiatrica Scandinavica, 95, 145–152.CrossRefGoogle ScholarPubMed
Lecrubier, Y. Judge, R. & The Collaborative Paroxetine Panic Study Investigators (1997b) Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Acta Psychiatrica Scandinavica, 95, 153–160.CrossRefGoogle ScholarPubMed
Lesch, K. P. Wiesman, M. Hoh, A. et al (1992) 5-HT1a receptor effector system responsivity in panic disorder. Psychopharmacology, 106, 111–117.CrossRefGoogle ScholarPubMed
Mavissakalian, M. & Perel, I. M. (1988) Imipramine dose reponse relationship in panic disorder with agoraphobia. Archives of General Psychiatry, 46, 127–131.CrossRefGoogle Scholar
Miner, H. Anderson, I. M. & Deakin, J. F. W. (1995) Acute tryptophan depletion increases panic anxiety in panic disorder patients, Behavioural Pharmacology, 6 (suppl. 1). 148.Google Scholar
Nutt, D. J. & Cowen, P. J. (1987) Diazepam alters brain 5-HT function in man; implications for the acute and chronic effects of benzodiazepines. Psychological Medicine, 17, 601.CrossRefGoogle ScholarPubMed
Nutt, D. J. & George, D. T. (1990) Serotonin and anxiety. In Handbook of Anxiety, Vol. 3, The Neurobiology of Anxiety (ed. Burrows, G. D. Roth, M. & Noyes, R.), pp. 189–221, Amsterdam: Elsevier.Google Scholar
Nutt, D. J. & Lawson, C. (1992) Panic attacks. A neurochemical overview of models and mechanisms. British Journal of Psychiatry, 160, 165–178.CrossRefGoogle Scholar
Oehrberg, S. Christiansen, P. E. Behnke, K. et al (1995) Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study. British Journal of Psychiatry, 167, 374–379.CrossRefGoogle ScholarPubMed
Pols, H. Griez, E. & Verbug, C. (1993) Fluvoxamine–ritanserin combination in the treatment of panic anxiety with avoidance behaviour. European Neuropsychopharmacology, 3 (suppl.), 377.CrossRefGoogle Scholar
Ramos, R. T. Gentil, V. & Gorenstein, C. (1993) Clomipramine and initial worsening in panic disorder: beyond the jitteriness syndrome. Journal of Psychopharmacology, 7, 265–269.CrossRefGoogle ScholarPubMed
Sehneier, F. Liebowitz, M. Davies, S. et al (1990) Fluoxetine in panic disorder. Journal of Clinical Psychopharmacology, 10, 119–121.CrossRefGoogle Scholar
Sheehan, D. V. Raj, A. B. Harnett, S. K. et al (1993) The relative efficacy of high dose buspirone and alprazolam in the treatment of panic disorder; a double blind placebo controlled study. Acta Psychiatrica Scandinavica, 88, 1–11.CrossRefGoogle ScholarPubMed
Targum, S. D. & Marshall, L. E. (1989) Fenfluramine provocation of anxiety in patients with panic disorder. Psychiatry Research, 28, 295–306.CrossRefGoogle ScholarPubMed
Van Vliet, I. M. den Boer, J. Westenberg, H. G. M. et al (1996) A double blind comparative study of brofaromine and fluvoxamine in outpatients with panic disorder. Journal of Clinical Psychopharmacology, 16. 299–306.CrossRefGoogle ScholarPubMed
Wade, A. G. Lepoia, U. Koponen, H. J. et al (1997) The effect of citalopram in panic disorder. British Journal of Psychiatry, 170, 549–553.CrossRefGoogle ScholarPubMed
Westenberg, H. & den Boer, J. (1989) Serotonin function in panic disorder effect of 1,5-hydroxytryptophan in patients and controls. Psychopharmacology, 98, 283–285.CrossRefGoogle ScholarPubMed
Westenberg, H. Van Vliet, I. den Boer, J. (1992) Flesinoxan, a selective 5-HT la agonist, in the treatment of panic disorder. Clinical Neuropharmacology, 15 (suppl. 1b), 60.CrossRefGoogle Scholar
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