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Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine
- Source :
- Europe PubMed Central, Scopus-Elsevier
-
Abstract
- The neurobiological basis of panic disorder has not been clearly established, although a role for serotonin (5-HT) has been postulated. It is clear that drugs which increase 5-HT neurotransmission are effective in treating the condition but how they do so remains a point of debate. The aim of this study was to determine if lowering brain serotonin activity using the technique of tryptophan depletion provoked a short-term relapse of panic symptoms in patients with panic disorder who had responded to drug treatment. Fourteen patients with panic disorder who had responded to treatment with the selective serotonin reuptake inhibitor (SSRI) paroxetine received a tryptophan-free amino acid drink on one occasion and a control drink on the other in a double-blind crossover design. In addition, they received an infusion of flumazenil (used as a pharmacological challenge) and placebo on each day. The tryptophan depleted drink produced an 87% reduction in plasma tryptophan concentration. Flumazenil produced a panic attack (defined by changes in the panic inventory) in seven out of 14 patients when tryptophan depleted and one out of 14 on the control day (p < 0.02). Three patients also experienced temporary depressive symptoms when tryptophan depleted, with no mood changes being seen on the control days. We conclude that rapid lowering of brain serotonin function can allow the precipitation of panic symptoms in response to flumazenil in panic disorder patients who have responded to treatment with an SSRI. This implies that in panic disorder increased 5-HT availability is important in maintaining the response to SSRIs.
- Subjects :
- Adult
Flumazenil
Male
Serotonin
medicine.medical_specialty
Serotonin reuptake inhibitor
behavioral disciplines and activities
03 medical and health sciences
0302 clinical medicine
Double-Blind Method
Internal medicine
mental disorders
medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
GABA Modulators
Agoraphobia
Aged
Psychiatric Status Rating Scales
Pharmacology
Cross-Over Studies
Panic disorder
Hemodynamics
Tryptophan
Panic
Middle Aged
medicine.disease
Paroxetine
030227 psychiatry
Affect
Psychiatry and Mental health
Endocrinology
Panic Disorder
Female
medicine.symptom
Reuptake inhibitor
Psychology
Selective Serotonin Reuptake Inhibitors
Anxiety disorder
medicine.drug
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Europe PubMed Central, Scopus-Elsevier
- Accession number :
- edsair.doi.dedup.....b1d08fb7fe2b8ce9d688e38b9594a693