Anxiety and the Effects of Sodium Lactate Assessed Clinically and Physiologically

Abstract

Anxiety neurosis has been the subject of intensive study during the past ten years. Renewed interest in this syndrome has arisen both from the stimulus of new methods of treatment and from attempts to classify anxiety more accurately. Recently Pitts and McClure (1967) reported that anxiety symptoms and anxiety attacks could be produced by a specific biochemical stimulus: sodium lactate. This work was prompted by the finding that 'standard exercise’ tends to produce an excess amount of lactic acid in patients with anxiety neurosis (Cohen and White, 1950; Jones and Mellersh, 1946; Linko, 1950; Holmgren and Strom, 1959). Pitts and McClure found that an intravenous infusion of 10 ml. of half-Molar sodium (DL) lactate per kilogram of body weight, given over a twenty minute period, produced an anxiety attack in patients suffering from anxiety neurosis. The symptoms began a minute or two after the infusion was started and developed rapidly, and some patients reported ‘exacerbations of their characteristic symptom profiles for two to five days after the sodium lactate infusion’. In their double-blind study, many fewer symptoms were produced when calcium ion was added to the lactate infusion, and almost no symptoms were produced by an infusion of glucose in saline of similar osmolarity. Many fewer and less severe symptoms were produced in normal controls than in the patient group, both in response to sodium lactate and to lactate with added calcium, and almost no symptoms during the glucose and saline infusion. Pitts and McClure postulated that anxiety symptoms may have a common determining biochemical end-mechanism, involving the complexing of ionized calcium at the surface of excitable membranes by lactate ion with resulting interference ‘with the normal functioning of calcium in transmitting nerve impulses' (Pitts, 1969). They concluded that ‘there may be something highly specific about lactate ion in producing the naturally occurring hypocalcaemic anxiety symptoms in human beings'.

Psychophysiological Factors in Panic Disorder

“…In agreement with previous investigations [2,[6][7][8], the present study showed that lac tate-induced panic attacks occurred with greater frequency in panic disorder patients than controls, and that sodium lactate pro duced these attacks more frequently than pla cebo. It was also demonstrated that panic attacks meeting DSM III criteria could be produced by isoproterenol, a hypothesis which has not been specifically tested be fore.…”

“…Although the mechanism linking sodium lac tate and panic symptoms is not known [3][4][5], other investigators have found an association between sodium lactate infusion and panic symptoms in anxious patients [6][7][8], Despite the fact that many symptoms of panic disorder are somatic, little has been done to characterize these patients physiolog ically. One study found that patients with anxiety neurosis had higher initial heart rates and forearm blood flows than normal con trols [8], but it was not clear if panic attacks could be differentiated from other periods using these measures. In the present investi gation, double-blind infusions of sodium lac tate and placebo were performed in panic dis order patients and normal controls and the following physiologic measures related to panic attack symptoms were recorded: heart rate, respiration rate, skin temperature, mus cle tension, and skin conductance level (sweat activity).…”

Application of a Novel Fiber-Optic Biosensor In Situ to Investigate the Metabolic Effect of Lactate Infusion

“…Intravenous infusion of sodium lactate can produce intense psychological and physiological symptoms characteristic of a panic response in susceptible individuals (Bonn et al 1971; Dager et al 1987;Fink et al 1970; Kelly et al 1971; Knot et al 1981; Liebowitz et al 1984; Pitts and McClure 1967; Rainey et al 1984 to lactate infusion appears to be a sensitive and specific marker for naturally occurring panic attacks (Cowley and Arana 1990).…”

Changes in the Drug Treatment of Anxiety Disorders

“…It suggests that sodium lac tate can be used to test whether a specific drug suppresses panic attacks. This hypoth esis has been tested in 8 patients who had lactate-induced anxiety attacks and were then treated with an MAOI [25]. Patients who responded well clinically experienced fewer symptoms during a repeat lactate in fusion.…”