Responses to hypercarbia induced by acetazolamide in panic disorder patients

Rj, Mathew; Wh, Wilson; Tant, Stephen R.

doi:10.1176/ajp.146.8.996

Cited by 19 publications

(3 citation statements)

References 60 publications

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“…The anxiety response to CO 2 inhalation is a useful clinical test to follow the effectiveness of treatments for panic disorders [349] . The response itself can be quelled by ACZ [350] but, as this is just a model of panic disorder, the use of CA blockers to treat actual panic disorders is unclear. The above-mentioned studies of ASIC1a-null mice suggest that ASIC1a inhibition could be therapeutic for panic disorder.…”

Section: Other Applications By Clinical Specialtymentioning

confidence: 99%

The therapeutic importance of acid-base balance

Quade

Parker

Occhipinti

2021

Biochemical Pharmacology

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Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on pharmacokinetic properties of drugs. Our review considers all major organs systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.

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Section: Other Applications By Clinical Specialtymentioning

confidence: 99%

The therapeutic importance of acid-base balance

Quade

Parker

Occhipinti

2021

Biochemical Pharmacology

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“…21 Panic challenge studies with acetazolamide shed light on the role of protons as effector molecules for generating panic responses; acetazolamide, a carbonic anhydrase inhibitor, blocks the facilitated conversion of CO 2 to bicarbonate and H + , leading to increases in CO 2 concentrations. Interestingly, administration of intravenous acetazolamide fails to induce panic attacks in patients with PD 53, 54 suggesting that H + ions, rather than CO 2 per se may facilitate panicogenesis.…”

Section: Acidosis An Interoceptive Trigger In Panic: Evidence For Rementioning

confidence: 99%

“…Contrary to this, panic attacks were not induced by acetazolamide. 53, 150 In fact, it was suggested that acetazolamide may serve as an anti-panic agent, as it buffers against CO 2 -induced hydrogen ion fluctuations. 151 As noted in that study, acetazolamide prevents the accumulation of H + ions due to inhibition of carbonic anhydrase and provides support for H + ions as the primary biological effector in CO 2 -evoked panic.…”

Section: Potential Therapeutic Agents Targeting Ph Chemosensory Mechamentioning

confidence: 99%

Acid–base dysregulation and chemosensory mechanisms in panic disorder: a translational update

2015

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Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with significant morbidity and an increased risk of suicide attempts and completed suicide. Recently however, neuroimaging and panic provocation challenge studies have provided insights into the pathoetiology of panic phenomena and have begun to elucidate potential neural mechanisms that may underlie panic attacks. In this regard, accumulating evidence suggests that acidosis may be a contributing factor in induction of panic. Challenge studies in patients with PD reveal that panic attacks may be reliably provoked by agents that lead to acid–base dysbalance such as CO2 inhalation and sodium lactate infusion. Chemosensory mechanisms that translate pH into panic-relevant fear, autonomic, and respiratory responses are therefore of high relevance to the understanding of panic pathophysiology. Herein, we provide a current update on clinical and preclinical studies supporting how acid–base imbalance and diverse chemosensory mechanisms may be associated with PD and discuss future implications of these findings.

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Testing the suffocation false alarm theory of panic disorder

Klein

1994

Anxiety

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The need for hypotheses concerning the nature of those functions that have been impaired in stereotyped psychiatric syndromes is emphasized. With regard to panic disorder, the key role of the spontaneous panic attack became apparent from several viewpoints. However, panics seem to be a type of misreleased fear, which guided the thinking concerning the nature of possible psychological or physiological malfunctions. We indicate that spontaneous panic cannot be fear, but must represent some other malfunction and suggest that the spontaneous panic is a suffocation false alarm. The development of this idea is outlined, and attempts to develop tests of this hypothesis are indicated. In particular, studies of children with congenital central hypoventilation syndrome, patients with Chronic Obstructive Pulmonary Disease, dyspnea, field measures of panic, pregnancy, childbirth and the postpartum period, as well as the premenstrual syndrome afford pointed opportunities, new information and potential tests of the theory. A recent challenge to the theory from acetazolamide infusion is discussed. Developing a possible antecedent for the pathologically depressed threshold for the suffocation alarm, in the form of a phasic endorphinergic deficiency, is presented.

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Responses to hypercarbia induced by acetazolamide in panic disorder patients

Cited by 19 publications

References 60 publications

The therapeutic importance of acid-base balance

The therapeutic importance of acid-base balance

Acid–base dysregulation and chemosensory mechanisms in panic disorder: a translational update

Testing the suffocation false alarm theory of panic disorder

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