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December 14, 2004
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American Psychological Association: Answers to Your Questions about Panic Disorder

Panic Disorder—What Happens in the Brain



   09.16.04
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Patients suffering from attacks of panic brought on by a hard to define fear factor may soon have better treatment options. As this ScienCentral News video reports, researchers are a step closer to understanding how this disorder works to alter biology in the brain.

Fear Factor

With cars blurring past to her left and right, Judy Niosi pried her fingers around the steering wheel as she drove along a major highway, struggling to come to grips with what she thought was a heart attack.

"My heart started pounding—forcefully—to the point where I thought my chest was going to explode," recalls the 37-year-old graphic artist. "My hands became sweaty and I had the constant thoughts that I was going to die."

Niosi gulped down air, talked to herself in a soothing tone and somehow rumbled up her driveway a short while later. By then, her symptoms had disappeared. "I immediately got on the Internet looking for things, you know, heart attack symptoms to make sure that I wasn't having a heart attack," she says. "And I came across panic attacks and then I realized it must've been a panic attack." Her physician confirmed her suspicions.

Doctors have long suspected that panic attacks like Niosi's—characterized by repeated bouts of intense fear that seem to come out of nowhere—could be hereditary and may result from the way our brains are wired. Piling up is new evidence that this may be the case. Psychiatrist Alexander Neumeister, an assistant professor at Yale University, reported in the Journal of Neuroscience that key brain receptors that receive chemical signals from other cells are deficient in those who suffer from panic attacks. The receptors help move the brain chemical serotonin—it regulates emotion—around the brain.

"What we were looking for is to count the number of receptors in very specific areas of the brain which we think are involved in the regulation of mood and anxiety in humans," Neumeister says. "And what we found in the brain of people with panic disorder is that they have a reduction of about 30 percent—which is a dramatic reduction—in the number of receptors compared to people who do not have panic disorder."

Neumeister and his colleagues used positron emission tomography, or PET scans, to look at the brains of 16 adults with panic disorder and 15 healthy people of the same age. Three brain areas—the anterior and posterior cingulates, which regulate mood and anxiety, and the raphe, which has a similar function—were found to have significantly fewer serotonin type-1A receptors in those suffering from panic disorder. People not prone to panic attacks had more of these receptors. "If you have a reduction of serotonin function in those areas then you're much more vulnerable to develop symptoms of anxiety," Neumeister says.

Brain receptors receive serotonin
Niosi has worked hard to conquer her anxiety and says her symptoms have abated somewhat. The National Institute for Mental Health (NIMH) estimates that there are 19.1 million American adults ages 18 to 54, or about 13.3 percent of people in this age group, struggling with panic disorder. The disorder quickly disrupts everyday life. "You become fearful of social situations," Niosi explains. "[The panic attacks] just hit you. And the main thing is you don't ever want other people noticing you when you're having these types of problems so, in essence, you become fearful of public places."

One of the ways doctors currently treat panic disorder is with medication called selective serotonin reuptake inhibitors, or SSRIs. When Niosi went to her physician, that's what she was prescribed. But Niosi wanted to handle her panic attacks differently, through talk therapy, breathing exercises and meditation. She says she's having increased success but complains that knowing more about the disorder "doesn't feel any better for the next panic attack that happens, because even though you know you're not having a heart attack, it still feels like one."

Psychiatrist Eric Hollander of Mount Sinai School of Medicine says that new technology like PET scans will eventually revolutionize psychiatric patient care. "One of the nice things about new imaging studies [like Neumeister's] is that they can tell us how sensitive specific serotonin receptors are in the brain in particular individuals," he says. "Ultimately this will help us tailor our treatments to specific individuals."

The most important thing for panic disorder patients is to immediately seek help, Neumeister says. If not, the disorder could wreak havoc. "In the long term in panic disorder people start out with one panic attack and then maybe another panic attack, and then those episodes become more intense, they become more frequent, and after a while those people develop depressive symptoms," Neumeister says. "Usually, at the end, if the disorder is not treated properly, they have panic disorder and depression."

Niosi says she's not about to let that happen. She battles hard to monitor her feelings: "The funny thing is, the days that I'm really successful—and I have been—I feel empowered. I feel like I took care of it myself. I was able to deal with it myself. And I conquered it."

This research appeared in the January, 2004 issue of the Journal of Neuroscience and was funded by the Intramural Research Program at the NIMH.


 
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