Neuroendocrine responses to laboratory panic: Cognitive intervention in the doxapram model

• Published in: Psychoneuroendocrinology Vol. 21; no. 4; pp. 375 - 390
• Main Authors: Abelson, James L., Weg, John G., Nesse, Randolph M., Curtis, George C.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.1996; Elsevier
• Subjects: Acoustic Stimulation; Adrenocorticotropic Hormone - blood; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Catecholamines; Catecholamines - blood; Central Nervous System Stimulants - pharmacology; Cognition; Cognition - drug effects; Cognition - physiology; Cortisol; Doxapram; Doxapram - pharmacology; Female; Growth hormone; Growth Hormone - blood; Hormones - blood; Humans; Hydrocortisone - blood; Male; Medical sciences; Neurosecretory Systems - drug effects; Neurosecretory Systems - physiopathology; Panic - physiology; Panic disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Research Design; Stress, Psychological - blood; Stress, Psychological - physiopathology; Stress, Psychological - psychology; Catecholamines; Cortisol; Cognition; Growth hormone; Doxapram; Panic disorder; Epinephrine; Human; Panic; STH; Anxiety disorder; ACTH; Catecholamine; Glucocorticoid; Respiratory analeptic; Experimental disease; Adenohypophyseal hormone; Adrenal hormone; Neurotransmitter; Norepinephrine; Hormonal investigation
• ISSN: 0306-4530; 1873-3360
• DOI: 10.1016/0306-4530(96)00005-4

Doxapram is a respiratory stimulant that appears to be a potent and specific panicogenic agent. It also elicits an abnormal ventilatory response in patients with panic. A replication study confirmed these findings and demonstrated that behavioral and ventilatory responses to doxapram were significantly modified by a psychological intervention designed to cognitively block panic. The replication study provided an opportunity to simultaneously investigate the neuroendocrine effects of the illness, the drug, the drug-induced panic attacks, and the cognitive intervention. Epinephrine (EPI), norepinephrine (NE), growth hormone (GH), adrenocorticotropin (ACTH), and cortisol were studied in patients with panic and control subjects given placebo and doxapran injections after receiving either standard instructions or a brief cognitive intervention. Patients with panic had elevated levels of EPI, ACTH, and cortisol throughout the study. Doxapram had little or no detectable effects on plasma NE, GH, ACTH, and cortisol. Doxapram-induced panic attacks were not associated with elevations in NE, GH, ACTH, or cortisol. Doxapram led to a rapid and very brief rise in plasma EPI, which was small in subjects who did not panic and pronounced in patients who did panic. The cognitive intervention attenuated the EPI response to doxapram, perhaps through its effect on panic, and modified the temporal pattern of ACTH and cortisol secretion. These results suggest that: (1) further study of catecholamine responses within the first few minutes after panic induction is needed; (2) intense panic can occur without significant activation of the hypothalamic-pituitary-adrenal axis; and (3) cognitive factors can modulate neuroendocrine activity in laboratory studies of patients with panic.