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Does the panic attack activate the hypothalamic-pituitary-adrenal axis?

Frederico G Graeff1, Cybele Garcia-Leal, Cristina M Del-Ben

  • 1Departmento de Neurologia, Psiquiatria e Psicologia Médica, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP 14048-900, Brazil. fgraeff@keynet.com.br

Anais Da Academia Brasileira De Ciencias
|August 30, 2005
PubMed
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Panic attacks do not activate the hypothalamic-pituitary-adrenal (HPA) axis. However, anxiety-inducing agents and certain peptides that increase stress hormones suggest direct HPA axis activation, unlike anticipatory anxiety.

Area of Science:

  • Neuroendocrinology
  • Psychopharmacology
  • Anxiety Disorders

Background:

  • The relationship between panic attacks and the hypothalamic-pituitary-adrenal (HPA) axis is not fully understood.
  • Previous research has yielded conflicting results regarding HPA axis activation during panic.
  • Distinguishing between panic attack-induced activation and other factors influencing stress hormones is crucial.

Purpose of the Study:

  • To investigate whether panic attacks activate the HPA axis.
  • To examine the effects of various pharmacological agents on stress hormone levels in the context of panic.
  • To differentiate HPA axis response during panic attacks versus anticipatory anxiety.

Main Methods:

  • Bibliographic search of MEDLINE using keywords 'cortisol' and 'panic'.

Related Experiment Videos

  • Inclusion of human studies, excluding reviews, case reports, and studies on inter-panic attack changes.
  • Analysis of studies involving real-life panic attacks, induced panic attacks, and pharmacological challenges.

    • Main Results:

    • Real-life and induced panic attacks do not activate the HPA axis.
    • Colecystokinin receptor B agonists increase stress hormones independently of panic attacks, suggesting direct HPA axis activation.
    • Pharmacological agents like yohimbine, mCPP, fenfluramine, and caffeine increase stress hormones and anxiety, indicating HPA axis activation.

    Conclusions:

    • Panic attacks themselves do not appear to activate the HPA axis.
    • Anticipatory anxiety, however, seems to activate the HPA axis.
    • Certain pharmacological agents directly influence HPA axis activity and stress hormone release.