A Comparison of Lactate and Isoproterenol Anxiety States

Abstract

Both sodium lactate and isoproterenol can produce anxiety symptoms in patients with panic attacks. We administered both substances intravenously under placebo-controlled, double-blind conditions to patients with panic attacks and normal control subjects. We measured changes in anxiety levels using the Hamilton Anxiety Scale, State-Trait Anxiety Inventory, and a Panic Severity Scale. Measurements of respiratory rate and blood pH, pO₂ pCO₂, HCO₃, and base excess were used to determine the relationship of hyperventilation to the symptoms induced by the infusions. Heart rate, epinephrine and norepinephrine levels were measured to determine whether there are changes related to palpitations and chest pain. Finger temperature and galvanic skin response were monitored to see whether any changes correlate with subject reports of hot or cold flashes and sweating. In this presentation, we will describe the clinical and biochemical changes that occur during panic attacks.

Sodium lactate infusions and panic attacks: a review and critique.

“…Twelve studies used one of the two following designs. A combination of both designs was used by the 13th study (39)(40)(41): Design A: Different infusions on separate days. Subjects received several different infusions (lactate, saline, lactate plus calcium, etc.)…”

“…There were clear differences in the responses of patients and controls to both lactate and placebo. Across all studies, 56% of the patients (110 of 197) panicked after roughly 12 min of lactate infusion whereas only 9% of the nonclinical control subjects (7 of 76) panicked, usually after a longer period of time [15-18 min-Kelly et al (48,49) and Rainey et al (39)(40)(41)]. Similarly, up to 36% of the patients (39-41) as compared to 0% of the controls panicked on placebo.…”

“…A panic rate in controls of up to 30% (39)(40)(41) and no significant difference between the panic rates of panic patients and patients with generalized anxiety disorder [Lapierre et al (38)-26.1% vs. 12.5%] indicate a lack of specificity of the lactate procedure that invalidates its clinical usefulness for discriminating between diagnostic groups.…”

“…Recently, Klein and his colleagues in a number of publications stated that they have confirmed Pitts and McClure's (25) finding that lactate infusions provoke panic attacks in most panic patients 1 but in very few control subjects (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Currently several other centers are working in this area (37)(38)(39)(40)(41). Contemporary researchers focus more narrowly on Panic Disorder instead of considering sodium lactate as the biochemical substrate of anxiety in general (42).…”

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).…”