The authors describe 10 patients who developed panic attacks only after
substantial cocaine use. The timing of the onset of symptoms, i.e., after
1-6 years of cocaine use, and the fact that only one patient had a
first-degree relative with panic disorder were more suggestive of acquired
than primary panic disorder. The patients' atypical symptoms and responses
to medications may be explained in terms of limbic- neuronal
hyperexcitability induced by cocaine through a kindling mechanism.