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Am J Psychiatry 1994; 151:57-63
Copyright © 1994 by American Psychiatric Association
Preliminary application of magnetic resonance spectroscopy to investigate lactate-induced panic
SR Dager, KI Marro, TL Richards and GD Metzger
Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, Seattle 98195.
OBJECTIVE: To characterize changes associated with lactate-induced panic,
proton magnetic resonance spectroscopy (MRS) was used to measure brain
lactate during intravenous infusion of 0.5-M sodium lactate in panic
disorder patients and comparison subjects. METHOD: Eight panic disorder
subjects, five medicated and three unmedicated, and eight healthy
comparison subjects were studied at baseline, during lactate infusion (5
meq/kg over 20 minutes), and after infusion. Localized proton MRS was used
to acquire averaged spectra every 5 minutes from a 27-ml sampling volume in
the insular cortex and adjacent regions. Brain lactate levels,
quantitatively estimated in relationship to N-acetyl aspartate, were
compared to blood lactate levels. RESULTS: The procedure was generally well
tolerated; one panic subject requested early termination before lactate
infusion. Significant rises in brain lactate levels occurred for all
subjects during infusion. The panic patients who responded to lactate (N =
3) had significantly higher brain lactate levels before, during, and after
infusion than did the comparison subjects (N = 8) and medicated patients
who were lactate nonresponders (N = 4). After infusion the panic patients
with lactate- induced panic exhibited a striking dissociation between
decreasing blood lactate and further increases in brain lactate levels.
CONCLUSIONS: These preliminary observations indicate that brain lactate
increases during a standard lactate infusion. Lactate-induced panic is
associated with greater increases than in comparison subjects and with
prolonged elevations in brain lactate that are decoupled from falling blood
lactate levels after completion of lactate infusion. Further investigation
is necessary to clarify the mechanism(s) responsible for these findings and
establish whether a causal relationship to the occurrence of
lactate-induced panic exists.
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