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Am J Psychiatry 1995; 152:666-672
Copyright © 1995 by American Psychiatric Association
Proton magnetic resonance spectroscopy investigation of hyperventilation in subjects with panic disorder and comparison subjects
SR Dager, WL Strauss, KI Marro, TL Richards, GD Metzger and AA Artru
Department of Psychiatry, University of Washington School of Medicine, Seattle, USA.
OBJECTIVE: The purpose of this study was to investigate differential
effects of hyperventilation on brain lactate in patients with panic
disorder and comparison subjects as a possible mechanism for explaining
previous observations of an excess rise in brain lactate among panic
disorder subjects during lactate infusion. METHOD: Seven treatment-
responsive patients with panic disorder and seven healthy comparison
subjects were studied with proton magnetic resonance spectroscopy to
measure brain lactate during controlled, voluntary hyperventilation over a
period of 20 minutes. Hyperventilation was regulated with the use of
capnometry to maintain end-tidal PCO2 at approximately 20 mm Hg during the
period of hyperventilation. Blood lactate was measured prior to and at the
end of hyperventilation. RESULTS: At baseline the two groups had similar
brain lactate levels. Panic disorder subjects exhibited significantly
greater rises in brain lactate than comparison subjects in response to the
same level of hyperventilation. Blood lactate levels before and after 20
minutes of hyperventilation were not significantly different between
groups. CONCLUSIONS: Controlled hyperventilation increases brain lactate
and does so disproportionately in subjects with panic disorder. This
increase in brain lactate may result from decreased cerebral blood flow due
to hypocapnia, and individuals with panic disorder may have greater
sensitivity to this regulatory mechanism.
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