Panic Disorder Research

Brain Lactate and Treatment of Outcome in Panic Disorder

The overall objective of this research has been to apply proton-planar spectroscopic imaging (PEPSI) during panic provocation, using intravenous lactate infusion, to measure brain metabolic changes that may help to establish the pathophysiological underpinnings of panic disorder and provide a better understanding of treatment refractoriness and relapse in this disorder.  In a series of Magnetic Resonance Spectroscopy (MRS) studies we have determined evidence of brain lactate abnormalities in individuals with panic disorder, which appear to be independent of or only indirectly related to state-dependent symptoms.

 Publications:

• Dager SR, Oskin NM, TL Richards TL, Posse S. Research Applications of MagneticResonance spectroscopy (MRS) to Investigate Psychiatric Disorders.  Topics in Magnetic Resonance Imaging (in press).

• Kucewicz JC, Dunmire B, Giardino ND, Leotta DF, Paun M, Dager SR, Beach KW.  Tissue Pulsatility Imaging of Cerebral Vasoreactivity During Hyperventilation.  Ultrasound Med Biol 2008 (In Press).
• Giardino ND, Friedman S, Dager SR. Every Breath You Take: Anxiety and its implications for functional brain imaging. Compr Psychiatry 48(2):103-12, 2007  PMID: 17292699 . 
• Han DH, Renshaw PF, Dager SR, Chung A, Hwang J, Daniels MA, Lee YS, Lyoo IK. Altered cingulate white matter connectivity in panic disorder patients.  J Psychiatric Research May 4; [Epub ahead of print], 2007  PMID: 17482647
• Friedman S, Jensen J, Frederick B, Artru A, Renshaw P, Dager SR. Brain changes to hypocapnia using rapidly interleaved phosphorus-proton magnetic resonance spectroscopy at 4 Tesla. J Cereb Blood Flow Metab. Epub 2006 Aug 9; 27(3):646-53, 2007.  PMID: 16896347
• Friedman SF, Mathis M, Hayes C, Renshaw PF, Dager SR. Brain pH response to hyperventilation in panic disorder: preliminary evidence for altered acid-base regulation. Am J Psychiatry 163:710- 715, 2006.
• Giardino N, Friedman S, Sparks BF, Petropoulos H, Dunner, P Renshaw PF, Dager SR.  A Comparison of Hippocampus and Amygdala Volumes in Patients with Bipolar Disorder, Panic Disorder, and Healthy Controls.  Depression and Anxiety 22: 212-213, 2005.
• Dager SR. Affective and Emotional Disorders: View of the Pathophysiology from Psychiatry and Implications for Imaging. ASNR Neuroradiology Education and Research Foundation Syllabus: 77-80, 2004.

• Nazemi H and Dager SR:  Coping strategies of panic and control subjects undergoing lactate infusion during MRI confinement.  Comp Psychiatry 44(3):190-197, 2003.PMID: 12764706

• Layton ME, Friedman SD, Dager SR:  Brain metabolic changes during lactate-induced panic:  effects of gabapentin treatment.  Depression and Anxiety 14:251-254, 2001.  PMID: 11754135
• Lee, YS,  Jeong DU, Han DH, Sim ME, Dager SR, Renshaw PF, Lyoo IK. Increased white matter hyperintensities in panic disorder but not in posttraumatic stress disorder (submitted for publication).
• Hwang J, Lyoo IK, Friedman SD, Oh JS, Lee JY, Kim SJ, Dager SR. Amygdalar and hippocampal shape alterations in panic disorder. (in preparation).