We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Catecholamines and Pathogenesis in Panic Disorder

George R. Heninger, MD
Arch Gen Psychiatry. 1998;55(6):522-523. doi:10.1001/archpsyc.55.6.522.
Text Size: A A A
Published online


THE POSSIBILITY that abnormalities in the sympathetic nervous system (SNS) cause panic disorder has been a central concern for well over a century. As early as 1871, DaCosta1 attributed the cause of "irritable heart" in soldiers to "hyperaesthesia of the cardiac nerve centers" (the description is similar to panic disorder). Important new data on this problem is now provided by Wilkinson et al2 who used infusion of radiolabeled epinephrine and norepinephrine with arterial catheterization and coronary sinus sampling and microneurography to assess the SNS in patients with panic disorder and healthy controls. No evidence of heightened SNS tone at rest was found in these patients. However, a marked increase in total body epinephrine-appearance rate (ie, spillover rate) and a smaller increase in the norepinephrine-appearance rate was seen during a spontaneous panic attack in the 3 patients who had one while measurements were being made. Increased appearance of both epinephrine and norepinephrine during a "stressful" mental arithmetic task was not different in the patients and controls.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

6 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles