A. Broocks et al., Increased psychological responses and divergent neuroendocrine responses to m-CPP and ipsapirone in patients with panic disorder, INT CLIN PS, 15(3), 2000, pp. 153-161
In patients with panic disorder and/or agoraphobia (PDA) an increased sensi
tivity of central 5-HT2C receptors and a decreased responsiveness of 5-HT1A
receptors has been postulated. In the present study, neuroendocrine challe
nges were performed using oral doses of the non-selective 5-HT2C agonist m-
chlorophenylpiperazine (m-CPP) (0.4mg/kg), the selective 5-HT1A antagonist
ipsapirone (0.3mg/kg), and placebo in 40 patients with PDA and 12 healthy c
ontrols in order to compare 5-HT2C and 5-HT1A-specific psychobehavioural an
d neuroendocrine response patterns. At baseline, all psychobehavioural vari
ables and the plasma concentration of noradrenaline (NE) were significantly
increased in the patient group compared to the controls. The administratio
n of m-CPP or ipsapirone was followed by comparable psychological symptoms
and, in 55% of all patients, panic attacks. In comparison to the control su
bjects, patients were characterized by significantly higher psychological r
eactions to both challenge agents and a significantly higher NE response to
m-CPP. In the patient group, there was also a trend towards an increased c
ortisol response after administration of m-CPP and a decreased cortisol and
hypothermia response after administration of ipsapirone compared to the co
ntrol group. The neuroendocrine findings of our study support earlier repor
ts of opposite changes in the responsiveness of 5-HT2C- and 5-HT1A-related
receptors in PDA patients. The behavioural hypersensitivity to both, m-CPP
and ipsapiron, shows that the provocation of anxiety and other psychologica
l symptoms might be influenced by cognitive factors. (C) 2000 Zippincott Wi
lliams & Wilkins.