Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Chronic Use of Alcohol and/or Benzodiazepines May Account for Evidence of Altered Benzodiazepine Receptor Sensitivity in Panic Disorder

Chronic Use of Alcohol and/or Benzodiazepines May Account for Evidence of Altered Benzodiazepine... Abstract To the Editor. — The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and References 1. Roy-Byrne PP, Cowley DS, Greenblatt DJ, Shader RI, Hommer D. Reduced benzodiazepine sensitivity in panic disorder . Arch Gen Psychiatry . 1990;47:534-538.Crossref 2. Nutt DJ, Glue P, Lawson C, Wilson S. Flumazenil provocation of panic attacks: evidence for altered benzodiazepine receptor sensitivity in panic disorder . Arch Gen Psychiatry . 1990;47:917-925.Crossref 3. Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders . Am J Psychiatry . 1990;147:685-695. 4. Pihl RO, Stewart SH. Substance abuse and behavioral pathology: a commentary . In: Nathan P, Lagenbucher JW, McCrady BS, Frankenstein W, eds. Annual Review of Addictions Research and Treatment . Elmsford, NY: Pergamon Press; 1991. 5. Cox BJ, Norton GR, Swinson RP, Endler NS. Substance abuse and panic-related anxiety: a critical review . Behav Res Ther . 1990;28:385-393.Crossref 6. Bibb J, Chambless DL. Alcohol use and abuse among diagnosed agoraphobics . Behav Res Ther . 1986;24:49-58.Crossref 7. Chambless DL, Charney J, Caputo G, Rheinstein B. Anxiety disorders and alcoholism: a study with inpatient alcoholics . J Anxiety Dis . 1987;1:29-40.Crossref 8. Malan J, Norton GR, Broughton R, Wozney K, Cairns S. Alcoholic panickers: a further analysis . Can Psychol . 1987;28(2a):363. 9. Cox BJ, Norton GR, Dorward J, Fergusson P. The relationship between panic attacks and chemical dependencies . Addict Behav . 1989;14:53-60.Crossref 10. Robins ZN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg BM, Burke JD, Regier DA. Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry . 1984;41:949-958.Crossref 11. Mhatre M, Ticku MK. Chronic ethanol treatment selectively increases the binding of inverse agonists for benzodiazepine binding sites in cultured spinal cord neurons . J Pharmacol Exp Ther . 1989;251:164-168. 12. Deitrich RA, Dunwiddie TV, Harris RA, Erwin VG. Mechanism of action of ethanol: initial central nervous system actions . Pharmacol Rev . 1989;41:489-537. 13. Engel J, Liljequist S. The involvement of different central neurotransmitters in mediating stimulatory and sedative effects of ethanol . In: Pohorecky LA, Brick J, eds. Stress and Alcohol Use . Amsterdam, the Netherlands: Elsevier Science Publishers; 1983:153-169. 14. Boisse NR, Okamoto M. Ethanol as a sedative-hypnotic: comparison with barbiturate and nonbarbiturate sedative-hypnotics . In: Rigter H, Crabbe JC Jr, eds. Alcohol Tolerance and Dependence . Amsterdam, the Netherlands: Elsevier Science Publishers; 1980: 265-292. 15. de Vries DJ, Ward LC, Wilce PA, Johnston GAR, Shanley BC. Effect of ethanol on the GABA-benzodiazepine receptor in brain . Alcohol Alcohol . 1987;1( (suppl) ):663-667. 16. Clark DB, Taylor CB, Roth WT, Hayward C, Ehlers A, Margraf J, Agras WS. Surreptitious drug use by patients in a panic disorder study . Am J Psychiatry . 1990;147:507-509. 17. Babor TF, Brown J, Del Boca FK. Validity of self-reports in applied research on addictive behaviors: fact or fiction? Behav Assessment . 1990;12:5-31. 18. Kozlowski LT, Heatherton TF. Selfreport issues in cigarette smoking: state of the art and future directions . Behav Assessment . 1990;12:53-75. 19. Sheehan DV, Coleman JH, Greenblatt DJ, Jones KJ, Leving PH, Orsulak PJ, Peterson M, Schildkraut JJ, Uzogara E, Watkins D. Some biochemical correlates of panic attacks with agoraphobia and their responses to a new treatment . J Clin Psychopharmacol . 1984;4:66-75.Crossref 20. Roth W, Telch M, Taylor B, Sachitano J, Gallen C, Kopell M, McClenahan K, Agras W, Pfefferbaum A. Autonomic characteristics of agoraphobia with panic attacks . Biol Psychiatry . 1986;21:1133-1154.Crossref 21. Sobell LC, Sobell MB. Self-reports across addictive behaviors: issues and future directions in clinical and research settings . Behav Assessment . 1990;12:1-4.Crossref 22. Rankin H. Validity of self-reports in clinical settings . Behav Assessment . 1990;12:107-116. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Chronic Use of Alcohol and/or Benzodiazepines May Account for Evidence of Altered Benzodiazepine Receptor Sensitivity in Panic Disorder

Loading next page...
 
/lp/american-medical-association/chronic-use-of-alcohol-and-or-benzodiazepines-may-account-for-evidence-xDt1e94C4G
Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1992.01820040046006
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. — The results of two studies1,2 in the Archives have been interpreted as being suggestive of reduced benzodiazepine receptor sensitivity (or, more specifically, a shift in benzodiazepine receptor "setpoint"2) resulting in reduced ɣ-aminobutyric acid (GABA) function in panic disorder, with these abnormalities possibly being pathogenic. We suggest two possible alternative or additional explanations.These Results Could Be Secondary to Chronic Alcohol Use.—In both studies,1,2 drinking history was either not assessed or not reported. Yet there is a strong relationship between alcohol abuse and the panic-related disorders.3-5 Data6-9 attest to the fact that rates of panic disorder in alcoholics and rates of alcohol abuse in patients with panic disorder are unusually high compared with the rates in the general population.10There is increasing evidence that alcohol mediates many of its pharmacologic effects through the GABA-ergic receptor system, from behavioral, electrophysiological, and References 1. Roy-Byrne PP, Cowley DS, Greenblatt DJ, Shader RI, Hommer D. Reduced benzodiazepine sensitivity in panic disorder . Arch Gen Psychiatry . 1990;47:534-538.Crossref 2. Nutt DJ, Glue P, Lawson C, Wilson S. Flumazenil provocation of panic attacks: evidence for altered benzodiazepine receptor sensitivity in panic disorder . Arch Gen Psychiatry . 1990;47:917-925.Crossref 3. Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders . Am J Psychiatry . 1990;147:685-695. 4. Pihl RO, Stewart SH. Substance abuse and behavioral pathology: a commentary . In: Nathan P, Lagenbucher JW, McCrady BS, Frankenstein W, eds. Annual Review of Addictions Research and Treatment . Elmsford, NY: Pergamon Press; 1991. 5. Cox BJ, Norton GR, Swinson RP, Endler NS. Substance abuse and panic-related anxiety: a critical review . Behav Res Ther . 1990;28:385-393.Crossref 6. Bibb J, Chambless DL. Alcohol use and abuse among diagnosed agoraphobics . Behav Res Ther . 1986;24:49-58.Crossref 7. Chambless DL, Charney J, Caputo G, Rheinstein B. Anxiety disorders and alcoholism: a study with inpatient alcoholics . J Anxiety Dis . 1987;1:29-40.Crossref 8. Malan J, Norton GR, Broughton R, Wozney K, Cairns S. Alcoholic panickers: a further analysis . Can Psychol . 1987;28(2a):363. 9. Cox BJ, Norton GR, Dorward J, Fergusson P. The relationship between panic attacks and chemical dependencies . Addict Behav . 1989;14:53-60.Crossref 10. Robins ZN, Helzer JE, Weissman MM, Orvaschel H, Gruenberg BM, Burke JD, Regier DA. Lifetime prevalence of specific psychiatric disorders in three sites . Arch Gen Psychiatry . 1984;41:949-958.Crossref 11. Mhatre M, Ticku MK. Chronic ethanol treatment selectively increases the binding of inverse agonists for benzodiazepine binding sites in cultured spinal cord neurons . J Pharmacol Exp Ther . 1989;251:164-168. 12. Deitrich RA, Dunwiddie TV, Harris RA, Erwin VG. Mechanism of action of ethanol: initial central nervous system actions . Pharmacol Rev . 1989;41:489-537. 13. Engel J, Liljequist S. The involvement of different central neurotransmitters in mediating stimulatory and sedative effects of ethanol . In: Pohorecky LA, Brick J, eds. Stress and Alcohol Use . Amsterdam, the Netherlands: Elsevier Science Publishers; 1983:153-169. 14. Boisse NR, Okamoto M. Ethanol as a sedative-hypnotic: comparison with barbiturate and nonbarbiturate sedative-hypnotics . In: Rigter H, Crabbe JC Jr, eds. Alcohol Tolerance and Dependence . Amsterdam, the Netherlands: Elsevier Science Publishers; 1980: 265-292. 15. de Vries DJ, Ward LC, Wilce PA, Johnston GAR, Shanley BC. Effect of ethanol on the GABA-benzodiazepine receptor in brain . Alcohol Alcohol . 1987;1( (suppl) ):663-667. 16. Clark DB, Taylor CB, Roth WT, Hayward C, Ehlers A, Margraf J, Agras WS. Surreptitious drug use by patients in a panic disorder study . Am J Psychiatry . 1990;147:507-509. 17. Babor TF, Brown J, Del Boca FK. Validity of self-reports in applied research on addictive behaviors: fact or fiction? Behav Assessment . 1990;12:5-31. 18. Kozlowski LT, Heatherton TF. Selfreport issues in cigarette smoking: state of the art and future directions . Behav Assessment . 1990;12:53-75. 19. Sheehan DV, Coleman JH, Greenblatt DJ, Jones KJ, Leving PH, Orsulak PJ, Peterson M, Schildkraut JJ, Uzogara E, Watkins D. Some biochemical correlates of panic attacks with agoraphobia and their responses to a new treatment . J Clin Psychopharmacol . 1984;4:66-75.Crossref 20. Roth W, Telch M, Taylor B, Sachitano J, Gallen C, Kopell M, McClenahan K, Agras W, Pfefferbaum A. Autonomic characteristics of agoraphobia with panic attacks . Biol Psychiatry . 1986;21:1133-1154.Crossref 21. Sobell LC, Sobell MB. Self-reports across addictive behaviors: issues and future directions in clinical and research settings . Behav Assessment . 1990;12:1-4.Crossref 22. Rankin H. Validity of self-reports in clinical settings . Behav Assessment . 1990;12:107-116.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Apr 1, 1992

References