title: Lack of specific association between panicogenic properties of caffeine and HPA-axis activation. A placebo-controlled study of caffeine challenge in patients with panic disorder.
abstract: A subgroup of patients with Panic Disorder (PD) exhibits increased sensitivity to caffeine administration. However, the association between caffeine-induced panic attacks and post-caffeine hypothalamic-pituitary-adrenal (HPA)-axis activation in PD patients remains unclear. In a randomized, double-blind, cross-over experiment, 19 PD patients underwent a 400-mg caffeine-challenge and a placebo-challenge, both administered in the form of instant coffee. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulfate (DHEAS) were assessed at both baseline and post-challenge. No patient panicked after placebo-challenge, while nine patients (47.3%) panicked after caffeine-challenge. Placebo administration did not result in any significant change in hormones' plasma levels. Overall, sample's patients demonstrated significant increases in ACTH, cortisol, and DHEAS plasma levels after caffeine administration. However, post-caffeine panickers and non-panickers did not differ with respect to the magnitude of the increases. Our results indicate that in PD patients, caffeine-induced panic attacks are not specifically associated with HPA-axis activation, as this is reflected in post-caffeine increases in ACTH, cortisol and DHEAS plasma levels, suggesting that caffeine-induced panic attacks in PD patients are not specifically mediated by the biological processes underlying fear or stress. More generally, our results add to the evidence that HPA-axis activation is not a specific characteristic of panic.
authors.affiliation: 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece. Electronic address: vmasdrakis@med.uoa.gr.
authors.forename: Vasilios G
authors.initials: VG
authors.lastname: Masdrakis
authors.affiliation: 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece.
authors.forename: Manolis
authors.initials: M
authors.lastname: Markianos
authors.affiliation: 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Oulis
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D001143:Arousal / Q000187:drug effects; D002110:Caffeine / Q000009:adverse effects*; D018592:Cross-Over Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000139:chemically induced* / Q000503:physiopathology* / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000503:physiopathology*
chemical_list: D002110:Caffeine; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Adrenocorticotropic hormone; Caffeine challenge; Cortisol; Dehydroepiandrosterone sulfate; Hypothalamic–pituitary–adrenal axis; Panic disorder