Journal Mobile Options
Table of Contents
Vol. 66, No. 2, 2012
Issue release date: August 2012
Neuropsychobiology 2012;66:106–111

Regional Brain Metabolism and Treatment Response in Panic Disorder Patients: An [18F]FDG-PET Study

Kang E.-H. · Park J.-E. · Lee K.-H. · Cho Y.-S. · Kim J.-J. · Yu B.-H.
Departments of aPsychiatry and bNuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, and cDepartment of Psychiatry and Diagnostic Radiology, Yonsei University College of Medicine, Seoul, and dDepartment of Psychiatry, Keyo Hospital, Uiwang, Korea

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Panic disorder (PD) is a common and often chronic psychiatric condition that can lead to considerable disability in daily life. Using [18F]fluorodeoxyglucose-PET, we examined brain baseline glucose metabolism in PD patients in comparison with normal controls and the changes in glucose metabolism after 12 weeks of escitalopram treatment. Methods: Fifteen patients with PD were compared to 20 normal controls using [18F]FDG-PET at baseline and brain metabolism after 12 weeks of escitalopram treatment was compared to pretreatment in the patient group using voxel-based statistical analysis and post hoc region-of-interest analysis. Results: Patients with PD showed decreased metabolism in both the frontal, right temporal, and left posterior cingulate gyruses. After 12 weeks of escitalopram treatment, treatment responders showed metabolic increases in global neocortical areas as well as limbic areas whereas nonresponders did not. Conclusion: Abnormal neocortical function appears to be associated with the pathophysiology of PD and escitalopram exerts its therapeutic action by modulating brain activity at the level of the neocortex and limbic system, notably the amygdala and parahippocampal gyrus.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE: The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006;63:415–424.
  2. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B: Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146:317–325.
  3. Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC: Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation 1994;89:1992–1997.
  4. Smoller JW, Pollack MH, Wassertheil-Smoller S, Jackson RD, Oberman A, Wong ND, Sheps D: Panic attacks and risk of incident cardiovascular events among postmenopausal women in the Women’s Health Initiative Observational Study. Arch Gen Psychiatry 2007;64:1153–1160.

    External Resources

  5. Albert CM, Chae CU, Rexrode KM, Manson JE, Kawachi I: Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 2005;111:480–487.
  6. Malhi GS, Lagopoulos J: Making sense of neuroimaging in psychiatry. Acta Psychiatr Scand 2008;117:100–117.
  7. Reiman EM, Raichle ME, Butler FK, Herscovitch P, Robins E: A focal brain abnormality in panic disorder, a severe form of anxiety. Nature 1984;310:683–685.
  8. Nordahl TE, Semple WE, Gross M, Mellman TA, Stein MB, Goyer P, King AC, Uhde TW, Cohen RM: Cerebral glucose metabolic differences in patients with panic disorder. Neuropsychopharmacol 1990;3:261–272.
  9. De Cristofaro MT, Sessarego A, Pupi A, Biondi F, Faravelli C: Brain perfusion abnormalities in drug-naive, lactate-sensitive panic patients: a SPECT study. Biol Psychiatry 1993;33:505–512.
  10. Bisaga A, Katz JL, Antonini A, Wright CE, Margouleff C, Gorman JM, Eidelberg D: Cerebral glucose metabolism in women with panic disorder. Am J Psychiatry 1998;155: 1178–1183.
  11. Prasko J, Horacek J, Zalesky R, Kopecek M, Novak T, Paskova B, Skrdlantova L, Belohlavek O, Hoschl C: The change of regional brain metabolism (18FDG PET) in panic disorder during the treatment with cognitive behavioral therapy or antidepressants. Neuro Endocrinol Lett 2004;25:340–348.

    External Resources

  12. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT, Keller MB: Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 2005;162:1179–1187.
  13. Gorman JM, Kent JM, Sullivan GM, Coplan JD: Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry 2000;157:493–505.
  14. Zhou L, Huang KX, Kecojevic A, Welsh AM, Koliatsos VE: Evidence that serotonin reuptake modulators increase the density of serotonin innervation in the forebrain. J Neurochem 2006;96:396–406.
  15. Lim YJ, Yu BH, Kim JH: Korean panic disorder severity scale: construct validity by confirmatory factor analysis. Depress Anxiety 2007;24:95–102.
  16. Oldfield RC: The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 1971;9:97–113.
  17. First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders. New York, New York State Psychiatric Institute, 1996.
  18. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
  19. Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55.
  20. Spielberger CD, Gorsuch RL, Lushene RE: Manual for the State Trait Anxiety Inventory. Palo Alto, Consulting Psychologists Press, 1970.
  21. Mueller CA, Weinmann W, Dresen S, Schreiber A, Gergov M: Development of a multi-target screening analysis for 301 drugs using a QTrap liquid chromatography/tandem mass spectrometry system and automated library searching. Rapid Commun Mass Spectrom 2005;19:1332–1338.
  22. Talairach J, Tournoux P: Co-Planar Stereotaxic Atlas of the Human Brain. New York, Thieme, 1988.
  23. Kim JJ, Kwon JS, Park HJ, Youn T, Kang DH, Kim MS, Lee DS, Lee MC: Functional disconnection between the prefrontal and parietal cortices during working memory processing in schizophrenia: a [15O]H2O PET study. Am J Psychiatry 2003;160:919–923.
  24. LeDoux JE, Iwata J, Cicchetti P, Reis DJ: Different projections of the central amygdaloid nucleus mediate autonomic and behavioral correlates of conditioned fear. J Neurosci 1988;8:2517–2529.
  25. Davis M: The role of the amygdala in fear and anxiety. Annu Rev Neurosci 1992;15:353–375.
  26. Schaefer SM, Jackson DC, Davidson RJ, Aguirre GK, Kimberg DY, Thompson-Schill SL: Modulation of amygdalar activity by the conscious regulation of negative emotion. J Cogn Neurosci 2002;14:913–921.
  27. Quirk GJ, Likhtik E, Pelletier JG, Pare D: Stimulation of medial prefrontal cortex decreases the responsiveness of central amygdala output neurons. J Neurosci 2003;23:8800–8807.
  28. Berkowitz RL, Coplan JD, Reddy DP, Gorman JM: The human dimension: how the prefrontal cortex modulates the subcortical fear response. Rev Neurosci 2007;18:191–207.

    External Resources

  29. Mathew SJ, Mao X, Coplan JD, Smith EL, Sackeim HA, Gorman JM, Shungu DC: Dorsolateral prefrontal cortical pathology in generalized anxiety disorder: a proton magnetic resonance spectroscopic imaging study. Am J Psychiatry 2004;161:1119–1121.
  30. Osuch EA, Benson B, Geraci M, Podell D, Herscovitch P, McCann UD, Post RM: Regional cerebral blood flow correlated with flashback intensity in patients with posttraumatic stress disorder. Biol Psychiatry 2001;50:246–253.
  31. Davidson RJ: Anxiety and affective style: role of prefrontal cortex and amygdala. Biol Psychiatry 2002;51:68–80.
  32. Wager TD, Davidson ML, Hughes BL, Lindquist MA, Ochsner KN: Prefrontal-subcortical pathways mediating successful emotion regulation. Neuron 2008;59:1037–1050.
  33. Allman JM, Hakeem A, Erwin JM, Nimchinsky E, Hof P: The anterior cingulate cortex. The evolution of an interface between emotion and cognition. Ann NY Acad Sci 2001;935:107–117.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50