From the Guidelines
Lactate can trigger panic attacks in susceptible individuals through its effects on brain chemistry and the autonomic nervous system, and managing lactate levels is crucial in preventing panic attacks. When sodium lactate is infused experimentally, it can reliably provoke panic symptoms in patients with panic disorder but rarely in healthy controls 1. This occurs because lactate can alter pH levels, activate the sympathetic nervous system, and potentially cross the blood-brain barrier to affect neurotransmitter function. For those experiencing lactate-induced panic, avoiding intense exercise that produces significant lactic acid buildup may help prevent attacks.
Key Considerations
- Lactate levels are associated with worse outcomes in patients with sepsis and septic shock, and lactate-guided resuscitation has been shown to reduce mortality in these patients 1.
- The Surviving Sepsis Campaign recommends guiding resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypoperfusion, although the quality of evidence is low 1.
- Treatment approaches for lactate-induced panic include cognitive behavioral therapy to address the fear response to physical sensations, gradual exposure to exercise with proper cool-down periods, and medications such as SSRIs or benzodiazepines that can reduce panic sensitivity.
- Some patients may benefit from beta-blockers to blunt the sympathetic response during activities that might increase lactate levels.
Management Strategies
- Avoiding intense exercise that produces significant lactic acid buildup
- Gradual exposure to exercise with proper cool-down periods
- Cognitive behavioral therapy to address the fear response to physical sensations
- Medications such as SSRIs or benzodiazepines to reduce panic sensitivity
- Beta-blockers to blunt the sympathetic response during activities that might increase lactate levels
Important Notes
- Lactate is not a direct measure of tissue perfusion, but increased lactate levels are associated with worse outcomes 1.
- The relationship between lactate and panic attacks highlights the complex interplay between body chemistry and anxiety disorders.
From the Research
Panic Attacks and Lactate
- Panic attacks can be precipitated by intravenous infusion of lactate in patients with panic disorder 2
- The mechanism behind lactate-induced panic attacks is unknown, but it may involve stimulation of serotonin reuptake in central serotonergic neurons, leading to decreased serotonergic activity and reduced inhibitory influence on locus ceruleus 2
- Lactate-induced panic attacks are symptomatically similar to naturally occurring panic attacks 3
- The likelihood of lactate-induced panic attacks is related to the frequency of spontaneous panic attacks 4
Treatment of Panic Disorder
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are commonly used to treat panic disorder 5, 6
- SSRIs, such as paroxetine, have been shown to be effective in reducing the frequency and severity of panic attacks 6
- Cognitive-behavioral therapy may also be used in combination with medication to treat panic disorder 5
Relationship between Lactate and Panic Attacks
- Lactate infusion can trigger panic attacks in vulnerable individuals, suggesting a possible link between lactate and the mechanisms underlying panic disorder 2, 3
- The relationship between lactate-induced panic attacks and depression is also being explored, with studies suggesting that patients with a history of panic attacks are more likely to experience lactate-induced panic 4