Re:히스타민분해로 해결하는 문제들 - 공황장애, panic disorder

[문형철]

beyond reason

히스타민과 공황장애

- 특별한 이유없이 가슴이 터질듯하고 가슴이 두근거려 공황장애같다는 히스타민 증후군 환자들이 많음. 

- 성격이 예민한 경우 히스타민은 심장근육을 수축하는 작용을 증강시켜 불안, 가슴두근거림 증상을 악화시킴. 대개 맥박수는 정상인데 자각하는 증상으로 맥박이 빨리 뛴다고 인식함. 

- 심하면 부정맥으로 진행함

PANIC DISORDER TREATED WITH THE ANTIHISTAMINE CHLORPHENIRAMINE

To the Editor:

The article by Dr. Goodwin1 describing comorbidity of panic disorder and hay fever is very interesting, raising questions about treatment options that might affect both disorders. Some years ago, we reported on a patient with comorbid panic disorder and hay fever, that had been treated with different antihistamines.2 The response pattern of this patient, whose panic attacks and phobias ameliorated while on dex- chlorpheniramine, made us believe that this drug possessed specific psychopharmacologic activity. This was supported by positive clinical results in 10 additional patients with panic disorder who were treated with dex-chlorpheniramine.3 This was further substantiated when we became aware that Nobel Prize laureate Arvid Carlsson along with Lindqvist4 had de- scribed the serotonin reuptake-inhibiting property of chlor- pheniramine as early as 1969.4 This pharmacologic discovery was not further explored through clinical studies at that time, yet it served as a starting point in the development of the first selective serotonin reuptake inhibitor, zimeldine.5

We now want to report another case, illustrating the clin- ical usefulness of acknowledging the varying specificity of antihistamine drugs.

A 67-year-old woman, complaining of chest pain, was investigated and treated at a ward of internal medicine. The cardiologist, however, found nothing wrong with her heart. It was felt that her symptoms were rather of a psychiatric origin, and one of us (MH) was consulted as a liaison psychiatrist. It turned out that she suffered from moderately severe panic attacks and agoraphobia in her 20s. These symptoms abated successively while her hay fever was chronically treated with chlorpheniramine. Two months before the present admission, her general practitioner had substituted this drug with lorata- dine, in the ambition to reduce possible side effects. Shortly after this, the reappearance of her panic attacks was accom- panied by chest pain, lowered mood, and a phobic tendency. Having delineated this sequence of events, it was decided to change back to dex-chlorpheniramine. Her symptoms gradu- ally subsided, and she was happy to continue with her “old- fashioned” antihistamine.

This case illustrates the consequences of ignoring the psy- chotropic properties of chlorpheniramine, and the usefulness of the varying pharmacologic actions of these agents. By use of chlorpheniramine in the treatment of patients with hay fever and panic disorder, one medication might treat both conditions. This could provide the benefits of simpler admin- istration as well as being more cost-effective. Controlled studies should be performed of this safe old drug.

EINAR HELLBOM, BA
Psychiatric Department
H Lundbeck AB
Helsingborg, Sweden
MATS HUMBLE, MD
Psychiatry of Northern and Western Dalecarlia Mora Hospital
Mora, Sweden

REFERENCES

1. Goodwin RD. Self-reported hay fever and panic attacks in the community. Ann Allergy Asthma Immunol 2002;88:556 –559. 2. Humble M, Hellbom E. Dex-chlorpheniramine treatment of

panic disorder. Nordic J Psychiatry 1998;52:440 – 441.
3. Hellbom E, Humble M, Larsson M. Antihistamines, selective serotonin reuptake inhibitors, and panic disorder. Nordic J Psy-

chiatry 1999;53:100.
4. Carlsson A, Lindqvist M. Central and peripheral monoaminer-

gic membrane-pump blockade by some addictive analgesics and

antihistamine. J Pharm Pharmacol 1969;21:460 – 464.

5. Carlsson A, Wong DT. Correction: a note on the discovery of selective serotonin reuptake inhibitors. Life Sci 1997;61:1203. 

Histamine and Anxiety

This post is part of an ongoing series on histamine intolerance, which Dr. Gannage has described as a “game changer in chronic illness”. If you missed the first post, which explains what histamine intolerance is, you can read it here.

When Excess Histamine Feels Like A Panic Attack

Histamine intolerance affects us in different ways, because histamine is found all throughout the body. Histamine always causes inflammation, but the symptoms that present themselves vary based on which receptors are being activated, and where.

In the heart, histamine functions as a vasodilator, meaning that it widens our blood vessels, and therefore there is less resistance to blood pumping through the body. Imagine a running hose that is widened, suddenly allowing more water to flow through, with less resistance or pressure. Just like this hose, the widening of blood vessels and decrease in resistance causes a drop in blood pressure. At the same time, your heart rate increases, as it works to get the same volume of blood through the widened vessels.

The combination of rapid heart rate and change in blood pressure can cause feelings of high anxiety, especially when they bring with them a pounding heart, shortness of breath, “flushing”, a rise in body temperature, dizziness, and/or redness in the face. Some people might feel that they are having a panic attack, when in reality the problem is excess histamine.

Excess histamine might help to explain panic attack symptoms that don’t appear to be linked to a panic disorder.

Beyond the heart, inflammation in the brain caused by excess histamine has also been linked to anxiety (as well as a series of other psychiatric presentations that are in fact, again, symptoms of histamine intolerance).

While the causes of histamine intolerance vary (and therefore so does the solution), a low-histamine diet is often a great place to start.