Panic Disorder and Gastrointestinal Issues
Are you aware that panic disorder may be brought about by excessive release of cholecystokinin into the small intestine? What is cholecystokinin anyway?
Based on observations, it has been proposed that abnormal bile flow may bring about panic disorder. This was based on endoscopy and observations of stomach and esophagus pH levels. To undersantd this, it helps to have some understanding of what controls bile flow. There is a neurotransmitter known as cholecystokinin (CCK) that is know to elicit anxiety attacks and CCK is known to be involved with the regulation of bile flow. CCK is usually released when food passes into the gastrointestinal tract and this in turn causes bile to flow into the small intestine. If bile isn’t flowing properly it may back up into the stomach causing what is known as gastritis. The stomach responds to this by releasing more acid to counterbalance the basic components of bile trying to maintain the acidic nature of the stomach. This in turn causes distention and pressure within the stomach and eventually gastrointestinal reflux or GERD. The individual may experience what is called heartburn. Bile may also flow down the intestine generating a fatty stool and possibly fecal incontinence. Some information about panic disorder and abnormal bile flow has been published but is not well known by most doctors.
Panic disorder has been demonstrated somewhat to be associated with irritable bowel syndrome and GERD however, psychiatrist do not link these phenomena together and tend to leave diagnosis and treatment of gastrointestinal (GI) problems to other doctors. GI internists end up prescribing acid blockers such as Zantac or Pepsid however, this deals with only part of the problem. The over section of acid in the stomach is due to bile that has refluxed into the stomach from the small intestine. It turns out that bile is a stronger stimulus for the production of acid than what Zantac or Pepsid can block. Another way to handle over acid production is to use a proton pump inhibitor such as Prilosec. This essentially stops the production of acid. However, you still continue to have excess bile in the stomach that is still causing gastritis.
A new approach has been suggested that involves blocking CCK release thereby inhibiting the release of bile. It makes sense to stop the pathway at the beginning not after the fact. The CCK antagonist drug known as Alprazolam has been proposed to inhibit this pathway. Alprazolam has been used in trials and has been demonstrated to work when administered before going to bed and when given 45 minutes before eating. Another drug known as Carafate has also been used that binds to bile making the bile less alkaline and therefore inhibiting the over production of acid of the stomach that generates gastritis. Carafate not only binds to bile but also binds to the stomach lining allowing for healing of areas that have been over exposed to acid where lesions develop.
Currently many doctors believe that Carafate has little effect in the use of GERD and irritable bowel syndrome and this is generally true. However, where panic disorder is concerned it is. The nice thing about Carafate is that it’s a relatively harmless drug that is not absorbed by your system. It has been demonstrated that oral administration of Carafate a half hour before eating and before going to bed inhibits gastritis, heartburn, fecal incontinence and panic disorder.