Ending the Nightmare

Michael Timmermann, personal storyAn excellent student, a talented singer and musician, a competitive athlete. That’s how I appeared on the outside as a young child, but I felt as though I were trapped in a nightmare that would never end. Years later, and after a lot of hard work, my bad dream is finally over.

The Role of Orexin in Human Panic Disorder

Eligibility Criteria

Men and women with panic disorder, and who are between the ages of 18 and 65, are eligible for this study. Must be:

  • in stable physical health as determined by a medical evaluation, including physical examination, electrocardiogram, laboratory findings (comprehensive metabolic panel, complete blood count [CBC], free T4, urine pregnancy test, urinalysis), urine toxicology screen, and a negative urine pregnancy test in women of child-bearing potential
  • Must satisfy the new clinical criteria in the Diagnostic and Statistical Manual for Mental Disorder, 5th edition (DSM-5) for a current principal diagnosis of PD as confirmed by a sem-structured, diagnostic interview, the Mini International Neuropsychiatric Interview (MINI), administered by the PI
  • Only patients with a current PD without MDD will be enrolled
  • Required to have current Montgomery-Asberg Depression Rating Scale (MADRS) total score <12
  • Will be off all regular psychiatric medications and avoid drinking grapefruit juice for at least 2 weeks prior to the 35% CO2 test
  • They must not be pregnant or breastfeeding a baby; and women of child-bearing potential must be using birth control while on this study
Exclusion Criteria
  • Any history of a psychotic disorder, bipolar disorder, MDD, depression not otherwise specified (NOS), obsessive-compulsive disorder, an eating disorder, post-traumatic stress disorder, or generalized anxiety disorder
  • Medical conditions for which suvorexant could be contraindicated, such as narcolepsy
  • Any other sleep disorder
  • A substance use disorder, as definied by the DSM-5, within 6 months of the screening visit
  • Ongoing use of psychiatric medications in the 2 weeks prior to the 35% CO2 test
  • Current use of certain drugs; including strong cytochrome P450 3A (CYP3A) inhibitors (ketoconazole, itraconazole, posaconazole, clarithromycin, nefazodone, ritonavir, saquinarvir, nelfinavir, indinavir, boceprevir, telaprevir, telithromycin, and conivaptan), moderate CYP3A inhibitors (amprenavir, aprepitant, atazanavir, ciprofloxacin, diltiazem, erythromycin, fluconazole, fosamprenavir, imatinib, verapamil), strong CYP3A inducers (rifampin, carbamazepine and phenytoin), digoxin
  • History of any neurological disorder affecting the CNS
  • History of uncontrolled or serious medical illness
  • History of hypersensitivity or allergy to suvorexant
  • Pregnany or lactation status, or unwillingness to use birth control while on this study, for women of child-bearing potention
  • Compromised lung function (e.g., chronic obstructive pulmonary disease [COPD], emphysema, idiopathic pulmonary fibrosis, lung cancer)
  • Inability to fast the required amount of time prior to study visit 2
  • A positive test for cannabinoids, opiated, benzodiazepines, amphetamines, cocaine, and metabolites
  • Out-of-range lab values
  • An abnormal EKG
  • A score > 12 on the Montgomery-Asberg Depression Rating Scale (MADRS)
  • Inability or unwillingness to avoid drinking grapefruit juice for two weeks prior to the 35% CO2 challange test
  • A history of sudden onset of muscle weakness (cataplexy)

The purpose of this study is to provide some information (pilot data) about whether the study drug, suvorexant, (1) affects levels of orexin in people with panic disorder, and (2) is associated with decreased panic symptoms in response to a carbon dioxide (CO2) challenge.

Stuck? Enhancing Treatments for Anxiety and Depression With Dialectical Behavior Therapy

Jennifer L. Taitz, PsyD
Director, Dialectical Behavior Therapy Program
American Institute for Cognitive Therapy

Dr. Taitz explains how the skills and strategies learned in dialectical behavior therapy, or DBT, can help people who have anxiety and depression. Skills include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Learn more...

Conference Highlights

On the Cutting Edge of Wellness: Behavioral Medicine and Its Application to Anxiety and Depressive Disorders

Anxiety and depressive disorders are characterized by significant functional limitations and comorbid mental and physical health conditions that diminish quality of life and sense of well-being. Behavioral medicine, an interdisciplinary field combining medicine and psychology, provides increasingly popular evidence-based approaches to the remediation and healing of mental and physical health concerns and the emergence of wellness.

College-Aged Adults Face Less Mental Health Stigma

College-aged adults (age 18–25) have more accepting views of mental health care than other adults, but they still see challenges when it comes to accessing care, according to results of a nationwide poll. The survey was conducted online among more than 2,000 adults, including 198 age 18–25, by Harris Poll on behalf of Anxiety and Depression Association of America (ADAA) and two partnering organizations.

Enhancing Panic and Smoking Reduction Treatment with D-Cycloserine

Eligibility Criteria

Male and female patients ages 18-65:

  • Daily smoker for at least one year
  • Currently smokes an average of at least 8 cigarettes per day
  • Reports a motivation to quit smoking in the next month
  • Evidence of panic attack within the past year and endorsement of smoking as an emotion regulation strategy
Exclusion Criteria
  • Subjects who do not use smoking as an emotion regulation strategy
  • Current diagnosis of a psychotic, eating, developmental or bipolar disorder
  • Significant suicide risk as determined by structured interview
  • Pregnant women, lactating women, and women of childbearing postential who are not using medically accepted forms of contraception (e.g., IUD, oral contraceptives, barrier devices, condoms and foam, or implanted progesterone rods stabilized for at least 3 months)
  • Psychoactive substance abuse or dependence (excluding nicotine dependence) within the past 6 months
  • Current use of isoniazid or ethionamide compounds
  • A history of significant medical condition and/or be deemed as currently unhealthy in the context of a complete physical examination
  • Limited mental competency and the inability to give informed, voluntary, written consent to participate
  • Current use of any pharmacotherapy or psychotherapy for smoking cessation not provided by the researchers during the quit attempt
  • Concurrent psychotherapy initiated within 3 months of baseline, or ongoing psychotherapy of any duration directed specifically toward treatment or anxiety or mood disorder other than general supportive therapy initiated at least 3 months prior to study
  • Use of other tobacco products
  • Plans to move (outside the immediate area) in the next 6 months
  • Insufficient command of the English language

The purpose of the current study is to evaluate the efficacy of d-cycloserine in augmenting treatment of smoking cessation for individuals with panic attacks. Individuals will receive 7 weeks of panic and smoking reduction treatment (PSRT) and one pill of d-cycloserine (DCS) or one pill placebo one hour prior to sessions 3, 4, and 5 (i.e., 3 single doses). Participants will also be given nicotine replacement therapy as part of PSRT (i.e., the patch).