Panic Anxiety in Humans with Bilateral Amygdala Lesions: Pharmacological Induction via Cardiorespiratory Interoceptive Pathways.

TitlePanic Anxiety in Humans with Bilateral Amygdala Lesions: Pharmacological Induction via Cardiorespiratory Interoceptive Pathways.
Publication TypeJournal Article
Year of Publication2016
AuthorsKhalsa SS, Feinstein JS, Li W, Feusner JD, Adolphs R, Hurlemann R
JournalJ Neurosci
Date Published2016 Mar 23
KeywordsAdrenergic beta-Agonists, Adult, Afferent Pathways, Amygdala, Female, Heart, Humans, Interoception, Isoproterenol, Lung, Male, Panic Disorder

UNLABELLED: We previously demonstrated that carbon dioxide inhalation could induce panic anxiety in a group of rare lesion patients with focal bilateral amygdala damage. To further elucidate the amygdala-independent mechanisms leading to aversive emotional experiences, we retested two of these patients (B.G. and A.M.) to examine whether triggering palpitations and dyspnea via stimulation of non-chemosensory interoceptive channels would be sufficient to elicit panic anxiety. Participants rated their affective and sensory experiences following bolus infusions of either isoproterenol, a rapidly acting peripheral β-adrenergic agonist akin to adrenaline, or saline. Infusions were administered during two separate conditions: a panic induction and an assessment of cardiorespiratory interoception. Isoproterenol infusions induced anxiety in both patients, and full-blown panic in one (patient B.G.). Although both patients demonstrated signs of diminished awareness for cardiac sensation, patient A.M., who did not panic, reported a complete lack of awareness for dyspnea, suggestive of impaired respiratory interoception. These findings indicate that the amygdala may play a role in dynamically detecting changes in cardiorespiratory sensation. The induction of panic anxiety provides further evidence that the amygdala is not required for the conscious experience of fear induced via interoceptive sensory channels.

SIGNIFICANCE STATEMENT: We found that monozygotic twins with focal bilateral amygdala lesions report panic anxiety in response to intravenous infusions of isoproterenol, a β-adrenergic agonist similar to adrenaline. Heightened anxiety was evident in both twins, with one twin experiencing a panic attack. The twin who did not panic displayed signs of impaired cardiorespiratory interoception, including a complete absence of dyspnea sensation. These findings highlight that the amygdala is not strictly required for the experience of panic anxiety, and suggest that neural systems beyond the amygdala are also involved. Determining these additional systems could provide key neural modulation targets for future anxiolytic treatments.

Alternate JournalJ. Neurosci.
PubMed ID27013684
PubMed Central IDPMC4804013
Grant ListP50 MH094258 / MH / NIMH NIH HHS / United States
UL1 TR000124 / TR / NCATS NIH HHS / United States
NIMH 3R01MH093535-02S2 / / PHS HHS / United States
UCLA CTSI UL1TR000124 / TR / NCATS NIH HHS / United States
R01 MH093535 / MH / NIMH NIH HHS / United States