Anxiety and the effects of sodium lactate assessed clinically and physiologically

Anxiety neurosis has been the subject of intensive study during the past ten years. Renewed interest in this syndrome has arisen both from the stimulus of new methods of treatment and from attempts to classify anxiety more accurately. Recently Pitts and McClure (1967) reported that anxiety symptoms and anxiety attacks could be produced by a specific biochemical stimulus: sodium lactate. This work was prompted by the finding that 'standard exercise’ tends to produce an excess amount of lactic acid in patients with anxiety neurosis (Cohen and White, 1950; Jones and Mellersh, 1946; Linko, 1950; Holmgren and Strom, 1959). Pitts and McClure found that an intravenous infusion of 10 ml. of half-Molar sodium (DL) lactate per kilogram of body weight, given over a twenty minute period, produced an anxiety attack in patients suffering from anxiety neurosis. The symptoms began a minute or two after the infusion was started and developed rapidly, and some patients reported ‘exacerbations of their characteristic symptom profiles for two to five days after the sodium lactate infusion’. In their double-blind study, many fewer symptoms were produced when calcium ion was added to the lactate infusion, and almost no symptoms were produced by an infusion of glucose in saline of similar osmolarity. Many fewer and less severe symptoms were produced in normal controls than in the patient group, both in response to sodium lactate and to lactate with added calcium, and almost no symptoms during the glucose and saline infusion. Pitts and McClure postulated that anxiety symptoms may have a common determining biochemical end-mechanism, involving the complexing of ionized calcium at the surface of excitable membranes by lactate ion with resulting interference ‘with the normal functioning of calcium in transmitting nerve impulses' (Pitts, 1969). They concluded that ‘there may be something highly specific about lactate ion in producing the naturally occurring hypocalcaemic anxiety symptoms in human beings'.

Treatment of phobic states with antidepressants. A retrospective study of 246 patients

The treatment of phobic states is one of the most challenging psychiatric problems that face doctors today. Many treatments have been advocated, including intensive psychotherapy (Friedman, 1959), behaviour therapy (Wolpe, 1958; Cooper, Gelder and Marks, 1965) and desensitization under drugs (Yorkston et al., 1968). None of these treatments has proved to be completely effective, and many patients still remain ill and incapacitated for many years. In the series to be reported here, some patients had been ill for as long as 40 years, despite many types of treatment.

A controlled physiological, clinical and psychological evaluation of chlordiazepoxide

“Much doubt persists about the different benefits from, and indications for, all the many drugs proposed for the relief of anxiety” (Lancet, 1965). Chlordiazepoxide is one of the most popular minor tranquillizers used by psychiatrists, physicians and general practitioners. Its efficacy has been advocated in the “Today's Drugs” column of the British Medical Journal (1967, 1968a and b). Others, however, have been “impressed by the number of patients who claim great benefit but show little evidence of this” (Jenner, 1965).

A clinical and physiological relationship between anxiety and depression

There has been a great deal of argument during the past 30 years about the symptomatic differences between anxiety and depressive states. Mapother (1926) thought that anxiety states should be regarded merely as one of the numerous sub-divisions of the manic-depressive illnesses, since they merged through a series of patients into agitated depression. Lewis (1966) too saw no sharp division between anxiety states and depression and classified agitated depression and anxiety states together as one sub-division of the affective disorders. Garmany (1956, 1958) and Mayer-Gross, Slater and Roth (1960), however, felt that anxiety states and depression were basically different forms of illness.

Complete longitudinal nephrolithotomy and the Shorr regimen in the management of staghorn calculi

Images