Some cases of panic attacks have long been associated with abnormal levels of certain neurotransmitters, including serotonin. A recent report of drug therapies for panic disorders has suggested that modulation of serotonin levels can alter panic the propensity and intensity of such attacks(1). Further, a selective serotonin reuptake inhibitor, paroxetine, has been shown to be quite effective in alleviating this condition. Of equal interest, perhaps, is the reported reduction in platelet receptors for serotonin, and hence a reduced capacity for transport of serotonin in the bloodstream, in celiac disease (3). The disturbances in behaviour and mood, which have long been recognized in celiac disease, have been postulated as a possible consequence of the altered serotonin metabolism which is often found in celiac disease (4,5). A connection between gluten and panic attacks seems a very reasonable possibility. I hope this is helpful. best wishes, Ron Hoggan 1. Blanchard DC, Griebel G, Rodgers RJ, Blanchard RJBenzodiazepine and sterotonergic modulation of antipredator and conspecific defense. Neurosci Biobehav Rev 1998 Sep;22(5):597-612 0 2. Dunner D, Kumar R Paroxetine: a review of clinical experience. Pharmacopsychiatry 1998 May;31(3):89-101 3. Chiaravalloti G, Marazziti D, Batistini A, Favilli T, Ughi C, Ceccarelli M, Cassano GB Platelet serotonin transporter in coeliac disease. Acta Paediatr 1997 Jul;86(7):696-699 4. Hernanz A, Polanco I Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Gut 1991 Dec;32(12):1478-1481 5. Challacombe DN, Wheeler EE Are the changes of mood in children with coeliac disease due to abnormal serotonin metabolism? Nutr Health 1987;5(3-4):145-152 ---------------------------------------------------------------------------- ---- Other Formats: Links: Pharmacopsychiatry 1998 May;31(3):89-101 Paroxetine: a review of clinical experience. Dunner D, Kumar R University of Washington Medical Center, Department of Psychiatry, Seattle 98105, USA. The selective serotonin reuptake inhibitor paroxetine has been extensively studied and is now an established therapy for the treatment of depressive disorders. Paroxetine has demonstrated efficacy in major depression in both young and elderly patients, with an improved tolerability profile over conventional antidepressants. Paroxetine is effective across a continuum of anxiety and depressive disorders, including severe depression, depression with anxiety, comorbid depression and obsessive-compulsive disorder. The first agent of its class licensed for use in panic disorder, paroxetine has been shown to be effective in reducing the number of panic attacks and preventing relapse. A worldwide clinical database has established that paroxetine has a benign adverse event profile. Paroxetine therefore offers an effective and well tolerated treatment for a broad spectrum of psychiatric disorders. Acta Paediatr 1997 Jul;86(7):696-699 Platelet serotonin transporter in coeliac disease. Chiaravalloti G, Marazziti D, Batistini A, Favilli T, Ughi C, Ceccarelli M, Cassano GB Institute of Paediatrics, University of Pisa, Italy. We investigated a peripheral serotonergic marker, i.e. platelet tritiated imipramine (3H-IMI) binding sites, which are part of the 5-HT transporter complex similar to that present in the brain, in 20 patients affected by coeliac disease (CD), as compared with 20 healthy controls. Platelet membranes and 3H-IMI binding were carried out according to a standardized protocol. The results showed that coeliac patients had significantly lower 3H-IMI binding sites than controls. This finding would suggest the presence of a dysfunction at the level of the 5-HT transporter that might underline the psychic disturbances frequently observed in coeliac patients. Gut 1991 Dec;32(12):1478-1481 Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Hernanz A, Polanco I Servicio de Bioquimica, Hospital La Paz, Madrid, Spain. Some children with coeliac disease show behavioural disorders such as depression and other signs which have been correlated with reduced central monoamine metabolism. We have therefore investigated the brain availability of the monoamine precursors tryptophan and tyrosine in 15 untreated children with coeliac disease and 12 treated children with coeliac disease as well as in 12 control children. Significantly decreased plasma concentrations of tryptophan were found in untreated children (mean (SD) 13 (4) mumols/l, p less than 0.001) compared with treated children (31 (13) mumols/l), and in both groups of coeliac children when compared with control children (81 (22) mumols/l). A significantly lower ratio of plasma tryptophan to large neutral amino acids (tyrosine, valine, isoleucine, leucine, and phenylalanine) was also observed, which could indicate impaired brain availability of tryptophan in coeliac children and was more pronounced in untreated children. The impaired availability of tryptophan could produce decreased central serotonin synthesis and in turn behaviour disorders in children with coeliac disease. Nutr Health 1987;5(3-4):145-152 Are the changes of mood in children with coeliac disease due to abnormal serotonin metabolism? Challacombe DN, Wheeler EE Somerset Children's Research Unit, Musgrove Park Hospital, Taunton, Somerset. Children with untreated coeliac disease are characteristically unhappy and after a few days of treatment with a gluten-free diet their mood improves. This improvement in mood can be rapidly reversed by introducing gluten into their diet again which suggests that a humoral agent could be involved in this process. As serotonin is a neurotransmitter in the brain and abnormalities of serotonin metabolism have been reported in coeliac disease, this biogenic amine could be the humoral agent that mediates the changes of mood in coeliac disease. In this review the relationship between the mood changes in coeliac disease and serotonin metabolism will be further examined.