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 

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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.