Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship

It is generally agreed that alcohol disorder and panic tend to occur within the same individual, thus being comorbid. However, the cause of this association remains controversial. Three main explanations are that panic disorder promotes pathological alcohol use as self medication, that chronic alcohol use and alcohol withdrawal induce neuro-chemical system changes which promote panic, and that a third factor, such as family transmission, promotes both conditions. We review epidemiological, family and laboratory studies bearing on the validity of these explanatory models. Findings converge on the conclusion that panic disorder and alcohol disorder can both serve to initiate the other via independent mechanisms. In panic disorder, alcohol dampens anxious apprehension, this by decreasing the likelihood of panic. In alcohol use disorder, alcohol increases CO2 sensitivity and thereby possibly promoting panic. In both cases a significant familial transmission contribute in determining the co-occurrence. Further studies are warranted.