A Hypothetical Explanation of Panic Disorder
Panic attacks may result from severe reduction of dehydroepiandrosterone (DHEA) in a person of low DHEAwith normal or increased levels of cortisol. That is, an excessive ratio of cortisol to DHEA occurs which extin-
guishes the effects of unstable DHEA and magnifies the effects of cortisol. Prolactin increases during panic
attacks and is correlated with attack severity. That is, prolactin increases to stimulate DHEA, but the re-
sponse is inadequate to stabilize the DHEA to cortisol ratio and inhibit prolactin production. Therefore, pro-
lactin remains elevated during an attack. Panic attacks occur when the effects of excessive cortisol excite
prolactin stimulation of DHEA in a person who cannot respond with adequate DHEA (German J Psychiatry
2001;4:40-42).
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