CHAPTER FIVE Natriuretic Peptides in Anxiety and Panic Disorder T. Meyer*,†,1, C. Herrmann-Lingen*,† *University of Gottingen€ Medical Centre, Gottingen,€ Germany †German Centre for Cardiovascular Research, University of Gottingen,€ Gottingen,€ Germany 1Corresponding author: e-mail address:
[email protected] Contents 1. Neuroendocrine Factors in Anxiety and Fear-Related Disorders 131 2. Molecular Mechanisms Involved in Natriuretic Peptide Synthesis 132 3. Expression of Natriuretic Peptides and Their Receptors in the Brain 135 4. Physiological Actions of Natriuretic Peptides in the Brain 138 5. Neuroprotective Effects of Natriuretic Peptides 139 6. Evidence of Anxiolytic-Like Effects of ANP 140 References 142 Abstract Natriuretic peptides exert pleiotropic effects on the cardiovascular system, including natriuresis, diuresis, vasodilation, and lusitropy, by signaling through membrane-bound guanylyl cyclases. In addition to their use as diagnostic and prognostic markers for heart failure, accumulating behavioral evidence suggests that these hormones also modulate anxiety symptoms and panic attacks. This review summarizes our current knowledge of the role of natriuretic peptides in animal and human anxiety and highlights some novel aspects from recent clinical studies on this topic. 1. NEUROENDOCRINE FACTORS IN ANXIETY AND FEAR-RELATED DISORDERS Anxiety and fear-related disorders, such as generalized anxiety disor- der, panic disorder, agoraphobia, and specific and social phobia, are clinically well-studied conditions characterized by an unpleasant state of inner tension and the expectation of future threat. The nosological entities subsumed under the rubric anxiety and fear-related disorders are usually accompanied by a variety of somatic symptoms, such as sweating, autonomic dysfunction, altered heart rate, abdominal distress, and nausea.