Ending the Nightmare

Michael Timmermann, personal storyAn excellent student, a talented singer and musician, a competitive athlete. That’s how I appeared on the outside as a young child, but I felt as though I were trapped in a nightmare that would never end. Years later, and after a lot of hard work, my bad dream is finally over.

The Role of Orexin in Human Panic Disorder

Eligibility Criteria

Men and women with panic disorder, and who are between the ages of 18 and 65, are eligible for this study. Must be:

  • in stable physical health as determined by a medical evaluation, including physical examination, electrocardiogram, laboratory findings (comprehensive metabolic panel, complete blood count [CBC], free T4, urine pregnancy test, urinalysis), urine toxicology screen, and a negative urine pregnancy test in women of child-bearing potential
  • Must satisfy the new clinical criteria in the Diagnostic and Statistical Manual for Mental Disorder, 5th edition (DSM-5) for a current principal diagnosis of PD as confirmed by a sem-structured, diagnostic interview, the Mini International Neuropsychiatric Interview (MINI), administered by the PI
  • Only patients with a current PD without MDD will be enrolled
  • Required to have current Montgomery-Asberg Depression Rating Scale (MADRS) total score <12
  • Will be off all regular psychiatric medications and avoid drinking grapefruit juice for at least 2 weeks prior to the 35% CO2 test
  • They must not be pregnant or breastfeeding a baby; and women of child-bearing potential must be using birth control while on this study
Exclusion Criteria
  • Any history of a psychotic disorder, bipolar disorder, MDD, depression not otherwise specified (NOS), obsessive-compulsive disorder, an eating disorder, post-traumatic stress disorder, or generalized anxiety disorder
  • Medical conditions for which suvorexant could be contraindicated, such as narcolepsy
  • Any other sleep disorder
  • A substance use disorder, as definied by the DSM-5, within 6 months of the screening visit
  • Ongoing use of psychiatric medications in the 2 weeks prior to the 35% CO2 test
  • Current use of certain drugs; including strong cytochrome P450 3A (CYP3A) inhibitors (ketoconazole, itraconazole, posaconazole, clarithromycin, nefazodone, ritonavir, saquinarvir, nelfinavir, indinavir, boceprevir, telaprevir, telithromycin, and conivaptan), moderate CYP3A inhibitors (amprenavir, aprepitant, atazanavir, ciprofloxacin, diltiazem, erythromycin, fluconazole, fosamprenavir, imatinib, verapamil), strong CYP3A inducers (rifampin, carbamazepine and phenytoin), digoxin
  • History of any neurological disorder affecting the CNS
  • History of uncontrolled or serious medical illness
  • History of hypersensitivity or allergy to suvorexant
  • Pregnany or lactation status, or unwillingness to use birth control while on this study, for women of child-bearing potention
  • Compromised lung function (e.g., chronic obstructive pulmonary disease [COPD], emphysema, idiopathic pulmonary fibrosis, lung cancer)
  • Inability to fast the required amount of time prior to study visit 2
  • A positive test for cannabinoids, opiated, benzodiazepines, amphetamines, cocaine, and metabolites
  • Out-of-range lab values
  • An abnormal EKG
  • A score > 12 on the Montgomery-Asberg Depression Rating Scale (MADRS)
  • Inability or unwillingness to avoid drinking grapefruit juice for two weeks prior to the 35% CO2 challange test
  • A history of sudden onset of muscle weakness (cataplexy)

The purpose of this study is to provide some information (pilot data) about whether the study drug, suvorexant, (1) affects levels of orexin in people with panic disorder, and (2) is associated with decreased panic symptoms in response to a carbon dioxide (CO2) challenge.

Stuck? Enhancing Treatments for Anxiety and Depression With Dialectical Behavior Therapy

Jennifer L. Taitz, PsyD
Director, Dialectical Behavior Therapy Program
American Institute for Cognitive Therapy

Dr. Taitz explains how the skills and strategies learned in dialectical behavior therapy, or DBT, can help people who have anxiety and depression. Skills include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Learn more...

Conference Highlights

On the Cutting Edge of Wellness: Behavioral Medicine and Its Application to Anxiety and Depressive Disorders

Anxiety and depressive disorders are characterized by significant functional limitations and comorbid mental and physical health conditions that diminish quality of life and sense of well-being. Behavioral medicine, an interdisciplinary field combining medicine and psychology, provides increasingly popular evidence-based approaches to the remediation and healing of mental and physical health concerns and the emergence of wellness.