Pergamon Journal of Anxiety Disorders, Vol. 8. No. 2, pp. 131-138, 1994 Copyright 0 1994 Elsevier Science Ltd Printed in the USA. All rights reserved 0887-6185/94 $6.00 + 00 0887-6185(94)EOOO2-Q Premenstrual Exacerbation of Symptoms in Women With Panic Disorder SUSAN P. KASPI, PH.D., MICHAEL W. om>, PH.D., MARK H. POLLACK, zyxwvutsrqponmlkjihgfed M.D., STEPHANIE EPPINGER, M.A., AND JERROLD F. ROSENBAUM, M.D. The Behavior Therapy and Clinical Psychopharmacology Units, Massachusetts General Hospital and Harvard Medical School, Boston, MA Abstract - Women with panic disorder commonly report a premenstrual worsening of panic symptoms, but to date this report has not been confirmed in prospective tri- als. The present study investigated fluctuations in panic symptomatology across the menstrual cycle, with particular attention to the discrepancies between retrospective and prospective studies. Ninety-four women with panic disorder reported their history of premenstrual symptoms of panic, and 24 of these patients completed prospective diaries comprising two full menstrual cycles. Similar to previous studies, 41% of the sample provided a retrospective report of premenstrual worsening of panic symptoms. Unlike previous investigations, a significant increase in panic frequency during the premenstruum was found in our prospective study, with 50% of subjects reporting at least a 100% increase in panic frequency. Women who experienced negative mood premenstrually were more likely to accurately report exacerbation of panic symptoms during the premenstruum. Premenstrual exacerbation of psychiatric symptoms has been identified for a number of disorders, including schizophrenia, bipolar disorder, and bulimia (Brockington, Kelly, Hall, & Deakin, 1988; Gladis & Walsh, 1987; Glick & Steward, 1980). The investigation of premenstrual worsening of symptoms of panic disorder is also of interest. Research on premenstrual syndrome indicates that many premenstrual complaints are similar to panic symptoma- tology, including muscle tension (Coyne, 1983), hot flushes (Casper, Graves, & Reid, 1987), overbreathing (Damas-Mora, Davies, Taylor & Jenner, 1980), and anxiety (Golub, 1976). Estrogen-induced panic episodes (Price & Heil, 1988) and perinatal changes in panic frequency (George, Ladenheim, & Nutt, 1987; Metz, Sichel, & Goff, 1987) also suggest a tentative link This research was supported in part by a grant from Roche Laboratories, Division of Hoffman LaRoche Inc., and a Faculty Scholar Award (NIMH #19600) awarded to Dr. Pollack. Dr. Kaspi is now at the Miami Valley Hospital, Dayton, Ohio. Reprint requests should be addressed to Michael W. Otto, Ph.D., Behavior Therapy Unit, WACC-8 15, Massachusetts General Hospital, Boston, MA 02114. 131