Attacks of anxiety, panic and frenzy, and their related depression: a hypothesis.

The hypothesis is that the pathogenesis of attacks of anxiety, panic or frenzy (hyperactive disorders) rests on the abnormal activation of the same brain-controlled survival mechanism, and that the subsequent depression is part of this nosological continuum. The acute activation phase would be the counterpart of two principal types of reaction to threat and imminent attack: run-for-life or fight-for-life, sub-served by brain-controlled metabolic activation to make energy available for either. The phase of depression that follows would represent the recovery phase during which homeostatic controls and metabolism, distorted during the acute attacks, are restored to normal. It is further tentatively postulated that anxiety and panic attacks may mimic run-for-life responses, whereas attacks of frenzy might be homologous to fight-for-life. Both the degree of dys-homeostasis and the completeness of the return to normality through the depression phase would depend on severity, duration and, importantly, spacing of the acute attacks. At the limit, severity, long duration and only short intermissions between hyperactive attacks may be postulated to result in persistence of the depression.