Panic disorder and the brain: the largest study ever conducted
Panic disorder is associated with changes in the brain, both in children, adolescents and in adults. This is the main outcome of the largest brain study ever conducted on panic disorder. Lead researcher and coordinator of the study, Moji Aghajani (Institute of Education and Child Studies), explains why this insight is so important.
Recurring panic attacks accompanied by symptoms such as chest pain, dizziness, sweating or shortness of breath: these are characteristics of panic disorder. In the Netherlands, around two to three per cent of the population is affected, which amounts to hundreds of thousands of people each year.
Such a disorder can significantly impact daily life. Situations that trigger panic are often avoided, such as travelling by public transport.
Link between the brain and panic disorder
What role do brain structures play in panic disorder? This was investigated by Assistant Professor Moji Aghajani together with 80 colleagues from across the world within the ENIGMA Anxiety Consortium.
‘Although it has long been suspected that changes in brain structure play a role in panic disorder, earlier studies often produced conflicting results. They included relatively small groups of participants, used varying analytical methods and examined very diverse patient groups,’ explains Aghajani. ‘Our study directly addressed these limitations by combining data worldwide and using standardised data processing and analyses.’
Researchers from the ENIGMA Anxiety Consortium analysed nearly 5,000 MRI brain scans of people with panic disorder. The brains of children, adolescents and adults were all examined. Never before has this been done on such a large scale.
Changes in the brain
What insights did the analyses provide? ‘The results point to subtle but widespread structural differences in the brains of people with panic disorder. We observed that in some areas the cortex of individuals with panic disorder differs in thickness and surface area. Deeper brain areas such as the thalamus and caudate nucleus also appear to have reduced volume,’ says Aghajani.
‘These regions play a central role in processing emotionally relevant information and monitoring bodily signals. These processes are likely disrupted during panic attacks.’
Age plays an important role
The study also revealed that panic disorder does not affect the brain in the same way at every age. ‘We found that some structural differences were age-dependent,’ says Aghajani.
For example, it became clear that people whose panic disorder began before the age of 21 later had larger lateral ventricles, which are fluid-filled spaces in the brain. ‘These findings suggest that atypical brain development and ageing processes may partly determine how panic disorder manifests across different stages of life.’
According to Aghajani, this study aligns well with a broader shift within mental health research: away from small, isolated studies and towards global collaborations capable of uncovering subtle but reliable neurobiological patterns.
‘By bringing together data from children, adolescents and adults, we aim to develop a more developmental perspective on anxiety disorders. This ia a perspective that may ultimately contribute to earlier detection and more personalised diagnostics, prognostics and treatment.’
Aghajani notes that the study reflects the tremendous collective effort of the ENIGMA Anxiety Consortium, with particular recognition for Dr. Willem Bruin and Dr. Laura Han as first authors of the study. He further emphasizes that the research would not have been possible without the generous support of ZonMw, NWO, and the Leiden University Fund (LUF), to whom the team is deeply thankful.
The results were previously published in the scientific journal Molecular Psychiatry.