Chronic idiopathic urticaria associated with panic disorder: a syndrome responsive to selective serotonin reuptake inhibitor antidepressants?

We present two patients with a history of chronic idiopathic urticaria occurring in conjunction with a panic disorder (DSM-IIIR), in whom both the urticaria and panic disorder responded favorably to a course of the selective serotonin reuptake inhibitor antidepressants fluoxetine and sertraline, respectively. Both patients had previously required systemic corticosteroids to manage their urticaria. Panic disorder is an anxiety disorder characterized by the presence of recurrent unexpected panic attacks. Serotoninergic mechanisms play an important role in panic disorder. In contrast to antidepressants such as doxepin, which have previously been found to be effective in the treatment of chronic urticaria, the newer selective serotonin reuptake inhibitor antidepressants are only weakly antihistaminic and anticholinergic. The response of both the urticaria and panic disorder to selective serotonin reuptake inhibitor antidepressants may suggest a common pathogenic factor involving serotoninergic mechanisms.