Two primary outcomes of efficacy and acceptability showed a possible advantage of benzodiazepines over placebo .
Low- quality evidence shows a possible superiority of benzodiazepine over placebo in the short-term treatment of panic disorders .
Due to these limitations , our results regarding the efficacy of benzodiazepines versus placebo provide only limited guidance for clinical practice .
BACKGROUND Panic disorder is characterised by recurrent unexpected panic attacks consisting of a wave of intense fear that reaches a peak within a few minutes .
Panic disorder is a common disorder , with an estimated lifetime prevalence of 1 % to 5 % in the general population and a 7 % to 10 % prevalence in primary care setting s. Its aetiology is not fully understood and is probably heterogeneous .
Panic disorder is treated with psychological and pharmacological interventions , often used in combination .
Although benzodiazepines are frequently used in the treatment of panic disorder , guidelines recommend antidepressants , mainly selective serotonin reuptake inhibitors ( SSRIs ) , as first-line treatment for panic disorder , particularly due to their lower incidence of dependence and withdrawal reaction when compared to benzodiazepines .
Despite these recommendations , benzodiazepines are widely used in the treatment of panic disorder , probably because of their rapid onset of action .
OBJECTIVES To assess the efficacy and acceptability of benzodiazepines versus placebo in the treatment of panic disorder with or without agoraphobia in adults .
Differences in pharmacodynamics but not pharmacokinetics between subjects with panic disorder and healthy subjects after treatment with a single dose of alprazolam.
The pharmacokinetics and pharmacodynamics of the benzodiazepine alprazolam ( 1 mg , administered orally ) were compared between eight patients with panic disorder and eight age- and sex-matched healthy volunteers . Subjects received orally administered placebo and alprazolam in a r and omized , double-blind , single-dose crossover study . The elimination half-life , time of maximum plasma concentration , maximum concentration , volume of distribution , and clearance of alprazolam were similar for both groups . For each cohort , alprazolam treatment ( vs. placebo ) produced significant changes in typical benzodiazepine agonist effects , such as increased sedation and impaired cognitive performance on the digit-symbol substitution test . For the panic disorder group only , there was a significant increase in the subjective rating of"contented " and a reduction in the rating of " easily irritated . " For the healthy volunteer group , alprazolam produced increases in ratings of " fatigued " and " slowed thinking , " but also increases in ratings of " relaxed . " In each group , alprazolam significantly increased the electroencephalographic ( EEG ) measure of relative beta amplitude ( range , 13 - 30 Hz ) compared with placebo .  Concentration-EEG response curves fit a sigmoid E(max ) model , and there was greater sensitivity to EEG effects , as measured by a 28 % reduction in the EC50 value , in the panic disorder group compared with healthy control subjects . After alprazolam treatment , there was increased sensitivity to EEG and mood effects and fewer aversive effects in the panic disorder group compared with healthy subjects . There were no differences in the pharmacodynamic measures of sedation and cognition or differences in pharmacokinetics between the two groups
Two primary outcomes of efficacy and acceptability showed a possible advantage of benzodiazepines over placebo .
Low- quality evidence shows a possible superiority of benzodiazepine over placebo in the short-term treatment of panic disorders .
Due to these limitations , our results regarding the efficacy of benzodiazepines versus placebo provide only limited guidance for clinical practice .
BACKGROUND Panic disorder is characterised by recurrent unexpected panic attacks consisting of a wave of intense fear that reaches a peak within a few minutes .
Panic disorder is a common disorder , with an estimated lifetime prevalence of 1 % to 5 % in the general population and a 7 % to 10 % prevalence in primary care setting s. Its aetiology is not fully understood and is probably heterogeneous .
Panic disorder is treated with psychological and pharmacological interventions , often used in combination .
Although benzodiazepines are frequently used in the treatment of panic disorder , guidelines recommend antidepressants , mainly selective serotonin reuptake inhibitors ( SSRIs ) , as first-line treatment for panic disorder , particularly due to their lower incidence of dependence and withdrawal reaction when compared to benzodiazepines .
Despite these recommendations , benzodiazepines are widely used in the treatment of panic disorder , probably because of their rapid onset of action .
OBJECTIVES To assess the efficacy and acceptability of benzodiazepines versus placebo in the treatment of panic disorder with or without agoraphobia in adults .