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 .
Correlates of Therapeutic Response in Panic Disorder Presenting with Palpitations: Heart Rate Variability, Sleep, and Placebo Effect
Objective : To examine the correlates of therapeutic response of patients with panic disorder presenting with palpitations , we hypothesized that therapeutic response would correlate with heart rate variability ( HRV ) and sleep measures . Methods : After a 1-week placebo washout , 27 patients free of structural heart disease and not on cardioactive drugs were r and omized in a double-blinded fashion to 4 weeks of treatment with clonazepam ( a known antipanic agent ) or placebo . We performed st and ard sleep measures and recorded HRV from 24-hour Holter acquisitions at baseline and end of study . We defined response to therapy as a 50 % improvement in the Hamilton Anxiety Rating Scale ( HARS ) score , confirmed by question naires and reaction to sodium lactate infusion . Results : There were 12 responders and 15 nonresponders . Normalization of sleep pattern ( including less stage 1 and rapid eye movement [ REM ] sleep ) was observed in both drug and placebo responders ( P = 0.011 and P = 0.05 , respectively ) and in placebo responders alone , compared with nonresponders ( P = 0.006 and P = 0.013 , respectively ) . Placebo responders were more likely to show less depression , but even after we controlled for depression , main sleep effects remained . None of the HRV measures correlated with response , but compared with placebo , clonazepam led to a decrease in all the time and frequency domain measures of HRV ( all P < 0.05 ) . Conclusions : Central mechanisms are related to the therapeutic response of patients with panic disorder presenting with palpitations , but this does not directly correlate with HRV . Larger and longer studies may allow objective explanations of placebo response in panic disorder
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 .