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 .
Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder: a placebo-controlled, multicenter study using optimized dosages.
BACKGROUND The purpose of this multicenter , double-blind , placebo-controlled study was to evaluate the efficacy and safety of optimized dosages of clonazepam for the treatment of panic disorder and assess the tolerability of a schedule for gradual discontinuation . METHOD Adult patients with panic disorder with or without agoraphobia ( DSM-III-R criteria ) were r and omly assigned to receive either placebo or clonazepam in individually adjusted doses over 3 weeks to approximate an optimal dosage , which was then maintained for an additional 3 weeks , amounting to a 6-week therapeutic phase . The daily dose range was 0.25 to 4.0 mg administered in 2 divided doses . In the following 7-week discontinuance phase , the doses were tapered gradually to cessation . RESULTS At the therapeutic endpoint , clonazepam ( N = 222 ) proved clinical ly and statistically superior to placebo ( N = 216 ) in change in the number of panic attacks and in Clinical Global Impressions-Severity of Illness ( CGI-S ) and CGI-Change scores , Patient 's Global Impression of Change scores , amount of fear and avoidance associated with phobic symptoms , and duration of anticipatory anxiety . The gradual tapering of clonazepam was not associated with symptoms suggestive of withdrawal syndrome . Although patients taking clonazepam experienced some clinical worsening compared with the status achieved at endpoint , particularly in terms of number of panic attacks , no deterioration was observed using their condition at baseline as point of reference . No overall evidence of rebound was found . All regimens were generally well tolerated . Somnolence was the main adverse event associated with clonazepam therapy . The percentage of patients who reported adverse events was higher in the clonazepam group than in the placebo group , as was the mean number of adverse events per patient . CONCLUSION In this placebo-controlled trial , clonazepam was an efficacious and safe shortterm treatment of the symptoms of panic disorder . Discontinuance during and after slow tapering was well tolerated
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 .