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 .
Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale.
BACKGROUND The Panic Disorder Severity Scale ( PDSS ) is promising to be a st and ard global rating scale for panic disorder . In order for a clinical scale to be useful , we need a guideline for interpreting its scores and their changes , and for defining clinical change points such as response and remission . METHODS We used individual patient data from two large r and omized controlled trials of panic disorder ( total n=568 ) . Study participants were administered the  PDSS and the Clinical Global Impression (CGI)--Severity and --Improvement .  We applied equipercentile linking technique to draw correspondences between PDSS and CGI-Severity , numeric changes in PDSS and CGI-Improvement , and percent changes in PDSS and CGI-Improvement . RESULTS The interpretation of the PDSS total score differed according to the presence or absence of agoraphobia . When the patients were not agoraphobic , score ranges 0 - 1 corresponded with " Normal , " 2 - 5 with " Borderline , " 6 - 9 with " Slightly ill , " 10 - 13 with " Moderately ill , " and 14 and above with " Markedly ill . " When the patients were agoraphobic , score ranges 3 - 7 meant " Borderline ill , " 8 - 10 " Slightly ill , " 11 - 15 " Moderately ill , " and 16 and above " Markedly ill . " The relationship between PDSS change and CGI-Improvement was more linear when measured as percentile change than as numeric changes , and was indistinguishable for those with or without agoraphobia . The decrease by 75 - 100 % was considered " Very much improved , " that by 40 - 74 % " Much improved , " and that by 10 - 39 % " Minimally improved . " CONCLUSION We propose that " remission " of panic disorder be defined by PDSS scores of five or less and its " response " by 40 % or greater reduction
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 .