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 .
Maintenance drug treatment for panic disorder. II. Short- and long-term outcome after drug taper.
Forty-eight patients with panic disorder completing 8 months of maintenance treatment with alprazolam ( mean dose , 5.2 mg [ n = 27 ] ) , imipramine hydrochloride ( mean dose , 175 mg [ n = 11 ] ) , or placebo ( mean dose , 8.0 pills [ n = 10 ] ) underwent a gradual taper from medication over a 4-week period . A withdrawal syndrome was observed in almost all alprazolam-treated patients but in only a few imipramine- or placebo-treated patients . The clinical worsening of withdrawal symptoms after discontinuation tended to subside over the course of 3 medication-free weeks , but 33 % of alprazolam-treated patients were unable to discontinue their medication regimen successfully . Severity of panic attacks at baseline but not daily alprazolam dose appeared as a significant independent predictor of taper difficulty . Forty-nine percent of the total study population continue to receive drug therapy : 82 % alprazolam and 18 % imipramine . Among patients who received alprazolam during study treatment and at follow-up , the mean daily dose was substantially reduced ( 6.1 vs 1.6 mg [ n = 14 ] ) . At follow-up , after 1 year of naturalistic treatment for panic symptoms and combining 8-month completers and study dropouts , there were no significant differences in remission ( 68 % to 71 % ) or in antipanic medication intake ( 39 % to 56 % ) at follow-up for the three original treatment groups . However , 8-month study completers compared with study dropouts had a significantly higher remission rate ( 85 % vs 55 % )
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 .