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 .
Alprazolam plasma concentrations and treatment response in panic disorder and agoraphobia.
OBJECTIVE The authors ' goal was to evaluate the relationship between plasma concentrations of alprazolam and both treatment response and side effects in patients with panic disorder and agoraphobia . METHOD Ninety-six patients with panic disorder and agoraphobia were treated at three sites in a 6-week , fixed-dose , double-blind , placebo-controlled , dose-response study of 2 mg/day or 6 mg/day of alprazolam . Assessment s were made of panic attacks , avoidance behavior , generalized anxiety , and global response . Blood sample s were collected throughout the study and analyzed for alprazolam and other benzodiazepines . RESULTS Patient compliance with the protocol was judged to be good on the basis of plasma concentrations . According to logistic regression analysis , the relationships between plasma alprazolam concentration and response , as reflected by number of panic attacks reported , phobia ratings , physicians ' and patients ' ratings of global improvement , and the emergence of side effects , were significant . However , there was no significant relationship between plasma alprazolam concentration and the degree of generalized anxiety symptoms . CONCLUSIONS The authors conclude that plasma concentration of alprazolam  is related to treatment response , particularly in panic attacks . The  alprazolam concentration associated with treatment response or with emergence of a given side effect varied widely among individuals , highlighting the necessity for individualized dose adjustment to obtain optimal treatment response while minimizing side effects
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 .