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 .
Plasma alprazolam concentrations. Relation to efficacy and side effects in the treatment of panic disorder.
A series of 237 patients with DSM-III-diagnosed panic disorder , or agoraphobia with panic attacks , received alprazolam as part of the placebo-controlled Cross-National Collaborative Panic Study . After a 1-week drug-free period , alprazolam dosage was titrated upward with the objective of reaching 6.0 mg/d in all patients . At week 3 of treatment , alprazolam  plasma levels were significantly correlated with daily dosage ( regression slope : 11.7 ng/mL per milligram per day ) but with considerable individual variation . Among patients with spontaneous panic attacks , 70 % of those with plasma alprazolam levels greater than 20 ng/mL achieved complete remission vs 31 % of those with levels less than 20 ng/mL. Situational panic attack remission increased in frequency with increasing plasma levels , but the relationship was not significant . Patient- and physician-rated global improvement and Hamilton Anxiety and Depression Scale score reductions were maximal at 20 to 39 ng/mL , with no further benefit at higher levels . Central nervous system-depressant side effects increased in frequency with higher plasma levels . Between weeks 3 and 8 of treatment , physicians were permitted to adjust dosage ( maximum : 10 mg/d ) to optimize response . At week 8 , the dose-concentration relationship was essentially identical ( regression slope : 10.8 ng/mL per milligram per day ) , but plasma levels were no longer related to efficacy or side effects . Thus , monitoring of plasma alprazolam concentrations may have a clinical ly useful role during short-term treatment of 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 .