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 .
The significance of HPA axis disturbance in panic disorder
Agoraphobic and panic disorder patients underwent 1-mg Dexamethasone Suppression Tests ( DST ) before , during , and after an 8-week trial of diazepam , alprazolam , or placebo . Previously described , never-ill controls underwent similar testing . At baseline , 21 of 82 ( 25.6 % ) panic disorder and 5 of 38 ( 13.2 % ) controls were nonsuppressors . This difference grew more marked with multiple testing over a 2-month period ; 18 of 44 ( 40.9 % ) panic disorder patients were nonsuppressors on at least 1 of 3 tests compared with only 5 of 35 ( 14.3 % ) controls ( p = 0.006 ) .  DST results were related to severity , but not to the presence or absence , of depressive syndromes . Control for plasma dexamethasone levels left highly significant differences in postdexamethasone cortisol across diagnostic groups . Neither  DST results nor plasma dexamethasone levels changed in concert with clinical change , and type of treatment had little differential effect on these measures . Nor did  DST results predict subsequent course when active treatment was extended by 6 months . However ,  DST results during the initial 8 weeks of treatment were strongly related to relapse when medications were tapered , even though this occurred 6 months after the last DST
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 .