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 .
Dehydroepiandrosterone-sulfate/cortisol ratio in panic disorder
We hypothesized that the dehydroepi and rosterone-sulfate (DHEA-S)/cortisol ratio , which has been used as an index of adrenocortical function , would be altered in panic disorder patients and would change after treatment . We evaluated 10 male and 14 female out patients meeting DSM-III-R criteria for panic disorder . Of these 24 subjects , 13 were treated with clonazepam  , 8 were treated with alprazolam , and 3 were treated with placebo as part of a double-blind study . The DHEA-S/cortisol ratio values in the 24 patients with panic disorder ( mean = 20.5 , SD = 11.6 ) were significantly higher than those of a group of 60 normal controls ( mean = 11.5 , SD = 6.01 ) and were also significantly higher than those of a group of 22 depressed patients ( mean = 10.6 , SD = 6.33 ) . Although there was no significant difference in the pretreatment DHEA-S/cortisol ratio values between male ( mean = 23.6 , SD = 11.8 ) and female ( mean = 18.2 , SD = 11.3 ) panic disorder patients , the effects of treatment on this ratio differed between the two sexes . In fact , in the female patients there was a significant decrease in the DHEA-S/cortisol ratio at the end of the study ( mean = 15.1 , SD = 7.9 ) , while in the male patients there was no significant change in this ratio at the end of the study ( mean = 30.2 , SD = 21.4 ) . No significant differences were noted between pretreatment and posttreatment DHEA-S/cortisol ratio values in patients treated with alprazolam ( n = 8) , in patients treated with clonazepam ( n = 13 ) , or in patients treated with placebo ( n = 3 ) . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .