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 Relationship of Alprazolam Dose to Steady‐State Plasma Concentrations
Alprazolam is a widely used antianxiety agent , yet relatively little is known about the relationship between chronic oral doses and steady-state plasma levels . This study examines the relationship over a wide range of therapeutic doses . We conducted a parallel , double-blind , placebo-controlled study in 36 patients with agoraphobia with panic attacks , or panic disorder with limited phobic avoidance based on DSM- III criteria . Patients received alprazolam ( N = 25 ) or placebo ( N = 11 ) beginning at 1 mg/day and increased weekly until either a maximum tolerated dose or 10 mg/day was achieved . Dosages were then gradually tapered according to a predetermined schedule . The entire study period lasted 14 weeks . Laboratory and clinical assessment s were conducted weekly . Doses up to 6 mg/day were tolerated by 80 % of patients on alprazolam and doses of 10 mg/day were tolerated by 40 % of patients . Twenty-seven percent of the placebo patients reached 10 tablets/day . In the alprazolam group , the principal cause of intolerance was sedation . Throughout the study no significant changes in vital signs or laboratory parameters were observed . Steady state alprazolam , 4-hydroxy alprazolam , and α-hydroxy alprazolam plasma levels were linearly related to dose . A 1 mg dosage increment produced , on the average , a corresponding 10 ng/ml increase in steady state level of the parent drug . Significant response was observed in subjects who achieved concentrations greater than 20 ng/ml , with a maximum of 81 % of the sample s classified as re- sponders within the 60 ng/ml and above group . During taper , no severe withdrawal symptoms were noted ; 12 of 25 alprazolam patients , however , reported rebound anxiety ( anxiety rating scale scores higher than baseline ) , which occurred most commonly at the reduction from 1 mg to 0 mg
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 .