Alprazolam, Propranolol, and Placebo in the Treatment of Panic Disorder and Agoraphobia with Panic Attacks

Munjack, Dennis J.; Crocker, Benjamin; Cabe, Dennis; Brown, Richard A.; Usigli, Rodolfo; Zulueta, Anicia; McManus, Marianne; McDowell, Diane E.; Palmer, Ruby; Leonard, Michele

doi:10.1097/00004714-198902000-00005

Cited by 67 publications

(31 citation statements)

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“…Munjack et al (1989) found little evidence for antipanic efficacy comparing propranolol with alprazolam in a placebo-controlled trial in contrast to findings by Ravaris et al (1991). Two controlled trials have evaluated 0-adrenoceptor blocking drugs in panic disorder.…”

Section: Patients In Combined Treatmentcontrasting

confidence: 61%

Drug Treatment of Panic Disorder

Rosenberg

1993

Pharmacology & Toxicology

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Drug treatment of panic disorder is reviewed with focus on recent controlled studies. The efficacy of alprazolam, a triazolobenzodiazepine, and imipramine, a tricyclic antidepressant, has consistently been demonstrated, but there is reasonable evidence that other benzodiazepines or antidepressants might also be effective if equipotent doses are used. Most controlled studies demonstrate drug efficacy on several psychopathological symptoms, including the core symptom panic attacks. Limited evidence indicates that alprazolam may be more efficacious in treating panic attacks than avoidance behaviour, and the reverse when imipramine is concerned. Drug efficacy appears to be most consistently documented in moderately to severely ill panic patients. The benzodiazepines are better tolerated than antidepressants in terms of patient acceptance, and the improvement sets in faster with benzodiazepines. In the presence of depressive symptoms considered secondary to panic attacks and/or agoraphobia, both types of drugs appear efficacious. Difficulty discontinuing high-dose benzodiazepine treatment remains the most important side effect of the treatment but sedation can, like anticholinergic side effects of the tricyclic antidepressants, be troublesome, thereby diminishing patient compliance. The role of newly developed antidepressants with a more specific mode of action and milder side effects awaits evaluation in controlled trials.

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Section: Patients In Combined Treatmentcontrasting

confidence: 61%

Drug Treatment of Panic Disorder

Rosenberg

1993

Pharmacology & Toxicology

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“…Á Because beta-blockers may influence autonomic anxiety symptoms such as palpitations, tremor, etc., they have been used in the treatment of panic disorder. However, the beta-blocker propranolol was not superior to placebo (Munjack et al 1989) and less effective than comparator drugs (Munjack et al 1989;Noyes et al 1984). In another DBPC study with small sample size, propranolol was not different from alprazolam, although alprazolam showed a more rapid onset of efficacy (Ravaris et al 1991) (E).…”

Section: Monoamine Oxidase Inhibitors (Maoi)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

718

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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“…Benzodiazepines are very frequently utilized and have demonstrated short-term efficacy in many studies [53,90,91]. Clonazepam in particular, is commonly used in bipolar patients because it has been shown in to be faster than lithium in the treatment of acute mania in a blinded cross-over trial [92], and because it has been shown to be effective in panic disorder [93] and possibly social phobia [94].…”

Section: Treatment Of Anxiety Disordersmentioning

confidence: 99%

Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis

El‐Mallakh

Hollifield

2008

Psychiatr Q

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Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are associated with extraordinarily high rates of comorbidity with a multitude of psychiatric and medical conditions. Among all the potential comorbidities, co-occurring anxiety disorders stand out due to their very high prevalence. Outcome in bipolar illness is worse in the presence of a comorbid anxiety disorder. The coexistence of an anxiety disorder presents a particularly difficult challenge in the treatment of bipolar illness since antidepressants, the mainstay of pharmacologic treatments for anxiety, may adversely alter the course of manic-depression. Identification of anxiety disorders in bipolar patients is important. The treatment plan needs to balance the potential benefit and harm of antidepressant administration.

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Alprazolam, Propranolol, and Placebo in the Treatment of Panic Disorder and Agoraphobia with Panic Attacks

Cited by 67 publications

References 0 publications

Drug Treatment of Panic Disorder

Drug Treatment of Panic Disorder

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Comorbid Anxiety in Bipolar Disorder Alters Treatment and Prognosis

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