The Role of High-Potency Benzodiazepines in the Treatment of Panic Disorder

Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

“…Although the number of panic attacks experienced was similarly reduced in both treatment groups by week 8, both CGI-I and HAMA scores were significantly better in clonazepam-treated patients than in paroxetine-treated patients at weeks 1 and 2. The slower onset of action of paroxetine is consistent with other studies of paroxetine and other SSRIs, and is often associated with increased agitation and anxiety at the beginning of treatment (14,33). Saeki et al (34) demonstrated that genetic and pharmacokinetic factors may affect the initial therapeutic response to paroxetine (34).…”

“…During long-term use, SSRIs may cause weight gain and sexual dysfunction, primarily anorgasmia and ejaculatory dysfunction (17,38,39), and benzodiazepine therapy in panic disorder may lead to abuse or misuse and physical dependence, and withdrawal and rebound symptoms when treatment is discontinued (40). Previous reports indicate a high level of relapse following discontinuation of panic disorder pharmacotherapy (6,13,14). In a study in patients with panic disorder who received paroxetine for 12 months, 17% of patients experienced one or more panic attacks during the 1-year follow-up period after paroxetine discontinuation (31).…”

“…In addition, the subtype of panic disorder (respiratory or non-respiratory) can influence the response to pharmacotherapy and affect outcomes (10)(11)(12). Furthermore, discontinuation of pharmacotherapy can lead to withdrawal symptoms and a significant number of panic disorder patients suffer relapse flowing cessation of treatment (13,14). Benzodiazepines (6,8,14) and selective serotonin reuptake inhibitors (SSRIs) (8,15) are two drug classes with proven efficacy in treating panic disorder.…”

“…Furthermore, discontinuation of pharmacotherapy can lead to withdrawal symptoms and a significant number of panic disorder patients suffer relapse flowing cessation of treatment (13,14). Benzodiazepines (6,8,14) and selective serotonin reuptake inhibitors (SSRIs) (8,15) are two drug classes with proven efficacy in treating panic disorder. In a metaanalysis of 53 studies including 7725 patients with panic disorder who received pharmacotherapeutic treatment, the benzodiazepines and SSRIs showed comparable efficacy (7).…”

“…Clonazepam also affects serotonin transmission (23,24) and is the only benzodiazepine on the market for which additional serotonergic activity has been shown, an action that may contribute to its ansiolytic effects (23)(24)(25). Benzodiazepines and SSRIs are associated with different adverse event (AE) profiles (6,14). When patients with panic disorder cannot tolerate the AEs associated with a particular drug class, switching to a different drug class can improve the safety outcomes of panic disorder (6,26).…”