Alprazolam in panic disorder: a retrospective analysis

Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: a review of the literature

Alprazolam is a benzodiazepine derivative that is currently used in the treatment of generalized anxiety, panic attacks with or without agoraphobia, and depression. Alprazolam has a fast onset of symptom relief (within the first week); it is unlikely to produce dependency or abuse. No tolerance to its therapeutic effect has been reported. At discontinuation of alprazolam treatment, withdrawal and rebound symptoms are common. Hence, alprazolam discontinuation must be tapered. An exhaustive review of the literature showed that alprazolam is significantly superior to placebo, and is at least equally effective in the relief of symptoms as tricyclic antidepressants (TCAs), such as imipramine. However, although alprazolam and imipramine are significantly more effective than placebo in the treatment of panic attacks, Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be superior to either of the two drugs. Therefore, alprazolam is recommended as a second line treatment option, when SSRIs are not effective or well tolerated. In addition to its therapeutic effects, alprazolam produces adverse effects, such as drowsiness and sedation. Since alprazolam is widely used, many clinical studies investigated its cognitive and psychomotor effects. It is evident from these studies that alprazolam may impair performance in a variety of skills in healthy volunteers as well as in patients. Since the majority of alprazolam users are outpatients, this behavioral impairment limits the safe use of alprazolam in patients routinely engaged in potentially dangerous daily activities, such as driving a car.

Panic disorder. When symptoms have no apparent physical cause

Patients with undiagnosed panic disorder often have symptoms of several associated physical and social problems, and they frequently seek help initially from their primary care physician. Therefore, it is important to be knowledgeable in diagnosis and treatment of panic disorder and to consider it in differential diagnosis in patients reporting nonpsychiatric complaints. Although the underlying pathophysiology of panic disorder is still unclear, current research suggests that an imbalance of several neurotransmitter systems may be responsible. Many effective cognitive, behavioral, and pharmacologic methods are available, and patients may require a combination of approaches. Selective serotonin reuptake inhibitors are emerging as first-line therapy because of their demonstrated efficacy and tolerability. Tricyclic antidepressants and monoamine oxidase inhibitors also have been used successfully, and high-potency benzo-diazepines are an option when rapid onset of drug activity is desired. Effective treatment of panic disorder can significantly decrease hospitalizations, reduce unnecessary healthcare expenditures, and improve patient quality of life.