Clonazepam for panic disorders and agitation

Benzodiazepines: abuse and new use

Both abuse and new uses for benzodiazepines are reviewed. The pharmacology of benzodiazepines is summarized and statistics regarding their general use are given. The question of benzodiazepine abuse is reviewed in some detail and the question of rebound, recurrence of symptoms and physiological withdrawal is differentiated. Benzodiazepines are regarded as a very safe class of drugs and the abuse potential is felt to be negligible provided that they are prescribed for appropriate conditions and monitored carefully. The dangers of alternatives to benzodiazepines such as alcohol or barbiturates is emphasized. New uses for benzodiazepines are reviewed including the use of benzodiazepines in panic disorder, as well as an adjunct in the therapy of mania and some psychotic states. Rational prescribing of benzodiazepines is encouraged and the attitude that these are dangerous and addictive drugs is discouraged and put into perspective.

The role of central- and peripheral-type benzodiazepine receptors in anxiolytic-agent augmentation of NaCl solution intake: effects of clonazepam and Ro 5-4864

Two 1,4 benzodiazepines bind preferentially to the central- and peripheral-type benzodiazepine receptor in the brain, clonazepam and Ro 5-4864, respectively. They were administered to rats to determine if the relation between known anxiolytic action and efficacy in augmenting NaCl solution ingestion in rehydrating rats would remain the case for these prototypic agents. Clonazepam (0.062-32.0 mg/kg, PO) was highly potent and efficacious and increased 1.5% NaCl solution intake in a dose-related fashion. Water intake could also be increased, but to a relatively minor degree. Ro 5-4864 (4-8 mg/kg, IP) did not affect 1.5% NaCl solution ingestion, nor did this dose range suppress the augmenting effect of clonazepam (0.5-2.0 mg/kg, PO) on the solution intake. Since clonazepam does, and Ro 5-4864 does not, possess punishment-attenuation properties in other tests, drug augmentation of NaCl solution ingestion by rehydrating rats continues to correlate well with known anxiolytic action.

Brain neurotransmission in panic disorder

For two decades it has been hypothesized that schizophrenia and depression are related to alterations in the activity of specific neurotransmitters in brain; to a great extent, these theories are based on the assumed mode of action of antipsychotic and antidepressant drugs. With the available knowledge of how panic anxiety can be effectively treated (and elicited) with drugs, it is now reasonable to formulate hypotheses also regarding the contribution of central neurotransmitters to the generation of panic. As will be discussed in this brief review, three substances seem to be of particular importance in this context: serotonin, noradrenaline and GABA. In view of this concept, the putative mode of action of the atypical benzodiazepine derivative alprazolam, which in contrast to other benzodiazepines has been attributed effectiveness in the treatment of panic, will also be discussed.

Psychopharmacological treatment of panic disorder and related states: a placebo controlled study of alprazolam

The paper consists of two parts. A review of the relationship of panic disorder to the phobic states and the treatment of these disorders by means of tricyclic antidepressants, MAOIs, beta blocking drugs and benzodiazepines. A double blind study of alprazolam and placebo in 118 patients with agoraphobia and panic is presented. In an eight week study alprazolam was found to be significantly superior to placebo in the treatment of panic attacks, phobic avoidance, anticipatory anxiety and general anxiety.