Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: a systematic review (original) (raw)
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Journal of Anxiety Disorders, 2002
Benzodiazepines (BZs) are commonly used in conjunction with cognitive behavioral therapy (CBT) in the treatment of panic disorder with agoraphobia (PDA). However, empirical evidence provides little support for the utility of this combined treatment approach over CBT alone. Westra and Stewart [Clin. Psychol. Rev. 18 (1998) 307] have proposed that prn or as-needed use of BZs may inhibit positive CBT outcome to a greater extent than regularly scheduled BZ use. Using a naturalistic design, the present study investigated the impact of manner of BZ use on treatment outcome from CBT in 43 patients with PDA. Among various BZ parameters (chronicity, frequency, dose, and frequency of prn use), prn use of BZs for coping with anxiety symptoms was a signi®cant negative predictor of degree of change in both anxiety sensitivity and anxious arousal from pre-to post-CBT. Although no signi®cant between-group differences were evident in pre-treatment symptomatology, unmedicated subjects demonstrated the most positive overall CBToutcome, while prn BZ users evidenced the fewest gains. Regular BZ users were generally not signi®cantly differentiated from unmedicated subjects in CBT outcome and both tended to obtain post-treatment scores in the nonclinical range. Implications of these ®ndings for clinical management of BZ use throughout CBT for PDA are discussed. #
Psychotherapy and Psychosomatics, 2013
BDZ in treating generalized anxiety disorder (GAD), complex phobias and mixed anxiety-depressive disorders. Indeed, BDZ showed fewer treatment withdrawals and adverse events than AD. In panic disorder with and without agoraphobia our meta-analysis found BDZ treatments more effective in reducing the number of panic attacks than TCA (risk ratio, RR = 1.13; 95% CI = 1.01-1.27). Furthermore, BDZ medications were significantly better tolerated than TCA drugs, causing less discontinuation (RR = 0.40; 95% CI = 0.20-0.57) and side effects (RR = 0.41; 95% CI = 0.34-0.50). As to newer AD, BDZ trials resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder. Conclusions: The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised.
Journal of Clinical Psychopharmacology, 2012
This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)YImprovement rating than treatment with paroxetine (mean difference: CGI-Severity scale j3.48 vs j3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P G 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clo-nazepam over paroxetine with respect to the frequency and nature of adverse events.
Antidepressants and benzodiazepines for panic disorder in adults
Protocols, 2015
Analysis 11.3. Comparison 11 Individual benzodiazepines versus another benzodiazepine, Outcome 3 Failure to remit. Analysis 11.4. Comparison 11 Individual benzodiazepines versus another benzodiazepine, Outcome 4 Panic symptoms. Analysis 11.5. Comparison 11 Individual benzodiazepines versus another benzodiazepine, Outcome