What is the role of benzodiazepines in the management of panic disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Answer

Benzodiazepines (e.g., alprazolam, clonazepam, lorazepam) can achieve long-term control of panic disorder, but these agents should be reserved for patients with refractory panic disorder.  Patients started on benzodiazepines for panic disorder should receive a  psychiatric referral for review of pharmacologic management and, potentially, a psychotherapist for any additional nonpharmacologic treatment options. Benzodiazepines should not be used as monotherapy in panic disorder unless there is no co-occurring mood disorder. [55]

Benzodiazepines act quickly but carry the liability of physiologic and psychological dependence. Benzodiazepines can be reasonably used as an initial adjunct while SSRIs are titrated to an effective dose; that is, these agents can then be tapered over 4-12 weeks while the SSRI is continued. This approach can improve short-term tolerability, although it may increase the risk of sedation and requires warnings for the patient to not operate motor vehicles after taking benzodiazepines or if they’re feeling sedated.

Alprazolam (Xanax) has been widely used for panic disorder, but its use is currently discouraged because of its higher abuse/dependence potential. This agent has a short half-life, which makes it particularly prone to rebound anxiety and psychological dependence. Clonazepam (Klonopin) has become a favored replacement, because it has a longer half-life and empirically elicits fewer withdrawal reactions upon discontinuation relative to alprazolam.


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