Panic disorder alprazolam

In two studies in which benzodia2epines were gradually tapered, concurrent cognitive-behavioral therapy (CBT) did not increase the proportion of patients who were able to successfully discontinue their use of these agents (Oude Voshaar et al. 2003 Vorma et al. 2003). On the other hand, other studies of patients with panic disorder found that CBT facilitated the discontinuation of benzodiazepine use (Otto et al. 1993). Similarly, CBT may be superior to supportive medical management in preventing the reoccurrence of panic attacks in panic disorder patients in whom alprazolam has been tapered (Bruce etal. 1999). 

Bruce TJ, Spiegel DA, Hegel MT Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation a longterm follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol 67 151-156, 1999... 

Schweizer E, Patterson W, Rickels K, et al Double-blind, placebo-controlled study of a once-a-day, sustained-release preparation of alprazolam for the treatment of panic disorder. Am J Psychiatry 150 1210-1215, 1993 Seivewright N Benzodiazepine misuse by illicit drug misusers. Addiction 96 333—334, 2001... 

The answer is c. (tiardman, p 372. Katzung, p 375.) Compared with other benzodiazepines, alprazolam is selective for treating agoraphobia and panic disorders. 

Panic disorder SSRIs Venlafaxine XR Alprazolam Clomipramine Clonazepam Imipramine Phenelzine... 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Benzodiazepines. The introduction of the benzodiazepines represented a significant advance in the treatment of panic disorder. In contrast to MAOIs and TCAs, the benzodiazepines begin to provide relief the very first day of treatment, and many patients experience a complete response by the end of the second week of therapy. All benzodiazepines should theoretically alleviate the symptoms of a panic attack at comparable doses, but the benzodiazepines of choice are alprazolam (Xanax, Xanax XR) and clonazepam (Klonopin). It likely is not coincidental that these two are among the highest potency benzodiazepines. However, they differ considerably from a pharmacokinetic standpoint. If clonazepam is the tortoise of benzodiazepines, then alprazolam is the hare. 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

Alprazolam is short-lasting tranquilizer used in conditions of anxiety, panic disorders, and depressive syndrome. The most conunon synonym for this drug is xanax. 

Panic disorder Treatment of panic disorder, with or without agoraphobia (alprazolam immediate-release, extended-release, and orally disintegrating clonazepam). 

Boyer W (1995) Serotonin uptake inhibitors are superior to imipramine and alprazolam in alleviating panic attacks a metaanalysis. Int Clin Psychopharmacol 10 45-49 Bradwejn J, Koszycki D (1994) Imipramine antagonism of the paniogenic effects of chole-cystokinin tetrapeptide in panic disorder patients. Am J Psychiatry 151 261-263 Bradwejn J, Koszycki D, Paradis M, Reece P, Hinton J, Sedman A (1995) Effect of CI-988 on cholecystokinin tetrapeptide-induced panic symptoms in healthy volunteers. Biol Psychiatry 38 742-746... 

Noyes R, Burrows GD, Reich JH, Judd FK, Garvey MJ, Norman TR, Cook BL, Marriott P (1996) Diazepam versus alprazolam for the treatment of panic disorder. J Clin Psychiatry 57 349-355... 

Curtis, G.C., Abelson, J.L., and Gold, P.W. (1997) Adrenocorticotropic and hormone and cortisol responses to corticotropinreleasing hormone changes in panic disorder and effects of alprazolam treatment. Biol Psychiatry 41 76-85. 

Greenblatt, D.J., Harmatz, J.S., and Shader, R.I. (1993) Plasma alprazolam concentrations relation to efficacy and side effects in the treatment of panic disorder. Arch Gen Psychiatry 50 715-722. 

Ravaris, C.L., Friedman, M.J., Hauri, P.J., and McHugo, G.J. (1991) A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. / Clin Psychopharmacol 11 344-350. 

A multitude of studies show that benzodiazepine is effective in the treatment of panic disorder, sometimes freeing patients from panic attacks after six to eight weeks of use. Benzodiazepines tend to work quickly, with a reduction in panic being observed as little as one week after the start of treatment. However, benzodiazepines have the risks of tolerance and dependency. Common benzodiazepines used to treat panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). 

Figure 1.4 The chemical structure of alprazolam (Xanax) categorizes the drug as a benzodiazepine. Treatment with benzodiazepine is recommended for patients with panic disorder. Xanax can be habit-forming and treatment should be closely monitored by a physician.

Although alprazolam is effective in the treatment of panic disorder, research has shown mixed results as to whether this drug can be effective in the treatment of social anxiety disorder. Although some studies have shown that alprazolam is not any better than the placebo, some have also shown that alprazolam can reduce some of social anxiety disorder symptoms. 

A meta-analysis (Boyer 1995) has compared some serotonin reuptake inhibitors (paroxetine, fluvoxamine, zimeldine, and clomipramine) with imipramine and alprazolam in the alleviation of panic attacks in patients with DSM-III or DSM-III-R panic disorder. Although all three classes of drugs were shown to be significantly more effective than placebo, the serotonin reuptake inhibitors were also significantly superior to both imipramine and alprazolam. The findings of this meta-analysis highlight the importance of... 

A second issue relating to long-term medication is the effect of withdrawing medication at the end of a period of treatment. Benzodiazepines are associated with discontinuation symptoms, and their repeated use may foster the development of true physiological dependence. In a study of discontinuation of treatment for panic disorder [Rickels et al. 1993) with either alprazolam [n = 27), imipramine [n = 11) or placebo [n = 10), a withdrawal syndrome was observed in almost all patients treated with alprazolam but in few pa-... 

In a study by another group, lymphocyte CCK-8S concentrations were measured in patients with panic disorder and psychiatrically healthy control subjects [Brambilla et al. 1993]. In patients, CCK-8S levels were measured again after a 30-day course of alprazolam therapy. The CCK-8S concentrations were significantly lower in the patients than in the control subjects but did not change after alprazolam therapy. 

Ballenger JC, Post RM Therapeutic effects of carbamazepine in affective illness preliminary report. Communications in Psychopharmacology 2 159-175, 1978 Ballenger JC, Burrows GD, Dupont R, et al Alprazolam in panic disorder and agoraphobia results from a multicenter trial, I efficacy in short term treatment. Arch Gen Psychiatry 45 413-422, 1988... 

Dunner DL, Ishiki D, Avery DH, et al Effectiveness of alprazolam and diazepam in patients with panic disorder a controlled study. J Chn Psychiatry 47 458-460, 1986... 

Herman JB, Rosenbaum JE, Brotman AW The alprazolam to clonazepam switch for the treatment of panic disorder. J Clin Psychophamacol 7 175-178, 1987 Herrmann N Valproic acid treatment of agitation in dementia. Can J Psychiatry 43 69-72, 1998... 

Richelson E, Nelson A Antagonism by neuroleptics of neurotransmitter receptors of normal brain in vitro. Eur J Pharmacol 103 197-204, 1984 Rickels K, Schweizer E The treatment of generalized anxiety disorder in patients with depressive symptomatology. J Clin Psychiatry 54 [suppl) 20-23, 1993 Rickels K, Weisman K, Norstad N, et al Buspirone and diazepam in anxiety a controlled study. J Chn Psychiatry 43(12 pt 2) 81-86, 1982 Rickels K, Feighner JP, Smith WT Alprazolam, amitriptyline, doxepin, and placebo in the treatment of depression. Arch Gen Psychiatry 42 134-141, 1985 Rickels K, Schweizer E, Weiss S, et al Maintenance drug treatment for panic disorder, 11 short- and long-term outcome after drug taper. Arch Gen Psychiatry 50 61-68, 1993... 

Scavone JM, Greenblatt DJ, Locniskar A, et al Alprazolam pharmacokinetics in women on low-dose oral contraceptives. J Clin Pharmacol 28 454-457, 1988 Schatzberg AF, Ballenger JC Decisions for the clinician in the treatment of panic disorder when to treat, which treatment to use, and how long to treat. J Clin Psychiatry 52 [suppl) 26-31, 1991... 

Benzodiazepines are highly effective anxiolytics and sedatives. They also have muscle relaxant, amnestic, and anticonvulsant properties. Benzodiazepines effectively treat both acute and chronic generalized anxiety and panic disorder. The high-potency benzodiazepines alprazolam and clonazepam have received more attention as antipanic agents, but double-blind studies also have confirmed the efficacy of diazepam and lorazepam in the treatment of panic disorder. Although only a few benzodiazepines are specifically approved by the... 

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