In panic disorder

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). 

Nutt DJ, Glue P, Lawson C, et al Flumazenil provocation of panic attacks evidence for altered benzodiazepine receptor sensitivity in panic disorder. Arch Gen Psychiatry 47 917-923, 1990... 

Otto MW, Pollack MH, Sachs GS, et al Alcohol dependence in panic disorder patients. J Psychiatr Res 26 29-38, 1992... 

Rees CS, Richards JC, Smith LM (1998). Medical utilisation and costs in panic disorder a comparison with social phobia. J Anxiety Disordl2A2 -55. 

Salvador-Carulla L, Segui J, Fernandez-Cano P, et al (1995). Costs and offset effect in panic disorders. Br J Psychiatry 166 (suppl. 27), 23-8. 

Malizia, AL, Cunningham, VJ, Bell, CJ, Liddle, PF, Jones, T and Nutt, DJ (1998) Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder preliminary results from a quantitative PET study. Arch. Gen. Psychiatry 55 715-720. 

The dose of benzodiazepine required for improvement in panic disorder generally is higher than that used in other anxiety disorders. 

Kenardy, J., Oei, T.P., Weir, D., and Evans, L., Phobic anxiety in panic disorder Cognition, heart rate, and subjective anxiety. Journal of Anxiety Disorders 7 (4), 359-371, 1993. 

Woods, S. W., Koster, K., Krystal, J. K. et al. Yohimbine alters regional cerebral blood flow in panic disorder. Lancet 2 678,1988. 

HT model. GAD symptoms may reflect excessive 5-HT transmission or overactivity of the stimulatory 5-HT pathways. Patients with SAD have greater prolactin response to buspirone challenge, indicating an enhanced central serotonergic response. The role of 5-HT in panic disorder is unclear, but it may have a role in development of anticipatory anxiety. Preliminary data suggest that the 5-HT and 5-HT2 antagonist meta-chlorophenylpiperazine causes increased anxiety in PTSD patients. 

BZs are second-line agents except when rapid response is essential. They should not be used as monotherapy in panic disorder patients with a history of depression or alcohol or drug abuse. BZs are often used concomitantly with antidepressants in the first weeks to offset the delay in onset of antipanic effects. 

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