Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Benzodiazepines for Panic Disorder in Adults

 

Am Fam Physician. 2020 Apr 1;101(7):online.

image

Details for This Review

Study Population: Adults with panic disorder, with or without agoraphobia

Efficacy End Points: Clinical response to treatment, remission, panic symptoms, frequency of panic attacks, anxiety, depression

Harm End Points: Treatment acceptability (using dropout rate as a proxy), adverse effects

Narrative: The treatment of panic disorder includes psychological and pharmacologic interventions. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment because of a lower adverse effect profile than monoamine oxidase inhibitors and tricyclic antidepressants and a lower incidence of dependence and withdrawal than benzodiazepines. Benzodiazepines continue to be prescribed during the initiation phase of SSRIs for acute relief of panic attacks.

 Enlarge     Print

BENZODIAZEPINES FOR PANIC DISORDER IN ADULTS

BenefitsHarms

1 in 4 patients experienced clinical improvement

1 in 41 patients experienced an adverse effect

BENZODIAZEPINES FOR PANIC DISORDER IN ADULTS

BenefitsHarms

1 in 4 patients experienced clinical improvement

1 in 41 patients experienced an adverse effect

A Cochrane review included 24 double-blind studies that lasted three to 15 weeks.1 The studies involved 4,233 randomized participants (2,124 received benzodiazepines; 1,475 received placebo; and 634 received paroxetine [Paxil], buspirone [Buspar], propranolol, or behavior change therapy). The certainty of evidence was low for all end points.

The primary end points were response to treatment and treatment acceptability, using dropout rate as a proxy. This review found greater response in the benzodiazepine group compared with placebo, with a number needed to treat (NNT) of 4 (95% CI, 3 to 7). Fewer participants dropped out from the benzodiazepine treatment group, with an NNT of 6 (95% CI, 5 to 9) for treatment acceptability.

There were nine secondary end points, including remission, panic symptoms, frequency

Author disclosure: No relevant financial affiliations.


Copyright © 2020 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Dean A. Seehusen, MD, MPH, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

1. Breilmann J, Girlanda F, Guaiana G, et al. Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2019;(3):CD010677.

2. National Institute for Health and Care Excellence. Generalized anxiety disorder and panic disorder in adults: management. Clinical Guideline CG113. Accessed July 2, 2019. https://www.nice.org.uk/guidance/cg113

 

 

Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

More in Pubmed

MOST RECENT ISSUE


Jun 1, 2020

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article