Medicine by the Numbers

A Collaboration of and AFP

Benzodiazepines for Panic Disorder in Adults


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


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.

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1 in 4 patients experienced clinical improvement

1 in 41 patients experienced an adverse effect



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 ( 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


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.



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