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Am Fam Physician. 2002;65(3):497-498

Treatment of panic disorder using a combination of benzodiazepines and antidepressants is a common clinical practice. Currently, the selective serotonin reuptake inhibitors (SSRIs), in particular, are recommended for treatment of panic disorder. However, few studies have examined the short- and long-term benefits of combining benzodiazepines with SSRIs. In one study, patients with panic disorder benefited immediately when a benzodiazepine was added to an SSRI treatment regimen, but the positive short-term results were offset by long-term problems. Goddard and colleagues studied the benefits of early coadministration of benzodiazepines and SSRIs in the rapid stabilization of panic disorder.

The study participants attended a university anxiety clinic and were diagnosed with panic disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). To qualify, participants had to have at least one panic attack per week for one month before the study. Patients who qualified for the study were treated with a flexible dosage of sertraline in an open-label fashion with a target dosage of 100 mg per day for 12 weeks. This group was randomized to receive either placebo or clonazepam in a dosage of 0.5 mg three times per day, followed by three weeks of tapering doses. All of the participants were assessed for panic disorder and anxiety level before the study and weekly during the treatment phase. Efficacy and safety issues were also monitored during these visits.

Participants who received the combination of SSRI and benzodiazepine had a better response at the end of weeks 1 and 3 of treatment than those who received placebo. The patients taking combination therapy scored better on the anxiety and panic disorder scales used during the study. By week 4, both groups had similar scores on these scales. Adverse reactions were the same in both groups, although participants taking SSRIs and benzodiazepines were more likely to develop diarrhea. There were no significant differences in dropout data in both groups.

The authors conclude that early coadministration of clonazepam and sertraline appears to be a safe and effective treatment for early stabilization of patients with moderate to severe panic disorder. Further studies are needed to better define the optimal timing of benzodiazepine use for treatment of this disorder.

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