Specific effects of benzodiazepines and tricyclic antidepressants in panicdisorder: Comparisons of clomipramine with alprazolam SR and adinazolam SR

In order to compare the efficacy and safety of tricyclic antidepressants an d benzodiazepines in panic disorder, with or without agoraphobia, two studi es were carried out comparing clomipramine with alprazolam sustained releas e (SR) or with adinazolam SR. Two hundred and fifty-seven patients received alprazolam SR (2-6 mg/day given in two divided daily doses) or clomipramin e (50-150 mg/day given in two divided daily doses) for 12 weeks in a single -blind, randomised, multicentre study and 347 patients received adinazolam SR (30-90 mg/day given in two divided daily doses) or clomipramine (50-150 mg/day given in two divided daily doses) for 24 weeks in a double-blind, ra ndomised, multicentre study. Both benzodiazepines showed an earlier onset o f therapeutic efficacy than clomipramine. At the end of the treatment perio ds, however, clomipramine was equally as effective as alprazolam SR and mor e effective than adinazolam SR. Withdrawal problems were also somewhat less common with clomipramine than with alprazolam SR and adinazolam SR. Both b enzodiazepines were clearly better tolerated than clomipramine. The rate of premature withdrawal was also notably higher with clomipramine than with a lprazolam SR. In conclusion, the benzodiazepines alprazolam and adinazolam SR are better tolerated than the tricyclic antidepressant clomipramine in t he treatment of panic disorder, but have no advantages in terms of efficacy . Copyright (C) 1999 John Wiley & Sons, Ltd.