DISCONTINUATION OF CLONAZEPAM IN THE TREATMENT OF SOCIAL PHOBIA

Patients with social phobia who responded well to 6 months of open-lab el treatment with clonazepam were assigned to receive either continuat ion treatment (CT) with clonazepam for another 5 months, or to undergo discontinuation treatment (DT) using a clonazepam taper at the rate o f 0.25 mg every 2 weeks, with double-blind placebo substitution. Clini cal efficacy was compared between the CT and DT groups using three dif ferent social phobia scales. Benzodiazepine withdrawal symptoms were a lso measured. Relapse rates were 6 and 21.1% in the CT and DT groups, respectively. Subjects in the CT group generally showed a more favorab le clinical response at midpoint and/or endpoint, although even in the DT group clinical response remained good. With respect to withdrawal symptoms, the rates were low in both groups (12.5% for CT and 27.7% fo r DT) with no real evidence suggesting significant withdrawal difficul ties. At the end of 11 months of treatment with clonazepam, however, a more rapid withdrawal rate was associated with greater distress. This study offers preliminary evidence to suggest that continuation therap y with clonazepam in the treatment of social phobia is safe and effect ive, producing a somewhat greater clinical benefit than a slow-taper d iscontinuation regime. However, even in the DT group, withdrawal sympt oms were not found to be a major problem. The study can be taken as su pportive of benefit for long-term clonazepam treatment in social phobi a, as well as being compatible with a reasonably good outcome after sh ort-term treatment and slow taper.