Panic disorder: the place of benzodiazepines and selective serotonin reuptake inhibitors

This article reviews the efficacy of the benzodiazepines and the selective serotonin reuptake inhibitor class of antidepressant in the treatment of pa nic disorder. The benzodiazepine alprazolam has been used successfully in t he treatment of panic disorder, but its long-term use presents problems wit h dependence. Since panic may be mediated by a dysfunction of serotonin neu ronal pathways, there is a rationale for treatment with antidepressants tha t modulate serotonergic systems. In clinical trials, members of the SSRI cl ass of antidepressant reduced panic attack frequency to zero in 36-86% of p atients and were well tolerated over long-term administration, all importan t factors in ensuring patient compliance. In addition, antidepressants are preferable to benzodiazepines in the treatment of panic and comorbid depres sion, of which there is a high prevalence among panic disorder patients. Th is review emphasises the need for long-term treatment of this chronic and d isabling condition with a therapy that is well tolerated and provides compl ete and sustained recovery from panic attacks, and resolution of anticipato ry anxiety. (C) 2001 Elsevier Science B.V. All rights reserved.