Early coadministration of clonazepam with sertraline for panic disorder

Background: There is debate about combining benzodiazepines with selective serotonin reuptake inhibitors in the acute treatment of panic disorder, Alt hough this medication combination is widely used in clinical practice, ther e is no well-tested, optimal method of coadministering these medications fo r the treatment of panic disorder. The purpose of this study was to test th e efficacy of early coadministration of clonazepam with sertraline in the t reatment of panic disorder. Methods: Fifty patients with panic disorder were randomized into a double-b lind clinical trial. Patients received open-label sertraline for 12 weeks ( target dose, 100 mg/d), and in addition were randomized to groups receiving either 0.5 mg of active clonazepam 3 times daily or placebo clonazepam for the first 4 weeks of the trial. The clonazepam dose was then tapered durin g 3 weeks and discontinued. Results: Thirty-four (68%) of 50 patients completed the trial. Drop-out rat es were similar in the sertraline/placebo vs the sertraline/clonazepam grou p (38% vs 25%) (P=.5). An intent-to-treat analysis (on last observation car ried forward data) revealed a much greater proportion of responders in the sertraline/clonazepam compared with the sertraline/placebo group at the end of week 1 of the trial (41% vs 4%) (P=.003). There was also a significant between-group difference at the end of week 3 with 14 (63%) of 22 of the se rtraline/clonazepam group responding to treatment vs 8 (32%) of 25 of the s ertraline/placebo group (P=.05), This difference was not observed at other times during the trial. Conclusion: These data indicate that rapid stabilization of panic symptoms can be safely achieved with a sertraline/clonazepam combination. supporting the clinical utility of this type of regimen for facilitating early improv ement of panic symptoms relative to sertraline alone.