>Benzodiazepines are anti-anxiety drugs that calm fear but don’t prevent panic attacks, while tricyclic antidepressants like imipramine prevent panic attacks but don’t do anything about fear.3
As far as I’m aware, the claim that benzos don’t prevent panic attacks is incorrect!
We don’t like to prescribe them for that purpose, or for most cases of Generalized Anxiety Disorder, as they’re strongly habit forming and sedative, but they are very effective in that regard.
“The most extensively studied benzodiazepine for the treatment of panic has been the high potency triazolobenzodiazepine alprazolam. The Cross National Collaborative Panic Study (CNCPS) (44), a multicentre study conducted in two phases, is generally regarded as the most ambitious attempt to demonstrate the antipanic efficacy of alprazolam. Phase One of the CNCPS (45) randomly assigned 481 panic disorder patients (80% of whom had agoraphobia) to alprazolam or placebo, utilizing a double blind design and flexible dose schedule. All groups received their respective treatments for 8 weeks. Treatment was then discontinued over 4 weeks, and subjects were followed for 2 weeks after discontinuance. The mean dose of alprazolam employed was 5.7mg/day. Alprazolam was shown to have a rapid onset of effect, with most improvement occurring in the first week of treatment. Alprazolam was far superior to placebo on measures of panic attacks, anticipatory anxiety and phobic avoidance; at the 8 week endpoint, 55% of alprazolam treated patients were panic free, compared to 32% of those given placebo.
Phase two of the Cross National Collaborative Panic Study (46) attempted to not only replicate phase one’s results in a larger sample, but also to compare alprazolam’s efficacy to that of a typical antidepressant treatment for panic. 1168 panic patients were randomly assigned to alprazolam, imipramine, or placebo for 8 weeks. This follow up study confirmed the earlier findings demonstrating superior antipanic activity of alprazolam (mean= 5.7mg/day) and imipramine (mean=155mg/day) compared with placebo, with 70% of both imipramine and alprazolam groups experiencing amelioration of panic compared to 50% for placebo. Significant drug effects were demonstrated for anticipatory anxiety and phobia. As in the phase 1 study, most of alprazolam’s beneficial effects were witnessed in the first and second weeks; imipramine, however, took four weeks or more to exert antipanic action. The main criticism of the Cross-National Study, forwarded by Marks et al (47), was that the high level (approximately 30%) of placebo dropouts due to inefficient treatment may have confounded the analysis of the endpoint data.
In addition to the CNCPS, several trials have conclusively established alprazolam’s efficacy in the acute and long term treatment of panic (48-52,21). Almost all studies found alprazolam to be superior to placebo in treating phobic avoidance, reducing anticipatory anxiety, and lessening overall disability. Further, comparator studies of alprazolam and imipramine found the two medications comparable in efficacy for panic attacks, phobias, Hamilton anxiety, CGI and disability. These studies have additionally revealed alprazolam to be uniformly better tolerated than imipramine, with a quicker onset of therapeutic effect. ”
″ Clonazepam was found to be superior to placebo in 2 placebo-controlled studies.35,36 In a 9-week study,35 74% of patients treated with 1 mg/day of clonazepam (administered b.i.d. after up-titration during 3 days) and 56% of placebo-treated patients were completely free of panic attacks at the study endpoint.”
I’m not sure if it’s you or the author making the claim that they don’t prevent panic attacks, but I hope this is a small sample of the evidence base that shows them being strongly effective in that regard, which only increases our chagrin when prescribing them can lead to significant harm in the long run.
>Benzodiazepines are anti-anxiety drugs that calm fear but don’t prevent panic attacks, while tricyclic antidepressants like imipramine prevent panic attacks but don’t do anything about fear.3
As far as I’m aware, the claim that benzos don’t prevent panic attacks is incorrect!
We don’t like to prescribe them for that purpose, or for most cases of Generalized Anxiety Disorder, as they’re strongly habit forming and sedative, but they are very effective in that regard.
https://acnp.org/g4/GN401000130/CH.html
“The most extensively studied benzodiazepine for the treatment of panic has been the high potency triazolobenzodiazepine alprazolam. The Cross National Collaborative Panic Study (CNCPS) (44), a multicentre study conducted in two phases, is generally regarded as the most ambitious attempt to demonstrate the antipanic efficacy of alprazolam. Phase One of the CNCPS (45) randomly assigned 481 panic disorder patients (80% of whom had agoraphobia) to alprazolam or placebo, utilizing a double blind design and flexible dose schedule. All groups received their respective treatments for 8 weeks. Treatment was then discontinued over 4 weeks, and subjects were followed for 2 weeks after discontinuance. The mean dose of alprazolam employed was 5.7mg/day. Alprazolam was shown to have a rapid onset of effect, with most improvement occurring in the first week of treatment. Alprazolam was far superior to placebo on measures of panic attacks, anticipatory anxiety and phobic avoidance; at the 8 week endpoint, 55% of alprazolam treated patients were panic free, compared to 32% of those given placebo. Phase two of the Cross National Collaborative Panic Study (46) attempted to not only replicate phase one’s results in a larger sample, but also to compare alprazolam’s efficacy to that of a typical antidepressant treatment for panic. 1168 panic patients were randomly assigned to alprazolam, imipramine, or placebo for 8 weeks. This follow up study confirmed the earlier findings demonstrating superior antipanic activity of alprazolam (mean= 5.7mg/day) and imipramine (mean=155mg/day) compared with placebo, with 70% of both imipramine and alprazolam groups experiencing amelioration of panic compared to 50% for placebo. Significant drug effects were demonstrated for anticipatory anxiety and phobia. As in the phase 1 study, most of alprazolam’s beneficial effects were witnessed in the first and second weeks; imipramine, however, took four weeks or more to exert antipanic action. The main criticism of the Cross-National Study, forwarded by Marks et al (47), was that the high level (approximately 30%) of placebo dropouts due to inefficient treatment may have confounded the analysis of the endpoint data. In addition to the CNCPS, several trials have conclusively established alprazolam’s efficacy in the acute and long term treatment of panic (48-52,21). Almost all studies found alprazolam to be superior to placebo in treating phobic avoidance, reducing anticipatory anxiety, and lessening overall disability. Further, comparator studies of alprazolam and imipramine found the two medications comparable in efficacy for panic attacks, phobias, Hamilton anxiety, CGI and disability. These studies have additionally revealed alprazolam to be uniformly better tolerated than imipramine, with a quicker onset of therapeutic effect. ”
https://pmc.ncbi.nlm.nih.gov/articles/PMC1076453/#:~:text=Clonazepam%20was%20found%20to%20be,in%202%20placebo%2Dcontrolled%20studies.&text=In%20a%209%2Dweek%20study,attacks%20at%20the%20study%20endpoint.
″ Clonazepam was found to be superior to placebo in 2 placebo-controlled studies.35,36 In a 9-week study,35 74% of patients treated with 1 mg/day of clonazepam (administered b.i.d. after up-titration during 3 days) and 56% of placebo-treated patients were completely free of panic attacks at the study endpoint.”
I’m not sure if it’s you or the author making the claim that they don’t prevent panic attacks, but I hope this is a small sample of the evidence base that shows them being strongly effective in that regard, which only increases our chagrin when prescribing them can lead to significant harm in the long run.
This was the author’s claim—thanks for the counter-evidence!