In a double-blind controlled study lasting 8 weeks, 50 anxious psychoneurotic outpatients with a primary diagnosis of generalized anxiety or panic disorder were randomly assigned to alprazolam (n=30), a new benzodiazepine, or placebo (n=20), after a washout period of 1 week. Alprazolam at dosages between 0.25 and 3 mg/day was found to be significantly better than placebo in the treatment of either disorder. The finding that alprazolam was effective in the treatment of panic disorder is of interest as this diagnostic category is usually treated with tricyclic antidepressants or MAO inhibitors.
"Alprazolam's superior short-term efficacy over placebo was demonstrated in numerous controlled clinical trials performed between 1980 and the early 1990s (Chouinard et al., 1982; Evans, 1981). Meta-analyses (Boyer, 1995; Cox et al., 1992) of the known controlled trials of alprazolam demonstrated clear advantage in reduction of panic symptoms .The first and second Cross-National Collaborative Panic Studies (CNCPS) (Ballenger et al., 1988; Cross- National Collaborative Panic Study SPI, 1992; Noyes et al., 1988) remain the largest randomised placebo-controlled trials of alprazolam use in PD. "
[Show abstract][Hide abstract] ABSTRACT: To investigate the potential impact of increasing prescription rates of alprazolam for the treatment of panic disorder (PD) in Australia through a review of efficacy, tolerability and adverse outcome literature.
Data were sourced by a literature search using MEDLINE, Embase, PsycINFO and a manual search of scientific journals to identify relevant articles. Clinical practice guidelines from the American Psychiatric Association, National Institute of Clinical Excellence, Royal Australian and New Zealand College of Psychiatrists and World Federation of Societies of Biological Psychiatry were sourced. Prescription data were sourced from Australian governmental sources.
Alprazolam has shown efficacy for control of PD symptoms, particularly in short-term controlled clinical trials, but is no longer recommended as a first-line pharmacological treatment due to concerns about the risks of developing tolerance, dependence and abuse potential. Almost no evidence is available comparing alprazolam to current first-line pharmacological treatment. Despite this, prescription rates are increasing. A number of potential issues including use in overdose and impact on car accidents are noted. conclusion: Although effective for PD symptoms in clinical trials, a number of potential issues may exist with use. Consideration of its future place in PD treatment in Australia may be warranted.
Australian and New Zealand Journal of Psychiatry 03/2012; 46(3):212-24. DOI:10.1177/0004867411432074 · 3.41 Impact Factor
"However, since the decreases in drug intake may have resulted from nonspecific effects on the ability of the rats to respond following pretreatment with higher doses of chlordiazepoxide, the next study was initiated. Alprazolam was investigated since this benzo-diazepine receptor agonist has been proven to be clinically effective in the treatment of anxiety and panic attacks (Chouinard et al. 1982) and has been proposed to be useful in the treatment of some types of depression (Dawson et al. 1984; Feighner et al. 1983; Rickels et al. 1985). "
[Show abstract][Hide abstract] ABSTRACT: In nonlaboratory settings, social users of cocaine are sometimes able to control their drug intake so their patterns of use do not escalate to levels that would increase their risk of dependency and toxicity (Siegel 1984). This suggests that there may be factors in addition to the primary reinforcing properties of cocaine that determine why some individuals can remain casual recreational users while others progress to compulsive drug use. Individual reactivity to anxiety or stress, either mitigated or induced by cocaine, may represent one such factor that could influence the awareness or perception of the reinforcing efficacy of the drug. Clinical evidence supports the concept that anxiety may be involved in the etiology of cocaine use and/or withdrawal. For example, initial cocaine use produces profound
[Show abstract][Hide abstract] ABSTRACT: 23 patients with a diagnosis of panic disorder with agoraphobia were randomly assigned to 8 weeks' treatment with alprazolam or placebo. They filled in self-ratings before and after treatment and competed on a competitive reaction time task, designed to measure behavioural aggression, after 8 weeks' treatment. Patients taking both alprazolam and placebo rated decreased anxiety after 8 weeks' treatment but those on alprazolam also tended to report less hostility. On the behavioural task, patients on alprazolam behaved more aggressively in response to provocation. This is the first study to confirm clinical reports of benzodiazepine-induced dyscontrol on an objective laboratory measure. It is important that it is followed up in a larger group of patients.
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