Clonazepam for the Treatment of Panic Disorder

Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015; 84 (2): 63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be shortlived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.

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“…Clonazepam [73][74][75][76] has a long elimination half-life, induced less frequently rebound anxiety than alprazolam [77].…”

Section: Rebound Symptoms After Benzodiazepine Discontinuationmentioning

confidence: 99%

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Cosci

Chouinard

2020

Psychother Psychosom

165

184

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“…Moreover, clonazepam’s absence of drug interactions with antidepressants could also be an important factor because all of our subjects were using a concomitant antidepressant. 27 , 28) Somnolence was more frequently observed in the alprazolam group than in the clonazepam and lorazepam groups. The higher dose prescribed for the alprazolam group than for the other two groups could have been a contributing factor to the increase in somnolence because higher BZD doses are associated with increased risk of this side effect.…”

Section: Discussionmentioning

confidence: 93%

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Wang

Kim

Sakong

et al. 2016

Clin Psychopharmacol Neurosci

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ObjectiveThis study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders.MethodsInclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep).ResultsAmong 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively.ConclusionThe present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

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“…Although CO 2 can induce a PA in most patients with PD, pretreatment with a single dose of a benzodiazepine (such as alprazolam or clonazepam) has been shown to block this effect. 71 , 72 Additionally, treatment with SSRIs and tricyclic antidepressants also reduced the sensitivity to CO 2 in PD patients. 32 RS patients treated with either benzodiazepines or tricyclic antidepressants improved faster than NRS ones.…”

Section: Response To Treatmentmentioning

confidence: 97%

Panic disorder respiratory subtype: psychopathology and challenge tests – an update

Okuro

Freire

Zin

et al. 2020

Braz. J. Psychiatry

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Panic disorder (PD) pathophysiology is very heterogeneous, and the discrimination of distinct subtypes could be very useful. A subtype based on respiratory symptoms is known to constitute a specific subgroup. However, evidence to support the respiratory subtype (RS) as a distinct subgroup of PD with a well-defined phenotype remains controversial. Studies have focused on characterization of the RS based on symptoms and response to CO 2 . In this line, we described clinical and biological aspects focused on symptomatology and CO 2 challenge tests in PD RS. The main symptoms that characterize RS are dyspnea (shortness of breath) and a choking sensation. Moreover, patients with the RS tended to be more responsive to CO 2 challenge tests, which triggered more panic attacks in this subgroup. Future studies should focus on discriminating respiratory-related clusters and exploring psychophysiological and neuroimaging outcomes in order to provide robust evidence to confirm RS as a distinct subtype of PD.How to cite this article: Okuro RT, Freire RC, Zin WA, Quagliato LA, Nardi AE. Panic disorder respiratory subtype: psychopathology and challenge tests -an update. Braz J Psychiatry. 2020;00:000-000. http://dx.

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Clonazepam for the Treatment of Panic Disorder

Cited by 12 publications

References 71 publications

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study

Panic disorder respiratory subtype: psychopathology and challenge tests – an update

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