Other Anxiety and Panic Disorder Studies
Compared to alprazolam, buspirone was as effective but safer in a 4 week trial[2]. Cognitive Behavior Therapy was found to be more effective than alprazolam in another study[3]. Another way to look at efficacy of an agent is to compare a symptom like anxiety while on the medication to the level of anxiety after withdrawal. No study was identified in which the observation period was long enough after alprazolam withdrawal to clearly separate withdrawal effects from anxiety per se. Ashton published a study in 1987[4], however, that evaluated outcomes up to 3.5 years after withdrawal from various benzodiazepines in 50 consecutive patients who desired withdrawal because of problems they attributed to the benzodiazepines. Ten of those patients (20%) had developed agoraphobia while still on benzodiazepines, and a “large majority of patients” had improvement in anxiety over time after withdrawal.
This is the central dilemma of both benzodiazepines and Z-drugs: they work well short-term, and it is assumed that continued use long-term is beneficial. When used beyond short-term, they often cause physiological dependence and an increase in adverse reactions that may be misinterpreted as being related to something else. And withdrawal from benzodiazepines can be extremely difficult.
Many of the other uses of benzodiazepines are either ineffective or problematic. Find out more.
Medical decision-making does not only reference a medication’s efficacy but needs also to consider its potential problems as well as considering the risks and benefits compared to those of alternative approaches for the medical conditions involved. Please refer to the “Problems” and “Alternatives” pages for details, but putting it altogether here the following key points can be made:
- Although alternative approaches may take longer to reduce symptoms, they may be as good as benzodiazepines and are more likely to be safer.
- Benzodiazepines often become ineffective over time.
- Benzodiazepines are ineffective for some common off-label applications.
- Benzodiazepines and non-benzodiazepines can induce new psychiatric, neurologic, and physical symptoms which may have an onset which is significantly delayed from the initiation of the medications.
- Both classes of drugs can lead to physiological dependence.
- Both classes of drugs can have additional or increased side effects when taken with other drugs.
[2] Cohn JB, Wilcox CS. Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study. J Clin Psychiatry. 1986;47(8):409-12. Abstract
[3] Klosko JS, Barlow DH, Tassinari R, Cerny JA. A comparison of alprazolam and behavior therapy in treatment of panic disorder. J Psychother Pract Res. 1994;3(2):163-79
[4] Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addict. 1987;82:655-71. Article
