Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder.
OBJECTIVE
The primary disadvantage of high-potency benzodiazepine treatment for panic disorder is the difficulty of discontinuing the treatment. During treatment discontinuation, new symptoms may emerge and anxiety may return, preventing many patients from successfully discontinuing their treatment. In this controlled, randomized trial the authors investigated the efficacy of a cognitive-behavioral program for patients with panic disorder who were attempting to discontinue treatment with high-potency benzodiazepines.


METHODS
Outpatients treated for panic disorder with alprazolam or clonazepam for a minimum of 6 months and expressing a desire to stop taking the medication (N = 33) were randomly assigned to one of two taper conditions: a slow taper condition alone or a slow taper condition in conjunction with 10 weeks of group cognitive-behavioral therapy.


RESULTS
The rate of successful discontinuation of benzodiazepine treatment was significantly higher for the patients receiving the cognitive-behavioral program (13 of 17; 76%) than for the patients receiving the slow taper program alone (four of 16; 25%). There was no difference in the likelihood of discontinuation success between the patients treated with alprazolam and those who received clonazepam. At the 3-month follow-up evaluation, 77% of the patients in the cognitive-behavioral program who successfully discontinued benzodiazepine treatment remained benzodiazepine free.


CONCLUSIONS
These findings support the efficacy of cognitive-behavioral interventions in aiding benzodiazepine discontinuation for patients with panic disorder.
Behavior Therapy Unit, Massachusetts General Hospital, Boston 02144.
M W
MW
Otto
M H
MH
Pollack
G S
GS
Sachs
S R
SR
Reiter
S
S
Meltzer-Brody
J F
JF
Rosenbaum
D000328:Adult; D000525:Alprazolam / Q000009:adverse effects; D000553:Ambulatory Care; D001569:Benzodiazepines / Q000009:adverse effects*; D002998:Clonazepam / Q000009:adverse effects; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000628:therapy*; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D001569:Benzodiazepines; D002998:Clonazepam; D000525:Alprazolam