Discontinuation of Alprazolam after successful treatment of panic disorder: a naturalistic follow-up study

Abstract

Low rates of benzodiazepine discontinuation have been seen in long-term outcome studies of alprazolam-treated panic disorder. Discontinuation studies reveal high rates of relapse when alprazolam is stopped. Available data may lack relevance to clinical practice, however, because drug taper rates are often more rapid than those used in many clinical settings. In order to obtain naturalistic data on the long-term course of alprazolam treatment of panic, we obtained follow-up data on 18 of 20 patients who had been enrolled one to two years earlier in a study of alprazolam effects on hypothalamic-pituitary-adrenal (HPA) axis functioning. The HPA protocol provided measures of symptom severity, biological markers, and short-term treatment response (12 weeks). Routine clinical care was then provided, with dosage adjustments dictated by individual clinical needs. The follow-up study repeated clinical measures at a mean of 21 months after initiation of treatment. Alprazolam was discontinued in 78% of patients. Relapse occured in 36% of these. At follow-up, 61% were medication-free. Only 28% were on a benzodiazepine. The four patients remaining on alprazolam were on reduced doses and had maintained clinical gains. HPA axis activity did not predict dose or outcome. Factors related to successful alprazolam discontinuation are discussed.