Continuation treatment of panic disorder with high-potency benzodiazepines

High-potency benzodiazepines such as clonazepam and alprazolam are effective and safe in the short-term treatment of panic disorder, but less is known about their effectiveness and safety over the long term. Further understanding of these issues is important since panic disorder is usually chronic and may call for long-term treatment. Available naturalistic data suggest that tolerance to the antipanic or antiphobic effects of clonazepam and alprazolam does not occur in panic disorder/agoraphobia; doses also tend to decrease over time. Withdrawal symptoms occur after short-term treatment with alprazolam, but less is known about clonazepam in this respect. Other issues discussed include management of withdrawal, clinical use of benzodiazepines, importance of comorbidity, and the use of benzodiazepines in association with behavior therapy.