Real-world Longitudinal Patterns of Benzodiazepine Use in Korean Patients with First-onset Panic Disorder: A...

Although benzodiazepines (BZDs) are recommended only for short-term adjunctive use in panic disorder, long-term use remains common in clinical practice. This study investigated real-world patterns of BZD prescribing and identified clinical factors associated with BZD dose reduction or discontinuation among BZD-initiating patients with first-onset panic disorder.

This multicenter retrospective longitudinal study included adults with first-onset panic disorder who initiated BZD treatment at psychiatric outpatient clinics between 2011 and 2023. Changes in BZD prescriptions were assessed at baseline, 3 months, and 12 months. Mixed-effects models were used to evaluate longitudinal changes in BZD dose. Logistic regression analyses examined clinical and treatment-related factors associated with BZD dose reduction or discontinuation at 12 months.

Among 733 patients who initiated BZD treatment, 32.3% had reduced or discontinued BZDs at 3 months, and 45.0% had done so at 12 months, while only 16.0% achieved complete discontinuation. Mean BZD dose showed no significant change at 3 months but decreased modestly by 12 months. Initial BZD dose was not significantly associated with long-term discontinuation. Alprazolam use was associated with higher odds of dose reduction or discontinuation, whereas comorbid psychiatric disorders and concomitant buspirone use were associated with lower odds. Antidepressant use did not significantly predict BZD tapering outcomes.

Long-term BZD use frequently persisted among BZD-initiating patients with first-onset panic disorder despite guideline recommendations for short-term adjunctive use. A substantial proportion of patients continue BZDs beyond 12 months in real-world clinical practice, indicating a clear gap between treatment guidelines and actual prescribing patterns.