Decreased plasma cortisol level during alprazolam treatment of panic disorder: a case report

1. Changes in the plasma cortisol level were reported in a male patient with panic disorder during the period of low-dose alprazolam treatment (mean 0.62 +/- 0.15 mg/day) compared with during the period of high-dose period (mean 1.08 +/- 0.28 mg/day). 2. The plasma cortisol level was significantly higher in the low-dose period (mean 13.90 +/- 3.35 micrograms/ml) than in the high-dose period (mean 9.06 +/- 2.75 micrograms/ml) although, paradoxically, the panic attack frequency was significantly lower in the low-dose period (mean 1.35 +/- 0.29/day) than in the high-dose period (mean 2.09 +/- 0.66/day). 3. Thus, the decreased plasma cortisol level during alprazolam treatment of panic disorder was suggested to be caused not by symptom alleviation due to alprazolam but by alprazolam administration itself.