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Safety and Side-effects of Alprazolam Controlled Study in Agoraphobia with Panic Disorder

Published online by Cambridge University Press:  02 January 2018

G. H. O'Sullivan ,
H. Noshirvani ,
M. Basoglu ,
I. M. Marks ,
R. Swinson ,
K. Kuch  and
M. Kirby
G. H. O'Sullivan*
Affiliation:
Institute of Psychiatry, London
H. Noshirvani
Affiliation:
Institute of Psychiatry, London
M. Basoglu
Affiliation:
Institute of Psychiatry, London
I. M. Marks
Affiliation:
Institute of Psychiatry, London
R. Swinson
Affiliation:
Toronto General Hospital and University of Toronto, Canada
K. Kuch
Affiliation:
Toronto General Hospital and University of Toronto, Canada
M. Kirby
Affiliation:
Toronto General Hospital and University of Toronto, Canada
*
Dr G. H. O'Sullivan, MOST, 5 Camberwell Church Street, London SE5 8QU
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Extract

Background

The widespread use of benzodiazepines has led to increasing recognition of their unwanted effects. The efficacy of alprazolam and placebo in panic disorder with agoraphobia, and the side-effect and adverse effect profiles of both drug groups were measured.

Method

In London and Toronto 154 patients who met DSM–III criteria for panic disorder with agoraphobia were randomised to alprazolam or placebo. Subjects in each drug group also received either exposure or relaxation. Treatment was from weeks 0 to 8 and was then tapered from weeks 8 to 16.

Results

Mean alprazolam dose was 5 mg daily. Compared with placebo subjects, alprazolam patients developed more adverse reactions (21 % v. 0%) of depression, enuresis, disinhibition and aggression; and more side-effects, particularly sedation, irritability, impaired memory, weight loss and ataxia. Side-effects tended to diminish during treatment but remained significant at week 8. Despite this, the drop-out rate was low.

Conclusions

Alprazolam caused side-effects and adverse effects during treatment but many patients were willing to accept these.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 165 , Issue 1 , July 1994 , pp. 79 - 86
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Aranko, K., Mattila, M. J. & Bordignon, D. (1985) Psychomotor effects of alprazolam and diazepam during acute and subacute treatment and during followup phase. Acta Pharmacologica Toxicologica, 56, 346–372.CrossRefGoogle Scholar
Ashton, H. (1984) Benzodiazepine withdrawal: an unfinished story. British Medical Journal, 288, 1135–1140.CrossRefGoogle ScholarPubMed
Ballenger, J. C., Burrows, G. D., Dupont, R. L., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicentre trial. 1 Efficacy in the short term. Archives of General Psychiatry, 45, 413–422.CrossRefGoogle Scholar
Balter, M. D., Manheimer, D. I., Mellinger, G. D., et al (1984) A cross-national comparison of anti-anxiety/sedative drug use. Current Medical Research and Opinion, 8 (suppl. 4), 5–20.Google ScholarPubMed
Baso$gblu, M., Marks, I., Kil$ic, C., et al (1994) Alprazolam and exposure for panic disorder with agoraphobia. Attribution of improvement to medication predicts subsequent relapse. British Journal of Psychiatry, 164, 652–659.Google Scholar
Bellantuono, C., Reggi, V., Tognoni, G., et al (1980) Benzodiazepines: clinical pharmacology and therapeutic use. Drugs, 19, 195–219.CrossRefGoogle ScholarPubMed
Bixler, E. O., Kales, A., Manfredi, R. L., et al (1991) Next-day memory impairment with triazolam use. Lancet, 337, 827–831.CrossRefGoogle ScholarPubMed
Block, R. I. & Berchou, R. (1984) Alprazolam and lorazepam effects on memory acquisition and retrieval processes. Pharmacology, Biochemistry and Behavior, 20, 233–241.CrossRefGoogle ScholarPubMed
Charney, D. S. & Heninger, G. R. (1985) Noradrenergic function and the mechanism of action of antianxiety treatment. Archives of General Psychiatry, 42, 473–481.CrossRefGoogle ScholarPubMed
Chouinard, G., Annable, L., Fontaine, R., et al (1982) Alprazolam in the treatment of generalized anxiety and panic disorders. Psychopharmacology, 77, 229–233.CrossRefGoogle ScholarPubMed
Cohen, S. I. (1992) Phobic disorders and benzodiazepines in the elderly. Letter to British Journal of Psychiatry, 160, 135.CrossRefGoogle ScholarPubMed
Dunner, D. L., Ishiki, D., A very, D. H., et al (1986) Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: A controlled study. Journal of Clinical Psychiatry, 47, 458–460.Google ScholarPubMed
Edwards, J. D. (1981) Adverse effects of antianxiety drugs. Drugs, 22, 495–514.CrossRefGoogle ScholarPubMed
Feighneer, J. P. (1987) Impact of anxiety therapy on patients' quality of life. American Journal of Medicine, 82 (suppl. 5A), 14–19.CrossRefGoogle Scholar
File, S. E. (1981) Rapid development of tolerance to the sedative effects of lorazepam and triazolam in rats. Psychopharmacology, 73, 240–245.CrossRefGoogle Scholar
Gaind, R. N. & Jacoby, R. (1978) Benzodiazepines causing aggression. In Current Themes in Psychiatry (eds Gaind, R. N. & Hudson, B. L.), pp. 371–379. London: Macmillan.CrossRefGoogle Scholar
Greenberg, H. R. (1971) Inhibition of ejaculation by chlorpromazine. Journal of Nervous and Mental Disease, 152, 364–366.CrossRefGoogle ScholarPubMed
Hamilton, M. (1959) The assessment of anxiety state by ratings. British Journal of Medical Psychology, 32, 50–55.CrossRefGoogle Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hughes, J. M. (1964) Failure to ejaculate with chlordiazepoxide. American Journal of Psychiatry, 121, 610–611.CrossRefGoogle ScholarPubMed
Kotin, J., Wilbert, D. E., Berburg, D., et al (1976) Thioridazine and sexual dysfunction. American Journal of Psychiatry, 133, 82–85.Google ScholarPubMed
Lader, M. (1983) Benzodiazepines, psychological functioning and dementia. In Benzodiazepines Divided (ed. Trimble, M. R.), pp. 309–325. Chichester: Wiley.Google Scholar
Lader, M. (1985) Achieving treatment goals: limitations of therapies. Internal Medicine for the Specialist (special issue), 29.Google Scholar
Lader, M., Curry, S. & Baker, W. (1980) Physiological and psychological effects of chlorazepate in man. British Journal of Clinical Pharmacology, 9, 83–89.CrossRefGoogle ScholarPubMed
Levine, J. & Schooler, N. R. (1986) SAFTEE: a technique for the systematic assessment of side effects in clinical trials. Psychopharmacology Bulletin, 22, 343–381.Google ScholarPubMed
Lydiard, R. B., Howell, E. F. & Laraia, M. T. (1987) Sexual side effects of alprazolam. American Journal of Psychiatry, 144, 254–255.Google ScholarPubMed
Marks, I. M., Swinson, R. P., Basoglu, M., et al (1993) Alprazolam and exposure alone and combined in panic disorder with agoraphobia: A controlled study in London and Toronto. British Journal of Psychiatry, 162, 776–787.CrossRefGoogle ScholarPubMed
Munjack, D. J. & Crocker, B. (1986) Alprazolam induced ejaculatory inhibition. Journal of Clinical Psychopharmacology, 6, 57–58.CrossRefGoogle ScholarPubMed
Monteiro, W. O., Noshirvani, H. F., Marks, I. M., et al (1987) Anorgasmia with clomipramine in obsessive compulsive disorder. A controlled trial. British Journal of Psychiatry, 151, 189–195.CrossRefGoogle ScholarPubMed
Noyes, R., Du Pont, R. L., Pecknold, J. C., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicentre trial. II Patient acceptance, side effects and safety. Archives of General Psychiatry, 45, 423–428.CrossRefGoogle ScholarPubMed
O'Donnell, V. M., Balkin, T. J. & Andrade, J. R. (1988) Effects of triazolam on performance and sleep in a model of transient insomnia. Human Performance (suppl. 3), 145–160.CrossRefGoogle Scholar
Oswald, I. (1989) Triazolam syndrome 10 years on. [Letter]. Lancet, 334, 451–452.CrossRefGoogle Scholar
Remick, R. A., Fleming, J. A. E., Buchanan, R. A., et al (1985) A comparison of the safety and efficacy of alprazolam and desipramine in moderately severe depression. Canadian Journal of Psychiatry, 30, 597–601.CrossRefGoogle ScholarPubMed
Rizley, R., Kahn, R. J., McNair, D. M. (1986) Comparison of alprazolam and imipramine in the treatment of agoraphobia and panic disorder. Psychopharmacology Bulletin, 22, 167–172.Google ScholarPubMed
Rosenbaum, J. F., Woods, S. W., Groves, J. E., et al (1984) Emergence of hostility during alprazolam treatment. American Journal of Psychiatry, 141, 792–793.Google ScholarPubMed
Sangal, R. (1985) Inhibited female orgasm as a side effect of alprazolam. American Journal of Psychiatry, 142, 1223–1224.Google ScholarPubMed
Schuckit, M. A. (1984) Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment, 2nd edn. New York: Plenum.CrossRefGoogle Scholar
Shader, R. I. & Greenblatt, D. J. (1983) Triazolam and anterograde amnesia: all is not well in the z-zone. Journal of Clinical Psychopharmacology, 3, 273.CrossRefGoogle Scholar
Smiley, A. (1987) Effects of minor tranquillizers and antidepressants on psychomotor performance. Journal of Clinical Psychiatry, 48 (suppl. 12), 22–28.Google ScholarPubMed
Spitzer, R. L. & Williams, J. B. W. (1983) Structured Clinical Interview for DSM–III, Upjohn Version (SCID-UP). New York: Biometric Research Division, New York State Psychiatric Institute.Google Scholar
Uhde, T. W., Tancer, M. E. & Shea, C. A. (1988) Sexual dysfunction related to alprazolam treatment of social phobia. American Journal of Psychiatry, 145, 531–532.Google ScholarPubMed
Wolkowitz, O. M., Weingartner, H., Thompson, K., et al (1987) Diazepam-induced amnesia. American Journal of Psychiatry, 144, 25–29.Google ScholarPubMed
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