Klein E, Colin V, Stolk J, Lenox R H
Department of Psychiatry, Rambam Medical Center, Haifa, Israel.
Am J Psychiatry. 1994 Dec;151(12):1760-6. doi: 10.1176/ajp.151.12.1760.
This study was designed to examine the possibility that patients with panic disorder are especially vulnerable to alprazolam withdrawal, as well as to evaluate the efficacy of carbamazepine as adjunctive treatment during alprazolam discontinuation.
After a 2-month open trial of alprazolam, 36 patients with panic disorder and 35 with generalized anxiety disorder entered a controlled discontinuation phase. Carbamazepine or placebo was added in a randomized, double-blind fashion, followed after 1 week by single-blind dose reduction of alprazolam, approximately 25% every third day.
Fifty-two percent of the patients were able to discontinue alprazolam, but only 37% completed the study, maintaining alprazolam-free status for 4 weeks. Survival analysis revealed that among the patients receiving placebo as adjunctive therapy, panic disorder patients had a significantly greater dropout rate than patients with generalized anxiety disorder. While carbamazepine exerted no beneficial effect for patients with generalized anxiety disorder, it appeared to improve outcome in the panic disorder group.
Results of this study indicate that panic disorder patients are more vulnerable to alprazolam withdrawal than patients with generalized anxiety disorder, and this may reflect a general diathesis of panic disorder patients to encounter more difficulty during drug withdrawal. Carbamazepine may selectively assist with alprazolam withdrawal in panic disorder patients. However, these data do not support its widespread use during benzodiazepine discontinuation, especially given its potential toxicity. In light of a proposed greater vulnerability of panic disorder patients to withdrawal, future studies need to account for differential effects related to specific diagnosis.
本研究旨在探讨惊恐障碍患者是否特别容易出现阿普唑仑戒断反应，并评估卡马西平在阿普唑仑停药期间作为辅助治疗的疗效。
在进行为期2个月的阿普唑仑开放试验后，36名惊恐障碍患者和35名广泛性焦虑障碍患者进入对照停药阶段。以随机、双盲方式添加卡马西平或安慰剂，1周后以单盲方式减少阿普唑仑剂量，大约每三天减少25%。
52%的患者能够停用阿普唑仑，但只有37%的患者完成了研究，保持无阿普唑仑状态4周。生存分析显示，在接受安慰剂作为辅助治疗的患者中，惊恐障碍患者的退出率显著高于广泛性焦虑障碍患者。虽然卡马西平对广泛性焦虑障碍患者没有有益效果，但它似乎改善了惊恐障碍组的结果。
本研究结果表明，惊恐障碍患者比广泛性焦虑障碍患者更容易出现阿普唑仑戒断反应，这可能反映了惊恐障碍患者在药物戒断期间普遍更容易遇到困难的素质。卡马西平可能选择性地帮助惊恐障碍患者停用阿普唑仑。然而，这些数据不支持在苯二氮䓬类药物停药期间广泛使用它，特别是考虑到其潜在毒性。鉴于惊恐障碍患者可能更容易出现戒断反应，未来的研究需要考虑与特定诊断相关的差异效应。
