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Dear Dr. {{$doctorName}} ,
Subject: A retrospective cross-sectional, observational survey study to analyze role
of clonazepam in management of panic disorder
Panic disorder is characterized by episodic, unexpected panic attacks that occur without a clear
trigger. Panic attacks are defined by the rapid onset of intense fear (typically peaking within about 10
minutes) with at least four of the physical and psychological symptoms in the DSM-5 diagnostic
criteria.1 The most common physical symptom accompanying panic attacks is palpitations. Although
unexpected panic attacks are required for the diagnosis, many patients with PD also have expected
panic attacks, occurring in response to a known trigger.2
Lifetime prevalence varies from 0.5 to 4%, with peak age of onset being 25 years. It is more common
in female, unemployed, divorced/separated/widowed, lower education, and low household income.3
An Indian epidemiological study reveals the prevalence of PD to be 0.52% and 1.6% of PD with
agoraphobia, while apparent treatment gap was 98%.4 A 5.6–19% of primary care patients may have
panic attacks,5 and about 85.8% may subjected to misdiagnosis.6 16 to 17.5% PD present in
emergency department present as chest pain,7 who may remain undiagnosed or subject to
investigation.
The symptoms of a panic attack
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Palpitations, pounding heart or accelerated heart rate.
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint
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Chills or heat sensations.
Paraesthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or "going crazy."
Fear of dying
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It is to be noted that about 56% of patients with PD remain untreated.8 For those who receive
treatment, 17–64% would not achieve remission and 50% of treatment responder would relapse
after discontinuation of medication.9
In general, the first-line drug of choice is Selective Serotonin Reuptake Inhibitors (SSRI), though if
patients opt for another antidepressant group (SNRI and tricyclic) they may be tried. In patients with
severe symptoms, short duration of regular benzodiazepine with gradual tapering to be done over
weeks along with antidepressants.10
ClonazepamThe precise mechanism by which clonazepam exerts its antiseizure and antipanic effects is unknown,
although it is believed to be related to its ability to enhance the activity of gamma aminobutyric acid
(GABA), the major inhibitory neurotransmitter in the central nervous system. Clonazepam is rapidly
and completely absorbed after oral administration
The effectiveness of Clonazepam in the treatment of panic disorder was demonstrated in two
double-blind, placebo-controlled studies of adult outpatients who had a primary diagnosis of panic
disorder with or without agoraphobia. In these studies, Clonazepam was shown to be significantly
more effective than placebo in treating panic disorder on change from baseline in panic attack
frequency, the Clinician’s Global Impression Severity of Illness Score and the Clinician’s Global
Impression Improvement Score. The effectiveness of clonazepam in long-term use, that is, for more
than 9 weeks, has not been systematically studied in controlled clinical trials.
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