A Cochrane review included 3 RCTs with a total of 293 participants with panic disorder. A 16-week behaviour therapy was used in two trials, and a 12-week cognitive-behaviour therapy intervention in the third. Alprazolam was used in two trials and diazepam in one trial. Duration of follow-up varied, ranging from 0 to 12 months. Two trials (n=166) provided data comparing combination with psychotherapy alone (both using behaviour therapy). No statistically significant differences were observed in response during the intervention (RR 1.25, 95%CI 0.78 to 2.03), at the end of the intervention (RR 0.78, 95%CI 0.45 to 1.35), or at the last follow-up time point, although the follow-up data suggested that the combination might be inferior to behaviour therapy alone (RR 0.62, 0.36 to 1.07). One trial (n=77) compared combination with a benzodiazepine alone. No differences were found in response during the intervention (RR 1.57, 95%CI 0.83 to 2.98). Although the combination appeared to be superior to the benzodiazepine alone at the end of treatment (RR 3.39, 95%CI 1.03 to 11.21) the finding was only borderline statistically significant, and no significant differences were observed at the 7-month follow-up (RR 2.31, 95%CI 0.79 to 6.74).
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and indirectness (differences in studied patients, trials recruited in-patients or patients at psychiatric clinics).
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