The high-potency
benzodiazepines have been effective in short-term treatment of
panic disorder, but systematic investigation of their long-term efficacy and safety is necessary. In a 1-year follow-up study of patients continuing treatment with
clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of
alprazolam therapy, little evidence of tolerance emerged and initial therapeutic gains were maintained, even among patients who decreased or discontinued medication. As with
antidepressants, many patients remain on high-potency
benzodiazepine medication after short-term treatment; the choice of maintenance agent should reflect side effects of treatment as well as the ease of discontinuation. The high-potency
benzodiazepines are a reasonable alternative to
antidepressants, which involve problems of morbidity, noncompliance, and risk for overdose. Discontinuation may be less difficult with the longer-acting high-potency
benzodiazepines, which thus may be advantageous for long-term treatment. It is necessary to determine the contributions of all aspects of treatment, both behavioral and pharmacologic, to the longitudinal course of patients with
panic disorders.