Xanax and Cognitive Behavior Therapy in Treatment of Panic Disorder

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Abstract: Panic is an often incapacitating and chronic disorder. Cognitive behaviour therapy (CBT) and Xanax have been shown to be effective in the treatment of panic disorder. Patients who met the DSM-III-R criteria for panic disorder, were randomized and given 16 weeks of double-blind treatment with CBT (n=16), or Xanax of up to 6 mg/day (n=18). The 17-item HAM-D and HAM-A scales were administered to all the subjects before and after treatment, which took place over 16 weeks, and the changes in the scores were analyzed. The patients’ anxiety levels and numbers of panic attacks were assessed at the beginning of treatment, and then at weeks 4,8,12 and 16 by means of self-monitoring. On the basis of HAM-D, HAM-A, anxiety level, and panic number, the CBT and Xanax groups showed a significant improvement at the end of treatment. When compared to each other, the groups showed no significant differences at the end of the treatment. In the last month, 10/16 (62.5%) of the CBT patients and 11/18 (61.1%) of the Xanax patients were panic-free. Key Words: Xanax, Cognitive behavior therapy, Panic disorder. Introduction Panic disorder is a common anxiety disorder associated with a great deal of distress as well as marked social and occupational disability (1,2). Such patients are over-represented with regard to the use of medical services, such as emergency room visits, the number of visits to physicians and the use of psychotropic medications (3,4,5,). In addition, their rate of attempted suicide has been reported to be either greater to that of the general population or equal to that of patients suffering from major depression (6,7,8). Clinical evidence suggests that cognitive-behaviour therapy (CBT) is an effective treatment for panic. For example, Gitlin et al. reported that 10 out of 11 patients receiving CBT were not panicking by the end of treatment (9). Beck, Ost, Craske have also reported nearly total elimination of panic in patients suffering from panic disorder using either cognitive behavioral or behaviorally- based relaxation treatments (10,11,12). In the 1980s, a new class of benzodiazepines, the triazolobenzodiazepines, became available. One member of that class, Xanax, has been reported to be effective in the treatment of panic disorder (13,14). To our knowledge, few reports have compared the efficiency of both treatment in patients with panic disorder. In view of the effectiveness of this CBT and of Xanax in panic disorder, the purpose of this study was to evaluate the effectiveness of each treatment.Buy Xanax Materials and Method Subjects: Patients were drawn from patients attending the psychiatry clinic. All had been given a diagnosis of panic disorder with mild or no agoraphobic avoidance, using DSM-III-R criteria. Only patients with at least four panic attacks within a four-week period, or those experiencing one or more attacks followed by a period of at least a month of persistent fear of another attack were included. The general exclusion criteria were as follows: age below 18 or above 65 years, current drug or alcohol abuse/dependency, principal diagnosis of major depression, and any signs of psychosis or organic brain syndrome. Finally, subjects were excluded if they had begun taking benzodiazepines or antidepressants within the previous six months. xanax and Cognitive Behavior Therapy in Treatment of Panic Disorder At the onset of treatment, the subjects comprised 40 patients with panic disorder. The patients were treated with either CBT or Xanax for two months, and then followed for two months without CBT and Xanax. Measures: Clinical assessment measures consisting of the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) were administered to all subjects before and after treatment, and the changes in the scores were analyzed. A self-monitoring measure was administered at the beginning of treatment and assessed at 4-week periods throughout treatment. Patients monitored their current levels of anxiety on a 0-to-8-point visual analogue scale, four times a day (morning, afternoon, evening and bedtime), stating whether or not they experienced panic (patients were instructed and trained to define and differentiate a panic attack from episodes of generalized anxiety). The data from the visual analogue scale served to measure the anxiety level and panic number Xanax treatment group: Patients received 1mg doses of Xanax (1 or 2 mg) up to four times daily. Medication was gradually increased until the maximum benefit was achieved or dose-limiting side effects occurred. Patients began taking one tablet per day (for two days) and then this was increased to two tablets (for three days), three tablets (for four days), four tablets (for four days), five tablets (for four days), and then six tablets per day on day 18. When side effects were reported, these increases in medication were slowed or the dose was reduced. Every effort was made to achieve a dosage of six tablets per day. Patients were given an explanation of their condition, including what could be expected of the medication. No other centrally active medications were administered during the trial. At the beginning of the 9th week of treatment, the psychiatrist began to taper the doses of Xanax at a rate no faster than one tablet every 3 days. The psychiatrist continued meeting patients until they had stopped taking medication completely. CBT group: The treatment consisted of a 2-month course of CBT. The patients received 8 individual sessions of CBT for panic disorder in weekly meetings. Buy Xanax Exposure plus cognitive restructuring were applied in the case of these patients. Treatment comprised a rationale and education concerning panic disorder, the components of anxiety and emphasized exposure to somatic cues. Cognitive approaches were also included. In cognitive therapy, we helped the patients to identify and modify their negative thoughts. In addition, the patients were encouraged to expose themselves to situations or activities which they were avoiding. They were also encouraged to modify behaviours which occur once symptoms have started and which maintain a patient’s belief that certain symptoms are highly dangerous. Results Out of 40 initial patients, 34 patients completed the study, and 6 patients dropped out. A higher rate of drop out was observed in the CBT group than in the other group. Two patients out of 20 (10%) dropped out of the Xanax group, while 4 out of 20 (20%) dropped out of the CBT group. A t-test analysis on these dorp-out frequencies showed no significant differences between the CBT and Xanax group (t=1.03,p=0.314). Patients who dropped out of the study were questioned about their reasons. Of the 4 patients who dropped out of the CBT group, 2 developed intense panic attacks in the 1 st week of the treatment, causing them to drop out of the study. Two were unavailable for interview after the second week of treatment. The 2 subjects who dropped out of the Xanax treatment group stated that they disliked the side effects of the medication in the 1 st week of treatment (1 reported over-sedation, and 1 reported suicidal ideation). In the CBT group, 9 men (56%) and 7 women (43%) completed the study. Buy Xanax The mean age was 30.81 years. In the Xanax group, 6 men (44%) and 12 women (56%) completed the study. The mean age was 31.44 years. The mean age difference between the groups was not significant (F=0.574, df=32, t=-0.234, p>0.05). In the CBT group (16 patients), the mean score on the Hamilton Depression Scale at week 0 was 12.06 (range, 2 to 45), with only 5 patients (31.2%) scoring values above 14. In the Xanax group (18 patients), the mean score on the Hamilton Depression Scale at week 0 was 10.83 (range, 2 to 40), with only 6 patients (33.3%) scoring in the range above 14. In the study intake, no statistical difference between the two groups in the average HAM-D and HAM-A scores were found using the Mann-Whitney test (z=-0.657, p>0.528), (z=-0.346, p>0.746).

Xanax and DN-2327 (Pazinaclone) in humans: Psychomotor, memory, subjective, and reinforcing effects.

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Abstract The psychomotor, memory, subjective, and reinforcing effects of DN-2327 (DN), a novel partial agonist at benzodiazepine receptors, were compared with those of Xanax (AL) in 14 men with histories of sedative drug abuse. Placebo, DN (8, 16, and 32 mg), and AL (0.5, 1.0, and 2.0 mg) were administered orally in a randomized, double-blind, cross-over design. DN and AL produced similar maximal impairment on psychomotor and memory performance. AL produced greater increases in participant ratings of sedation and a variety of somatic symptoms that were absent following DN. Abuse liability measures showed both drugs increased liking and good effects and were categorized by participants as sedative-hypnotics; however, 2 of 3 indirect and 1 direct measure of drug reinforcement were greater with AL than with DN. The dissociation between psychomotor-memory performance effects and various subjective effects demonstrates a novel pharmacological profile of DN. (PsycINFO Database Record (c) 2007 APA, all rights reserved)