Alprazolam Group Research Articles

Efficacy of oral alprazolam in the management of perioperative anxiety in dental implant surgeries: A randomized controlled study

ABSTRACT Objectives: Surgical anxiety has emerged as a major limitation of implant surgery impeding its emergence as a leading choice of rehabilitation. It also triggers a series of physiological, emotional, and cognitive responses which adversely affects treatment outcomes and postoperative management. Hence, this study was designed specifically to address anxiety in patients undergoing dental implant surgeries. Materials and Methods: This study included 54 partially edentulous patients requiring single-implant rehabilitation. The patients were randomly assigned to the test group (Alprazolam group) and control group (Placebo group). Twenty-seven patients (test group) received Alprazolam 0.5 mg as a preemptive anxiolytic and 27 patients (control group) received a multivitamin tablet as placebo 1 h before implant surgery. Heart rate, blood pressure and respiratory rate of patients were measured to access the activation of sympathetic nervous system. Results: Oral administration of Alprazolam 1 h before the procedure showed significant reduction in preoperative anxiety in patients undergoing surgical placement of dental implants. Conclusion: Anxiolytic effect of Alprazolam mediated by binding to the alpha 1 subunit of GABA A receptor enhances the inhibitory effect on the nervous system. Preoperative administration of alprazolam 0.5 mg h prior, conceivably be standardized for management of surgical anxiety.

Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery.

To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate. Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods. Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027). Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.

Efficacy of Aerobic Exercise Added to Alprazolam in Panic Disorder Treatment: Clinical Randomized Trial

Objective: The purpose of this study is to determine whether the combination of aerobic physical exercise and alprazolam in patients with panic disorder has a better therapeutic response than treatment with alprazolam alone. Description: We have observed in our clinical practice that patients who practiced aerobic physical exercise had faster remissions and better improvement in their treatments than those who did not. The objective is to compare the efficacy of a pharmacological monotherapy (alprazolam), which is one of the options for the pharmacological treatment of panic disorder, with another treatment such as the combination of aerobic physical exercise and alprazolam, and to determine if this combination results in a better therapeutic response. Methods: 150 outpatients with panic disorder were randomly assigned to 4 mg of alprazolam or 4 mg of alprazolam associated to a programmed aerobic exercise reaching a heart rate between 50% and 75% of their maximum. Both groups completed their treatments in 12 weeks and were scored using the Hamilton Anxiety Rating Scale (H.A.R.S./14) and the Clinical Global Impression (CGI) before the study and during weeks 1, 4, 8, and 12. Patients assigned to the pharmacological plan received 4 mg alprazolam daily for 12 weeks. Two weeks after the first interview they had their first baseline psychiatric control, where all the patients were evaluated. Then, at the same visit, all the patients were prescribed 4 mg of alprazolam. The dose was gradually increased from 1 to 4 mg throughout the first week of treatment. The test was repeated during weeks 2, 4, 8 and 12. Patients assigned to exercise had to pass an ergometric test to determine their functional capacity expressed in METs for future indication of exercise. Two weeks after the first interview they had their first baseline psychiatric control and at the same time a 4 mg dose of alprazolam was prescribed, gradually increased from 1 to 4 mg along the first week of treatment. The test was repeated during weeks 2, 4, 8 and 12. Then they followed a protocolized aerobic exercise plan for this study for 12 weeks. The type of exercise consisted of a brisk walk for 30 minutes divided into stages. After each stage, the patient must control his own heart frequency, which must be between 50 and 75% of its maximum to ensure an aerobic condition (according yo American Cardiological Association criteria) Results: 106 of the 150 selected patients managed to fulfill both treatments: 51 for the alprazolam + exercise group (dropout rate 32%) and 55 for the alprazolam group (dropout rate 27 %). The group treated with alprazolam + exercise experienced a significant improvement (p &lt; 0.001) respect to the group treated only with alprazolam, reaching lower Hamilton Anxiety Scale scores (4,16 ± 1,06 and 8.57 ± 2,39 respectively) and Global Clinical Evaluation scores (Severity 1,86 ± 0,60 and 2.71 ± 0,62 ; Improvement 2,19 ± 0,49 and 2,87 ± 0,63 respectively for each group). Also, the remission rates were higher for the first group. Conclusion: Aerobic physical exercise in addition to pharmacological treatment (alprazolam) is more effective than the alprazolam treatment alone, and could be a useful alternative to treat this disorder.

Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study.

Background:The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT).Materials and Methods:In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale.Results:There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported.Conclusion:Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.

A Comparative Study on the Use of Alprazolam and Melatonin for Sleep Disturbances in Hemodialysis Patients.

Background and objectivesSleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis.Materials and methodsWe conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS).ResultsA total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062).ConclusionAs melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.

A comparative analysis of anxiolytic activity of Arnica montana and alprazolam in rats using open field test

Background: Anxiety affects around 7.3% of the total population worldwide. Benzodiazepines are preferred anxiolytic agents and are still frequently used in spite of the side effect profile including muscle relaxation, memory disturbances, sedation, physical dependence. Arnica montana, a traditional herb is known to possess significant anxiolytic effect at the dose of 100mg/kg. In this study, Arnica montana has been compared for the first time with alprazolam, a most commonly used anxiolytic drug.Methods: Forced swim test was used to induce anxiety. Anxiolytic action of study drugs which were given orally, was evaluated using Open field test (OFT) in healthy wistar rats of either sex. Behavior of rats, locomotion and number of squares crossed was recorded. Rats were divided into four groups with eight rats in each group. Study groups were Group I Control; Group II Alprazolam 0.08mg/kg; Group III Arnica montana extract (AME) 100mg/kg; Group IV AME + Alprazolam group 100mg/kg+0.08mg/kg. Statistical analysis was done using ANOVA followed by Tukey’s test (p&lt;0.05).Results: Increase in frequency of rearing was significant (p&lt;0.05) in AME group and highly significant (p&lt;0.001) in Alprazolam and combination group in comparison to control. Decrease in frequency of grooming was highly significant (p&lt;0.001) in Alprazolam and combination group. AME also showed significant (p&lt;0.05) decrease in grooming activity.Conclusions: Arnica montana extract showed anxiolytic activity and can be used as an add on drug after further studies and validation in the treatment of anxiety disorders.

Effect of alprazolam on rat serum metabolic profiles.

We developed a serum metabolomic method by gas chromatography-mass spectrometry (GC-MS) to evaluate the effect of alprazolam in rats. The GC-MS with HP-5MS (0.25 μm × 30 m × 0.25 mm) mass was conducted in electron impact ionization (EI) mode with electron energy of 70 eV, and full-scan mode with m/z 50-550. The rats were randomly divided to four groups, three alprazolam-treated groups and a control group. The alprazolam-treated rats were given 5, 10 or 20 mg/kg (low, medium, high) of alprazolam by intragastric administration each day for 14 days. The serum samples were corrected on the seventh and fourteenth days for metabolomic study. The blood was collected for biochemical tests. Then liver and brain were rapidly isolated and immersed for pathological study. Compared with the control group, on the seventh and fourteen days, the levels of d-glucose, 9,12-octadecadienoic acid, butanoic acid, l-proline, d-mannose and malic acid had changed, indicating that alprazolam induced energy metabolism, fatty acid metabolism and amino acid metabolism perturbations in rats. There was no significant difference for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea and uric acid between controls and alprazolam groups. According to the pathological results, alprazolam is not hepatotoxic. Metabolomics could distinguish different alprazolam doses in rats.

Effect of Zuogui Pill () on monoamine neurotransmitters and sex hormones in climacteric rats with panic attack.

To explore the effects of Chinese medicine prescription Zuogui Pill (, ZGP) on monoamine neurotransmitters and sex hormones in climacteric rats with induced panic attacks. Forty-eight climacteric female rats were randomized into 6 groups with 8 rats in each group: the control group, the model group, the low-, medium- and high-dose ZGP groups and the alprazolam group. Rats in the low-, medium- and high-dose ZGP groups were administered 4.725, 9.45, or 18.9 g/kg ZGP by gastric perfusion, respectively. The alprazolam group was treated by gastric perfusion with 0.036 mg/kg alprazolam. The control and model groups were treated with distilled water. The animals were pretreated once daily for 8 consecutive weeks. The behaviors of rats in the open fifield test and the elevated T-maze (ETM) were observed after induced panic attack, and the levels of brain monoamine neurotransmitters and the plasma levels of sex hormones were measured. Compared with the control group, the mean ETM escape time and the levels of 5-hydroxytryptamine (5-HT) and noradrenalin (NE) of the model group were signifificantly reduced (P<0.05), Compared with the model group, the mean ETM escape time and the 5-HT and NE levels of all the ZGP groups increased signifificantly (P<0.05 or P<0.01). However, no signifificant difference was observed in the levels of sex hormones between the groups. Pretreatment with ZGP in climacteric rats may improve the behavior of panic attack, which may be related to increased 5-HT and NE in the brain.

Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy

Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD.Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).

The Effect of Chronic Alprazolam Intake on Memory, Attention, and Psychomotor Performance in Healthy Human Male Volunteers.

Alprazolam is used as an anxiolytic drug for generalized anxiety disorder and it has been reported to produce sedation and anterograde amnesia. In the current study, we randomly divided 26 healthy male volunteers into two groups: one group taking alprazolam 0.5 mg and the other taking placebo daily for two weeks. We utilized the Cambridge Neuropsychological Test Automated Battery (CANTAB) software to assess the chronic effect of alprazolam. We selected Paired Associates Learning (PAL) and Delayed Matching to Sample (DMS) tests for memory, Rapid Visual Information Processing (RVP) for attention, and Choice Reaction Time (CRT) for psychomotor performance twice: before starting the treatment and after the completion of the treatment. We found statistically significant impairment of visual memory in one parameter of PAL and three parameters of DMS in alprazolam group. The PAL mean trial to success and total correct matching in 0-second delay, 4-second delay, and all delay situation of DMS were impaired in alprazolam group. RVP total hits after two weeks of alprazolam treatment were improved in alprazolam group. But such differences were not observed in placebo group. In our study, we found that chronic administration of alprazolam affects memory but attentive and psychomotor performance remained unaffected.

Alprazolam for essential tremor.

Essential tremor (ET) is one of the most common movement disorders. Treatment is based primarily on pharmacological agents. On this basis, although primidone and propranolol are well-established treatments in clinical practice, they could be ineffective in 25% to 55% of patients and can produce serious adverse events (AEs) in a large percentage of individuals. For these reasons, evaluating treatment alternatives for ET may be a worthwhile pursuit. Alprazolam has been suggested as a potentially useful agent for treatment of individuals with ET, but its efficacy and safety are uncertain. PrimaryTo assess the efficacy and safety of alprazolam in the treatment of individuals with ET. SecondaryTo examine effects of alprazolam treatment on the quality of life of people with ET. We carried out a systematic search without language restrictions to identify all relevant trials. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (January 1966 to September 2015), EMBASE (January 1988 to September 2015), the National Institute for Health and Care Excellence (NICE) (1999 to September 2015), ClinicalTrials.gov (1997 to September 2015) and the World Health Organiza tion (WHO) International Clinical Trials Registry Platform (ICTRP) (2004 to September 2015). We handsearched grey literature and examined the reference lists of identified studies and reviews. We included allrandomised controlled trials (RCTs) of alprazolam versus placebo or any other treatment. We included studies in which ET was diagnosed according to accepted and validated diagnostic criteria. We excluded studies that included patients presenting with secondary forms of tremor or reporting only neurophysiological parameters for the pur p ose of assessing outcomes. Two review authors independently collected and extracted data using a data collection form. We assessed risk of bias and the body of evidence. We used inverse variance methods for continuous outcomes and measurement scales. We compared differences between treatment groups as mean differences. We used Review Manager software for management and analysis of data. We included in this review one trial that compared alprazolam versus placebo (24 participants). It was judged to have high overall risk of bias. We graded the overall quality of evidence as very low. Compared with those given placebo, participants treated with alprazolam showed a significant reduction in tremor severity (mean difference (MD) -0.75, 95% confidence interval (CI) -0.83 to -0.67). Nine alprazolam-treated participants (75%) developed AEs, mainly represented by sedation (50%), constipation (17%) and dry mouth (9%). No participants in the alprazolam group and no p articipants in the placebo group discontinued treatment and dropped out of the study. Currently available data reveal evidence insufficient for assessment of the efficacy and safety of alprazolam treatment for individuals with ET.

Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: a randomized controlled trial.

BackgroundAdjustment disorder with anxiety (ADWA) is a highly prevalent condition, particularly in primary care practice. There are relatively few systematic treatment trials in the area of ADWA, and there are few data on predictors of treatment response. Etifoxine is a promising agent insofar as it is not associated with dependence, but in primary care settings benzodiazepines continue to be frequently prescribed for psychiatric symptoms. A randomized controlled trial of etifoxine versus alprazolam for ADWA was undertaken, focusing on efficacy and safety measures, and including an investigation of predictors of clinical response.MethodsThis was a comparative, multicenter, double-blind, randomized trial in two parallel groups of outpatients with ADWA. One group was treated with 150 mg/day for etifoxine, and the other with 1.5 mg/day for alprazolam for 28 days. Patients were followed for 4 weeks of treatment, and for an additional week after treatment discontinuation. The primary outcome measure was the Hamilton Anxiety Rating Scale (HAM-A), while secondary outcome measures included the Sheehan Disability Scale (SDS), the Clinical Global Impressions-Change Scale (CGI-C), and the Self-Report for the Assessment of Adjustment Disorders. Non-inferiority analysis was used to assess the primary outcome measure, and a multivariate logistic regression was employed to investigate predictors of response.ResultsTwo hundred and two adult outpatients with ADWA were enrolled at 17 primary care sites. One hundred and seventy seven patients completed the study (n = 87 in the etifoxine group; n = 90 in the alprazolam group). Etifoxine and alprazolam were accompanied by decreases in the HAM-A at day 28, with a difference between treatment groups in HAM-A score of 1.78 [90% CI; 0.23, 3.33] in favor of alprazolam. However, after medication discontinuation, HAM-A scores continued to improve in the etifoxine group, but increased in the alprazolam group; the difference between groups in mean change between day 28 and day 35 was significant (p = 0.019). Secondary outcome measures showed similar results for etifoxine and alprazolam at day 35. More treatment-related adverse events were reported in patients treated with alprazolam, particularly central nervous system-related AEs, and especially after medication discontinuation. No significant predictors of treatment response were found.ConclusionThis randomized controlled trial provides support for the efficacy and safety of etifoxine in the management of adjustment disorder with anxiety, particularly when treatment discontinuation data are also assessed. Etifoxine has the important clinical advantage of having anxiolytic effects, which are not being associated with dependence. Pharmacotherapy was equally efficacious in patients with more severe anxiety symptoms at baseline. Additional work using longer-term follow-up and collecting data on cost-efficiency of management options would further advance the field of ADWA.FundingSponsorship and article processing charges for this study were provided by Biocodex, Gentilly, France.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0176-6) contains supplementary material, which is available to authorized users.

Efficacy and safety of etifoxine versus alprazolam in the management of adjustment disorder with anxiety (ADWA)

BackgroundWell-conducted treatment trials and data on predictors of treatment response are both lacking for ADWA, despite the high prevalence of the condition. While benzodiazepines are frequently prescribed for anxiety disorders, etifoxine is also an effective agent not associated with dependence. A randomized controlled trial of etifoxine versus alprazolam for ADWA was undertaken, aiming at comparing efficacy and safety of the two treatments, and investigating predictors of the clinical response.MethodsTwo hundred and two adult outpatients with ADWA were enrolled at primary care settings sites in South Africa. Patients were followed for 4 weeks of treatment, and for an additional week after treatment discontinuation. The primary outcome measure was the Hamilton Anxiety Rating Scale (HAM-A) and was assessed by using a non-inferiority analysis. Secondary outcomes included the Sheehan Disability Scale (SDS) and the Clinical Global Impressions-Change Scale (CGI-C). Predictors of response were investigated with a multivariate logistic regression.ResultsBoth etifoxine and alprazolam dramatically decreased the HAM-A score at 4 weeks. The difference between treatment groups in HAM-A was of 1.78 [90% CI; 0.23, 3.33] in favor of alprazolam. The two treatments were equally efficacious in patients with more severe anxiety symptoms at baseline. Between week 4 and week 5, after treatment discontinuation, HAM-A scores continued to improve in the etifoxine group, but increased in the alprazolam group (P = 0.019); no difference was found between the two groups regarding the secondary outcomes. No significant predictors of treatment response were found. Patients treated with alprazolam experienced more treatment-related adverse events, mostly of central nervous origin, and especially after medication discontinuation.ConclusionThis trial confirms the efficacy and safety of etifoxine in the management of ADWA.

Response to Granoff

Back to table of contents Previous article Next article Communications and UpdatesFull AccessResponse to GranoffBarbara Olasov Rothbaum, Ph.D., A.B.P.P. Kerry Ressler, M.D., Ph.D.Barbara Olasov RothbaumSearch for more papers by this author, Ph.D., A.B.P.P. Kerry ResslerSearch for more papers by this author, M.D., Ph.D.Published Online:1 Nov 2014https://doi.org/10.1176/appi.ajp.2014.14070821rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Dr. Granoff comments on the benzodiazepine arm of our study in which Afghanistan and Iraq veterans with posttraumatic stress disorder (PTSD) received six sessions total, with five sessions of virtual reality exposure therapy combined with 0.25 mg of alprazolam or 50 mg of d-cycloserine or pill placebo administered 30 minutes prior to the virtual reality sessions. We agree with Dr. Granoff’s first comment that the dose of alprazolam at 0.25 mg is generally subtherapeutic. However, we would point out that this can be an effective dose for some people with anxiety, so it is not entirely a subclinical dose. With that said, we did purposefully choose a low dose of alprazolam in an attempt to not break the blind. d-Cycloserine is virtually undetectable when administered as used in our study (i.e., 50 mg once/week), and it was felt that even 0.50 mg of alprazolam may be noticeable by the subject and thus break the blind. Dr. Granoff’s second point, that “having participants discontinue their short-acting benzodiazepines 2 weeks before screening and discontinue their long-acting benzodiazepines 1 month before screening followed by a subtherapeutic dose of alprazolam is likely to have contributed to the lack of treatment effects in the alprazolam group,” likely had less of an impact. This is because very few subjects in the study discontinued chronic benzodiazepine use, so we do not believe that this possibility explains our data. This also addresses Dr. Granoff’s third point, that the number of patients who discontinued benzodiazepines was not reported. The fact that such a low dose of alprazolam was associated with lower efficacy of virtual reality exposure therapy we feel makes an even stronger case that benzodiazepines should be used with caution in general with patients with PTSD and certainly when patients are receiving exposure therapy. In conclusion, we agree that benzodiazepines in general can be quite useful for treatment of anxiety disorders. However, there is also the possibility, specifically with regard to extinction-based prolonged exposure therapy, that benzodiazepines may in some cases interfere with the consolidation of emotional memory during this process, as suggested in our study, and that this possibility warrants further investigation.From the Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta; and the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.The authors’ disclosures accompany the original article. FiguresReferencesCited byDetailsCited byNone Volume 171Issue 11 November 01, 2014Pages 1222-1222 Metrics PDF download History Accepted 1 August 2014 Published online 1 November 2014 Published in print 1 November 2014

Study on efficacy of zaoren anshen capsules in treating senile insomnia and changes in its hemorheology

To observe the effect of Zaoren Anshen capsules in treating senile insomnia and changes in its hemorheology. A total of 120 patients with senile insomnia were randomly divided into the Zaoren Anshen capsules group (five capsules, n = 60) and the Alprazolam group (0.8 mg, n = 60) for treatment and control observation. Pittsburgh sleep quality index (PSQI) was used for evaluating clinical efficacy in the first and fourth week before and after treatment. The Zaoren Anshen capsules group had lower higher scores in PSQI (5.91 +/- 1.37) than that before treatment (13.49 +/- 3.87), with great statistical significant in difference (P < 0.01). The alprazolam group had lower higher scores in PSQI than that before treatment, with great statistical significant in difference (P < 0.01). apart from higher PSQI scores in the Zaoren Anshen capsules group than that of the Alprazolam group after treatment for one week (P < 0.05), the comparison between the Zaoren Anshen capsules group and the alprazolam group before and after treatment for four weeks showed no statistical significance. As for hemorheological parameters, the difference in the whole blood viscosity (including high-shear, middle-shear and low-shear) of patients in the Zaoren Anshen capsules showed great statistical significance before and after treatment (P < 0.01), and so did the plasma viscosity (P < 0.05). Zaoren Anshen capsules showed less adverse reactions than alprazolam. Zaoren Anshen capsules have similar effect in treating senile insomnia with alprazolam, with less adverse reactions. They are so suitable for patients with senile insomnia that they can improve hemorheological indicators of patients with senile insomnia and have good effect in promoting circulation and removing stasis.

Alprazolam for depression.

The 'off-label' effect of alprazolam on depression has not been systematically evaluated. To determine the antidepressant effect, including tolerability and acceptability, of alprazolam as monotherapy for major depression, when compared to placebo and conventional antidepressants in outpatients and patients in primary care. We searched the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register, which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years to February 2012); EMBASE (1970 toFebruary 2012); MEDLINE (1950 to February 2012) and PsycINFO (1960 to February 2012). Two review authors identified relevant trials by assessing the abstracts of all possible studies. We applied no language restrictions. We selected randomised controlled trials (RCTs) of alprazolam versus placebo or conventional antidepressants for depression in adults, excluding studies with inpatients only. Two review authors performed the data extraction and 'Risk of bias' assessment independently with disagreements resolved through discussion with a third review author. Primary outcomes included the mean difference (MD) in reduction of depression on a continuous measure of depression symptoms, and the risk ratio (RR) of the clinical response based on a dichotomous measure, with 95% confidence intervals (CI). We identified 21 alprazolam studies (22 reports) with a total of 2693 participants. Seven studies used a placebo (n = 771) and 20 used cyclic antidepressants (n = 1765). The typical duration of the studies was four to six weeks. We considered six studies to have a high risk of bias.When alprazolam was compared with placebo for reduction in symptoms all estimates indicated a positive effect for alprazolam. Pooled estimates of efficacy data showed a moderately large continuous mean difference (MD) at the end of trial (-5.34, 95% CI -7.48 to -3.20; I(2) = 68%). The risk difference (RD) for the dichotomous measure of clinical response (50% improvement) was 0.32 in favour of alprazolam (95% CI 0.22 to 0.42; I(2) = 0%), with a number needed to treat to benefit (NNTB) of 3 (95% CI 2 to 5). The RD of all-cause withdrawals did not differ between alprazolam and placebo.When depression severity was measured as a continuum the effect of alprazolam did not differ statistically or clinically from the effects of any of the conventional antidepressants combined (MD 0.25, 95% CI -0.93 to 1.43; I(2) = 55%). However, for dichotomised depression severity, alprazolam had less effect than antidepressants (RR 0.86, 95% CI 0.75 to 0.99; I(2) = 37%; RD -0.11, 95% CI -0.24 to 0.01; I(2) = 58%; NNTB 9, 95% CI 4 to 100). The RD of all-cause withdrawals was -0.04 (95% CI -0.07 to 0.00; I(2) = 35%), in favour of alprazolam. Alprazolam appears to reduce depressive symptoms more effectively than placebo and as effectively as tricyclic antidepressants. However, the studies included in the review were heterogeneous, of poor quality and only addressed short-term effects, thus limiting our confidence in the findings. Whilst the rate of all-cause withdrawals did not appear to differ between alprazolam and placebo, and withdrawals were less frequent in the alprazolam group than in any of the conventional antidepressants combined group, these findings should be interpreted with caution, given the dependency properties of benzodiazepines.

Effect of Preoperative Alprazolam on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis

IntroductionSuccess of inferior alveolar nerve (IAN) block decreases in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of preoperative administration of alprazolam on the success of the IAN block for teeth with irreversible pulpitis. MethodsSixty patients with irreversible pulpitis of a mandibular molar were selected for this prospective, randomized, double-blind, placebo-controlled study. The patients received identical capsules of either 0.5 mg of alprazolam or placebo 45 minutes before the administration of a conventional IAN block. Access cavity preparation was initiated 15 minutes after the IAN block injection. Lip numbness was recorded for all the patients. Success was defined as no or mild pain on the basis of visual analogue scale recordings during access cavity preparation and initial instrumentation. Data were analyzed by t test, Mann–Whitney, and χ2 tests. ResultsThe success rate was 53% for alprazolam group and 40% for placebo group, with no significant difference between the 2 groups (P = .301). ConclusionsWithin the scope of the current study, preoperative oral administration of 0.5 mg of alprazolam did not improve the success of the IAN block in mandibular molars in patients with irreversible pulpitis, and the success rate was not adequate to ensure profound pulpal anesthesia.

Oral Alprazolam Attenuates Preoperative Stress Responses to Regional Anesthesia

Background: Preoperative anxiety activates the hypothalamo-pituitary-adrenal axis and the sympathetic nervous system, and also affects immune responses. Therefore, there is a need to reduce the anxiety. Methods: Forty-eight healthy patients scheduled for elective knee arthroscopic and reconstructive surgery under spinal anesthesia (SA) were randomly allocated into the control (CG, n = 24) and the alprazolam group (AG, n = 24). Oral 0.25 mg alprazolam in the evening before SA and 0.5 mg alprazolam 90 min before SA were administered to patients of the AG. Visual analogue scale (VAS) scores of anxiety were measured in the operating room before SA (ORSA) and operating room during operation and discharge day (DD). Serum ACTH and cortisol in the ORSA and DD, systolic and diastolic blood pressure and heart rate in the ward and ORSA, sleep time and number of night awakenings in the night before SA were measured. Results: Age (31.9 ± 10.8 yr), sex, height, weight, and sleep time were not significantly different between the two groups. The number of night awakenings in the AG were significantly lower than in the CG. VAS scores of anxiety in the ORSA were significantly higher in the CG than in the AG. ACTH and cortisol levels in the CG were significantly higher in the ORSA than in the DD. ACTH and cortisol levels in the AG were not significantly different between the ORSA and the DD. Cortisol level in the ORSA were significantly lower in the AG than in the CG. Diastolic blood pressure and heart rate in the ORSA were significantly lower in the AG than in the CG. Conclusions: These indicate that oral alprazolam attenuates preoperative stress responses to regional anesthesia. (Korean J Anesthesiol 2007; 52: 132～7)

Comparison to the efficacy of trazodone, tandospirone and alprazolam in treatment of patients with general anxiety

目的 比较曲唑酮、坦度螺酮和阿普唑仑对广泛性焦虑症的短、中期疗效和安全性及服药依从性的差异.方法 223例广泛性焦虑症患者随机分入曲唑酮组(77例)、坦度螺酮组(74例)和阿普唑仑组(77例),分别给予相应的药物治疗6周,半年后随访.于治疗前、治疗后1,2,4,6周末和随访时应用汉密尔顿焦虑量表(HAMA)和副反应量表(TESS)评定疗效和安全性;并于治疗前、治疗6周末和随访时检测血压、心电图、血常规.结果 曲唑酮和阿普唑仑2组患者治疗第1周末HAMA总分与治疗前比较有显著下降(P＜0.01),坦度螺酮组患者治疗第2周末HAMA总分显著下降(P＜0.01).随访时阿普唑仑组患者HAMA总分显著高于曲唑酮和坦度螺酮组(P＜0.05).曲唑酮、坦度螺酮和阿普唑仑3组的显效率分别为71.5%、67.6%和67.5%,经x2检验均差异无显著性(P＞0.05).曲唑酮和坦度螺酮2组副反应的总发生率均显著低于阿普唑仑组(x2总2=7.68,P＜0.05;x分2=7.44,P＜0.01),曲唑酮组性功能障碍的发生率显著低于坦度螺酮组(x2=16.03,P＜0.01),曲唑酮和阿普唑仑组患者嗜睡的发生率显著高于坦度螺酮组(x总2=16.51,P＜0.01;x分2=11.94,P＜0.01).随访时曲唑酮和坦度螺酮组服药依从性好者显著高于阿普唑仑组(x总2=19.43,P＜0.01;x分2=19.19,P＜0.01).结论 曲唑酮和坦度螺酮治疗广泛性焦虑症的短期疗效与阿普唑仑相当,中期疗效和服药依从性优于阿普唑仑,副反应的发生率低。

Pregabalin for Treatment of Generalized Anxiety Disorder

Pregabalin inhibits release of excess excitatory neurotransmitters, presumably by binding to the alpha2-delta subunit protein of widely distributed voltage-dependent calcium channels in the brain and spinal cord. To assess the anxiolytic efficacy of pregabalin in patients with generalized anxiety disorder. Double-blind, placebo-controlled, active-comparator trial. Patients were randomized to 4 weeks of treatment with pregabalin, 300 mg/d (n = 91), 450 mg/d (n = 90), or 600 mg/d (n = 89); alprazolam, 1.5 mg/d (n = 93); or placebo (n = 91). Psychiatry research and clinic settings. Outpatients meeting the DSM-IV criteria for generalized anxiety disorder, with a baseline Hamilton Anxiety Rating Scale (HAM-A) total score of 20 or greater. Change from baseline to end point in total HAM-A score in the pregabalin and alprazolam groups compared with the placebo group. The end point response criterion was 50% or greater reduction in the HAM-A total score. Pregabalin and alprazolam produced a significantly greater reduction in mean +/- SE HAM-A total score at last-observation-carried-forward end point compared with placebo (-8.4 +/- 0.8): pregabalin, 300 mg (-12.2 +/- 0.8, P<.001), 450 mg (-11.0 +/- 0.8, P = .02), and 600 mg (-11.8 +/- 0.8, P = .002), and alprazolam (-10.9 +/- 0.8, P = .02). By week 1 and at last-observation-carried-forward end point, the 3 pregabalin groups and the alprazolam group had significantly (P<.01) improved HAM-A psychic anxiety symptoms compared with the placebo group. Compared with the placebo group, HAM-A somatic anxiety symptoms were also significantly (P<.02) improved by the 300- and 600-mg pregabalin groups, but not by the 450-mg pregabalin (week 1, P = .06; week 4, P = .32) and the alprazolam groups (week 1, P = .21; week 4, P = .15). Of the 5 treatment groups, the 300-mg pregabalin group was the only medication group that differed statistically in global improvement at treatment end point not only from the placebo group but also from the alprazolam group. Pregabalin was significantly more efficacious than placebo for the treatment of psychic and somatic symptoms of generalized anxiety disorder and was well tolerated by most study patients.