Personality and symptom sensitivity predictors of alprazolam withdrawal in panic disorder

Abstract

Background. Discontinuation of benzodiazepine (BZ) treatment results in a well-characterized withdrawal syndrome in 40–50% of anxious patients. While numerous studies have established the role of BZ dose, treatment duration, half-life, potency, rate of withdrawal and severity of underlying anxiety disorder in predicting severity of withdrawal symptoms, fewer studies have examined the role of psychological and personality factors.Method. In 123 panic disorder patients undergoing gradual tapered discontinuation of alprazolam in conjunction with pre-treatment with carbamazepine or placebo, the relationship between measures of ‘symptom sensitivity’ and ‘harm avoidance’, and severity of withdrawal symptoms measured as peak severity of symptoms, time before taper needed to be slowed due to symptoms, and ability to complete taper, was examined.Results. After controlling for the less substantial effects of dose, treatment duration, pre-taper anxiety and panic attack frequency, measures of symptom sensitivity and harm avoidance accounted for an additional 3–6% of withdrawal variance.Conclusions. These results show an effect of symptom sensitivity and harm avoidance on BZ withdrawal symptoms, comparable to prior findings linking dependent personality characteristics to withdrawal severity. Failure to show the expected effect on ability to complete taper may be due to either the more symptomatic nature of the patients in this study.