We thank Dr. Nutt and colleagues for their comments on our paper (Potokar et al this
issue;
Strohle et al 1999
) and on their own earlier study (
Nutt et al 1990
) on the same topic. We are grateful for the opportunity to further discuss the possible
reasons for our apparently contradictory findings on the putative panicogenic activity
of flumazenil in patients with panic disorder. A comparison of clinical and demographic
parameters indicates that in both studies the patients had at least some degree of
agoraphobia and were anxious at the time of testing. Whereas in our study patients
with a comorbid DSM-III-R Axis I disorder were excluded, in the study by Nutt and
co-workers, the subjects were moderately depressed (Whether they had any additional
comorbid Axis I disorders is not stated.) This, together with the higher panic attack
frequency (3.9 vs. 1.3) in the study of Nutt and coworkers, raises the question of
whether the anxiogenic activity of flumazenil may be related to clinical characteristics
other than those essential for the diagnosis of panic disorder with agoraphobia according
to DSM-III-R. In addition, more females in the study of Nutt’s group (7/10 vs. 4/8)
and the reported anxiogenic activity of flumazenil in premenstrual dysphoric disorder
(
Le Melledo and Van Driel 1998
) suggest a possible role of the menstrual cycle in the described anxiogenic or panic-provoking
effects of flumazenil. However, no data on the women’s menstrual cycle status on the
day of testing are available for our study, and none are stated for the Nutt and colleagues
study.To read this article in full you will need to make a payment
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© 1999 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
