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 (
- Ströhle A.
- Kellner M.
- Holsboer F.
- Wiedemann K.
Behavioral, neuroendocrine, and cardiovascular response to flumazenil No evidence for an altered benzodiazepine receptor sensitivity in panic disorder.
Biol Psychiatry. 1999; 45: 321-326
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 (
- Nutt D.J.
- Glue P.
- Lawson C.
- Wilson S.
Flumazenil provocation of panic attacks. Evidence for altered benzodiazepine receptor sensitivity in panic disorder.
Arch Gen Psychiatry. 1990; 47: 917-925
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.
- Le Melledo J.M.
- Van Driel M.
- Coupland N.J.
- Lott P.
- Jhangri G.S.
Response to flumazenil in women with premenstrual dysphoric disorder.
Biol Psychiatry. 1998; 42: 91S
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© 1999 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.