Objectives Researchers have long hypothesized that the benzodiazepine-GABA system plays a role in the pathophysiology of panic disorder (PD). However, previous neuroimaging studies have been inconclusive, possibly due to matching discrepancies between patients and controls, confounding medication factors, and/or image analyzing methods. This study aimed to compare benzodiazepine receptor binding between PD patients and healthy controls. Methods Via 123I-iomazenil single-photon emission computed tomography (IMZ-SPECT), we obtained regional brain patterns of benzodiazepine receptor binding for 12 unmedicated PD patients and 8 healthy age-and sex-matched volunteer controls. To analyze the image data, we used statistical parametric mapping (SPM). Results Benzodiazepine receptor binding showed a decrease in both the parietal and occipital lobes in PD patients as compared to controls. The anterior cingulate cortex, left parahippocampal gyrus, and both temporal lobes showed increased binding in PD patients. Conclusion Our findings provide evidence of an abnormal BZD-GABA system in PD patients, suggesting that basal and/or compensatory changes in inhibitory neurotransmissions contribute to the pathogenesis of human PD
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