Cognitive behavior therapy (CBT) with or without medication has been used in the treatment of
panic disorder (PD). The purpose of this study is 1) to determine whether nine months of
maintenance cognitive-behavior therapy (CBT) significantly improves the likelihood of
sustained improvement; and 2) to determine the acute acceptability and efficacy of medication
therapy or continued CBT alone among patients who fail to respond sufficiently to an initial
course of CBT alone.
It has been found that patients with PD respond as well to CBT or medication alone as they do
to a combination of the two. Since the combined treatments are expensive and CBT is
associated with less risk of medical toxicity compared to medications, CBT alone will be used
first.
All patients will first receive CBT alone. If the patient responds to this therapy, the
patient will be assigned randomly (like tossing a coin) to 1 of 2 groups. One group will
continue to receive CBT (maintenance therapy) for 9 months. The other group of responders
will not receive any further therapy. If a patient does not respond to CBT alone, he/she will
be assigned randomly to 1 of 2 different groups. One group will receive paroxetine; the other
will continue to receive CBT for a longer period. The response to treatment will be evaluated
to see which regimen works best to treat PD. The study will last approximately 3 years.
An individual may be eligible for this study if he/she has panic disorder with no more than
mild agoraphobia (fear of being in public places) and is at least 18 years old.