The Course of Panic Attacks and Agoraphobia-Reply

To the Editor.—  In their letter, Maier and Buller report that significant reductions in levels of anxiety occur among patients with panic disorder one year after entering treatment. Based on these data, they conclude that the course of panic disorder is less severe than reported in our study¹ and by other investigators.^2-4 Several points warrant further discussion.First, we reported that although our patient group had nonremitting, chronic courses before admission to our clinic, most patients subsequently made an excellent recovery from their panic and agoraphobic symptoms after combined behavioral therapy and imipramine hydrochloride or alprazolam treatment.¹ Moreover, in a recent prospective 2.5-year outcome study of patients from our study, Nagy et al⁵ reported that the significant reductions in anxiety symptoms derived from our treatment program persisted throughout the follow-up period. These data indicate that agoraphobia, with panic attacks, is very responsive to appropriate treatment. However, when panic disorder is