Depression in Panic Disorder and Response to Alprazolam Therapy

To the Editor.—  Many patients followed up for panic disorders eventually develop major depressive disorder with endogenous features,¹ and therefore it is important to determine the effective therapy for patients with this complication. Lesser et al,² in the May 1988 issue of the Archives, concluded that subjects with panic disorder and phobic avoidance responded positively to alprazolam therapy regardless of whether they had coexistent major depression.This appears to directly contradict the findings of Pyke and Kraus,¹ who found the administration of alprazolam to be ineffective or even detrimental in patients with panic attacks and concurrent major depression but effective in patients with either panic disorder or agoraphobia with panic attacks in the absence of depression.In both the studies of Lesser et al² and Pyke and Kraus,³ diagnoses were made by DSM-III criteria, rating scales were employed, a dosage of up to 10 mg of