In Reply.—
Dr Pyke questions the efficacy of alprazolam therapy in patients who have panic disorder with or without agoraphobia and also have a secondary major depression. Results of the Pyke and Kraus retrospective chart review of five such patients showed that they responded poorly to alprazolam therapy compared with 11 patients without major depression. This stands in contrast to our prospective, placebo-controlled study of 481 patients, 48 of whom had current secondary major depression and 91 of whom had secondary major depression but were not depressed at time of study, wherein alprazolam was shown to be an effective treatment of both the panic disorder and the depression.As Dr Pyke mentioned, the studies are difficult to compare. The nature and extent of the depression in the Pyke and Kraus study is not provided, although the letter notes that four of five patients fulfilled criteria for melancholia (symptoms not given),