We appreciate the letter supporting our finding that the antipanic and antiphobic efficacy of combined alprazolam and behavioral therapy is sustained following shortterm treatment. We reemphasize that we could not address the comparative efficacy of one or both forms of treatment, as all our patients received both medication and behavioral treatment. However, our data do address the issue of what happens when drug therapy is withdrawn, in that several patients maintained treatment gains when not receiving medication, and the vast majority maintained treatment gains while receiving substantially reduced doses of alprazolam.Judd et al share interesting data regarding 12-month follow-up of patients with panic attacks treated with pharmacotherapy, some of whom also received behavioral therapy. It is unclear why 12 patients received adjunctive behavioral treatment. If treatments were not randomly assigned, it is likely that selection based on clinical features accounts for any differences between these groups. We also caution
Nagy LM, Krystal JH, Charney DS, Woods SW. Follow-up Study of Patients With Panic Disorder-Reply. Arch Gen Psychiatry. 1991;48(9):861–862. doi:10.1001/archpsyc.1991.01810330085018
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