Drugs May Help Talk Therapy Beat Panic

Jan. 22, 2003 -- Panic attacks sometimes come back after treatment. Now Italian researchers say they can stop panic relapses with a clever combination of drugs and psychotherapy.

Panic disorder disrupts the lives of three in every 100 people. These people suffer sudden attacks of shortness of breath, pounding heart, dizziness, and bowel distress. A form of psychotherapy called cognitive-behavioral therapy or CBT is an effective treatment. CBT involves learning to think differently about the attacks, learning to breathe during and through an attack, and step-by-step exposure to situations that trigger panic. Another effective treatment is drug therapy, particularly with antidepressants.

It would seem logical that combining these two effective treatments would work better and last longer. Not so, according to a large study funded by the National Institute of Mental Health. It found that the combination didn't work as well as either treatment alone.

Now a much smaller study suggests that how CBT and drug treatments are combined makes a difference. A big difference.

Nearly 80% of patients treated with drugs alone had a relapse within a year. But only 14% of patients given combination treatment had a relapse, according to the report in the January 2003 issue of the journal Psychotherapy and Psychosomatics. Lead researcher Massimo Biondi, MD, is a professor of psychiatry at the University of Rome, Italy.

"The problem is that if you use only anti-panic drugs, the relapse rate is much, much higher," Biondi tells WebMD. "If you integrate the anti-panic drugs and this kind of psychotherapy, you can have a very much higher rate of remission. It is stable for many years."

Biondi says that combination treatment hasn't worked in the past because patients come to think that it is the drug -- not their own effort -- that stops the panic attacks. When weaned off the drugs, the panic attacks come back. On the other hand, he says, without help from the drugs it takes a lot longer for patients to master their panic.

"I tell the patients to take the drug with an active mind and not in a passive way," Biondi says. "Don't just take the pills and wait for the results. Take the pill and go out. Try to do everything normal again. Use the drug to help you confront difficult situations."

Something else that Biondi does differently is to add something to CBT. He calls it "cognitive-existential" therapy.

"The key question for the patients is why this disease happens at this point of their life cycle," Biondi says. "So it is important to give a meaning to the panic."

Panic disorder expert David H. Barlow, PhD, is director of the Center for Anxiety and Related Disorders at Boston University. He led the large U.S. study of combination CBT/antidepressive therapy for panic disorder. Barlow says that Biondi may be right about why some people relapse from drug-only therapy but that more study is needed.