Drugs May Help Talk Therapy Beat Panic
But First Try Psychotherapy Alone, Experts Say
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.
"If you look closely at our findings, there did seem to be some advantage to combination therapy after nine months of treatment. But our judgment was that this difference was not robust enough to recommend combination treatment," Barlow tells WebMD. "The other thing is that for reasons we don't yet understand, combination treatment had the greatest rate of relapse. It could be that whatever progress was made was attributed to the drug, or that patients got some benefit from drug that stopped when the drug was taken away."
Barlow says people with panic disorder -- and their families -- should know that there are two very effective treatments.
"The general recommendation we make is that if a patient hasn't been treated before, we start with CBT because it is the least intrusive," he says. "But very seldom do you get a situation where a patient hasn't tried some kind of treatment. So the message is to find a doctor or therapist who has expertise in anxiety disorders. Talk carefully about which treatment might be right for you."