The efficacy of cognitive-behavioral therapy(CBT), of selective serotonin reuptake inhibitors (SSRI) and other antidepressants in panic disorder and agoraphobia(PDA) has been proven in many controlled trials. However,efficacy does not guarantee good effectiveness in certain subgroups of patients. Only few studies have investigated the effectiveness of CBT with or without concomitant medication in inpatients with severe PDA. Methods: 80 inpatients were treated with CBT comprising intense exposure in vivo. 41 of them received additional medication, mostly SSRI and other antidepressants. Drug treatment was not randomized or blinded. Progress in therapy was measured weekly with Bandelow’s Panic and Agoraphobia Scale. Psychopathology, demographic and clinical features were assessed as well. The temporal course was analyzed using cox regression. Results:71 patients (89%) improved by at least 30%. At posttest 12 patients (15%) were free of panic and avoidance, another 49 patients (61,2%) experienced only mild residual anxiety symptoms. The main outcome measure yielded an effect size of 2,50. A reliable improvement by 30% took 7 weeks in median. Female sex and secondary school education, but not university degree, predicted better outcome. Depression and multiple comorbidity influenced results adversely. Additional pharmacotherapy did not enhance or accelerate treatment outcome in general, but the medication group had more severe psychopathology at pretest. Conclusions: CBT brings about a good reduction of anxiety and avoidance in inpatients with serious PDA. Residual symptoms remain in many of these patients. Combining SSRI or other antidepressant drugs with CBT is not generally beneficial. Future studies should investigate the differential effectiveness of CBT/drug combination.

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2004
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