Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia

Acta Psychiatr Scand. 2008 Apr;117(4):260-70. doi: 10.1111/j.1600-0447.2008.01157.x. Epub 2008 Feb 26.


Objective: To establish whether the combination of cognitive-behavioral therapy (CBT) and pharmacotherapy (SSRI) was more effective in treating panic disorder (PD) than either CBT or SSRI alone, and to evaluate any differential effects between the mono-treatments.

Method: Patients with PD (n = 150) with or without agoraphobia received CBT, SSRI or CBT + SSRI. Outcome was assessed after 9 months, before medication taper.

Results: CBT + SSRI was clearly superior to CBT in both completer and intent-to-treat analysis (ITT). Completer analysis revealed superiority of CBT + SSRI over SSRI on three measures and no differences between CBT and SSRI. ITT analysis revealed superiority of SSRI over CBT on four measures and no differences between CBT + SSRI and SSRI.

Conclusion: Both the mono-treatments (CBT and SSRI) and the combined treatment (CBT + SSRI) proved to be effective treatments for PD. At post-test, CBT + SSRI was clearly superior to CBT, but differences between CBT + SSRI and SSRI, and between SSRI and CBT, were small.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Agoraphobia / drug therapy
  • Agoraphobia / therapy*
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / therapy
  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Panic Disorder / diagnosis
  • Panic Disorder / drug therapy
  • Panic Disorder / therapy*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome


  • Serotonin Uptake Inhibitors