It is unclear whether elevated cholesterol level is a complication of panic disorder (PD) or is associated with pharmacotherapy. We compared the total cholesterol (TC) level in 47 PD patients with that in 47 gender- and age-matched normal controls (NC), and we also examined the pre- and post-treatment TC levels. There was no sex difference in TC. Before pharmacotherapy, the mean TC level in the PD group (194.9 +/- 39.6 mg/dl) was non-significantly higher than that in the NC group (190.5 +/- 26.7 mg/dl). The mean TC level in the PD group was significantly reduced following the pharmacotherapy (post-TC: 184.7 +/- 31.0 mg/dl; t = 2.44, P < 0.02), and the subgroup treated with alprazolam (n = 26) showed markedly significant decrease of TC after the treatment (t = 2.36, P < 0.03). The TC level in the PD subgroup with agoraphobia (n = 24, 198.9 +/- 37.9 mg/dl) was slightly higher than that in the group without agoraphobia (n = 23, 190.8 +/- 41.6 mg/dl). These findings suggest that there is a relationship between cholesterol levels and treatment in PD.