Therapy for Depression With Co-occurring Panic or Anxiety Symptoms

Inclusion Criteria: DSM-IV diagnosis of major depression with co-existing panic or anxiety symptoms. Exclusion Criteria: History of manic episode(s). Patients who have had hypomanic episodes in the past will be accepted into the study, provided they meet other admission criteria and are not presenting in a current hypomanic or mixed episode. History of schizophrenia or schizoaffective disorder. Organic affective syndrome. Unspecified functional psychosis. Anorexia nervosa or bulimia nervosa. Patients meeting criteria for an eating disorder not otherwise specified will not be excluded. Chronic drug or alcohol abuse/dependence within the past 2 years. Patients with abuse related to episodes will not be excluded. DSM-IV criteria for borderline or antisocial personality disorder. Patients who meet criteria for other Axis II disorders will not be excluded. Inpatient treatment due to suicide risk or psychotic symptoms. Index episode secondary to the effect of medically prescribed drugs. Significant or untreated medical illness, including cardiovascular disorder, renal or liver disease, epilepsy, untreated hypertension, or unstabilized endocrine disease. Medical illness that would interfere with the best treatment strategy for the potential participant. Current treatment with an antidepressant. Patients on a stable dose of anxiolytics for at least 3 months prior to study participation who are able to maintain this dosage throughout the study will not be excluded. Pregnant and breast-feeding women will be accepted into the study, but will not be prescribed adjunctive medications.