There are six points that can be addressed in the letter of Drs. Busch, Milrod, and Gabbard. 1) We agree that more long-term studies of panic disorder are urgently needed and make that suggestion on page 26. There is, however, already a substantial literature on this problem (e.g., R4415512BCFBIEBE–R4415512BCFDBCIB) in addition to the paper by Drs. Milrod and Busch that they cite. Exactly how the lack of long-term studies bears on the issue of acute treatment effects, however, is not clear to us. 2) It should be noted that the ratings of the recommendations is a statement of clinical confidence and, as these authors noted, is not always correlated with the ratings of evidence in the literature. 3) We strongly disagree that the "tone" or any other aspect of the Guideline in any way implies that psychoanalytic treatments "lack...therapeutic efficacy." We agree, however, that there is no way to compensate for the lack of rigorous scientific treatment studies. 4) It seems a quibble to object to our comment that venlafaxine may be effective. It is a member of a class of medications that have been shown to be effective for panic disorder, and therefore we feel it is reasonable to suggest that it "may be effective" as well. This does not seem to be the same as saying that psychoanalytic psychotherapies are effective for panic disorder on the basis of case reports, given that they do not belong to a class of interventions that has documented efficacy. 5) We certainly hope that Drs. Busch, Milrod, and Gabbard do not believe that a treatment guideline for panic disorder is the place to rehearse the debate about the validity of DSM-IV categories. Indeed, the Guideline is written under the assumption that panic disorder is an illness that the psychiatrist has already diagnosed using the criteria of DSM-IV. 6) It is well-known that necessary exclusion criteria in clinical trials rarify the sample of patients enrolled. This clearly imposes the risk of lack of representation of community samples. Again, however, it is unclear what bearing this has on the recommendations given in the Guideline. Treatment guidelines must obviously offer recommendations based on the available scientific literature and acknowledge, as the panic Guideline does at many points, that individual clinicians must tailor treatment to individual patients. Is there evidence that psychoanalytic therapies are as effective as, or superior to, medication or cognitive behavioral therapies in the "community"? We are hopeful that the American Psychiatric Association’s Practice Research Network will contribute to the growth of evidence from the community to help with this and many other areas where rigorous studies are not available or are inadequate.