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Treatments and drugs
By Mayo Clinic staffAs with many other mental disorders, agoraphobia treatment typically includes a combination of medication and psychotherapy. Treatment of agoraphobia is often successful, and you can overcome agoraphobia and learn to keep it under control.
Medications
Antidepressant and anti-anxiety medications are commonly used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.
Your doctor is likely to prescribe one or both of the following:
- A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are commonly used to treat agoraphobia include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) or sertraline (Zoloft).
- Another type of antidepressants, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.
- An anti-anxiety medication. Also called benzodiazepines, these drugs — including alprazolam (Xanax), clonazepam (Klonopin) and others — can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs.
Both starting and ending a course of antidepressants can cause side effects that mimic the symptoms of a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled.
Psychotherapy
Several types of psychotherapy or counseling can help agoraphobia. One common therapy used is cognitive behavioral therapy.
Cognitive behavioral therapy has two parts. The cognitive portion involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms, and what makes them worse. You also learn how to cope with these distressing symptoms, such as using breathing and relaxation techniques.
The behavioral portion of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely confront the places and situations that cause fear and anxiety. A therapist may accompany you on excursions to help you remain safe and comfortable, such as trips to the mall or driving your car. Through gradually practicing going to feared places, people with agoraphobia learn that the fears don't come true and that their anxiety goes away with time.
If you have trouble leaving your home, you may wonder how you can possibly venture out to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer initial appointments in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through e-mail. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.
- Agoraphobia. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed March 10, 2009.
- Hollander E, et al. Panic disorders. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed March 10, 2009.
- Ciechanowski P. Overview of phobic disorders in adults. http://www.uptodate.com/home/index.html. Accessed March 3, 2009.
- Shearer SL. Recent advances in the understanding and treatment of anxiety disorders. Primary Care: Clinics in Office Practice. 2007;34:475.
- Agoraphobia. In: Moore DP, et al. Handbook of Medical Psychiatry. Philadelphia, Pa.: Mosby; 2007. http://www.mdconsult.com/das/book/body/125211023-6/0/1243/85.html?tocnode=52436571&fromURL=85.html#4-u1.0-B0-323-02911-6..X5001-5--section6_797. Accessed March 10, 2009.
- Richardson WH, et al. Herbal drugs of abuse: An emerging problem. Emergency Medicine Clinics of North America. 2007;25:435.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. March 12, 2009.
