Treatments and drugsBy Mayo Clinic staff
Agoraphobia treatment usually includes both medication and psychotherapy. It may take some time, but treatments can help you get better.
Antidepressant and anti-anxiety medications are often 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 FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).
- Another type of antidepressant, 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 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. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).
Both starting and ending a course of antidepressants can cause side effects that seem just like 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.
Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy.
Cognitive behavioral therapy has two parts. The cognitive part 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 symptoms, such as using breathing and relaxation techniques.
The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely face the places and situations that cause fear and anxiety. A therapist may join you on outings to help you stay safe and comfortable, such as trips to the mall or driving your car. The more you go to feared places and realize you're okay, the more your anxiety will lessen.
If you have trouble leaving your home, you may wonder how you can possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first 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 email. 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 Jan. 7, 2011.
- Panic disorder. In: Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, D.C.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.com. Accessed Jan. 7, 2011.
- Schatzberg AF, et al. Anxiety disorders. In: Schatzberg AF, et al. Manual of Clinical Psychopharmacology. 7th ed. Washington, D.C.: American Psychiatric Publishing; 2010. 7th ed. http://www.psychiatryonline.com. Accessed Jan. 7, 2011.
- Shih RD. Plants, mushrooms and herbal medications. In: Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/page.do?sid=1102110593&eid=4-u1.0-B978-0-323-05472-0..00162-6--s0135&isbn=978-0-323-05472-0&type=bookPage§ionEid=4-u1.0-B978-0-323-05472-0..00162-6--s0135&uniqId=231117875-7. Accessed Jan. 7, 2011.
- Hepatic toxicity possibly associated with kava-containing products - United States, Germany, and Switzerland, 1999 - 2002. Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5147a1.htm. Accessed Jan. 7, 2011.
- Ciechanowski P, et al. Overview of panic disorder. http://www.uptodate.com/home/index.html. Accessed Jan. 7, 2011.
- Satterfield JM, et al. Panic disorder, with or without agoraphobia. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00025-1--sc0035&isbn=978-0-323-05610-6&sid=1102117058&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00025-1--sc0035&uniqId=231117875-8#4-u1.0-B978-0-323-05610-6..00025-1--sc0035. Accessed Jan. 7, 2011.
- Agoraphobia. Micromedex Healthcare Series. http://www.micromedex.com. Accessed Jan. 13, 2011.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 11, 2011.