What is agoraphobia?

Agoraphobia is an anxiety disorder. The people with agoraphobia avoid being in certain places or situations. They are afraid about having no way to escape or be overwhelmed with panic and having no help. An intense fear of driving, flying, crossing bridges, or being in shops are examples. The patients may become afraid of their reactions to these situations and this fear in itself can be disabling. In extreme cases, the agoraphobic person may never leave home.

Agoraphobia is often the end stage of panic disorder. Panic disorder is characterized by severe frequent panic attacks marked by a sense of impending doom. A person may be called agoraphobic when he/she tries to avoid situations, which he/she feels might trigger a panic attack.

How does it occur?

The exact cause is unknown. As with other types of mental illness, both genetic and environmental factors play a role.

What are the symptoms?

Agoraphobia may be the cause if a person often avoids going to places or doing things because of the fear of having no way to escape.

Typical symptoms of panic attack may be:

*  Palpitations or suddenly fast heartbeat
*  Sweating even when it is not hot
*  Trembling or shaking
*  Shortness of breath, feeling of not getting enough air
*  Feeling of choking or chest pain
*  Nausea
*  Dizziness
*  Fear of going crazy, losing control of body functions or of dying
*  Numbness or detachment
*  Chills or hot flashes.

Panic attacks may occur several times a day, or the attacks may be scattered, occurring only occasionally. Even occasional attacks can lead to fear of returning to a place or doing something associated with a past attack. A panic attack may last 10-15 minutes, or longer, after which the person may be exhausted.

Women have agoraphobia two to four times more often than men. The condition tends to run in families. Agoraphobia may cause a person to avoid going places or doing things because of the fear of having a panic attack, of having no way to escape.

How is it diagnosed?

The doctor will enquire about the symptoms. Other common causes of the symptoms, such as a medical illness or a drug or alcohol problem should be ruled out. This requires a medical examination and tests.

What is the treatment?

The treatment depends on how the disorder interferes with the routine life. Agoraphobia can be treated by various therapies. These include behaviour therapy, relaxation therapy, cognitive therapy, visual imagery techniques and medications (antidepressants and anti-anxiety drugs) to prevent panic attacks. The most effective treatments usually require that the person be exposed to the feared situation repeatedly, perhaps accompanied by a trusted companion, until they learn that the experience (such as crossing a bridge or riding in an elevator) is not dangerous.

MEDICATION?

The main classifications of medications prescribed for agoraphobia are:

1) Benzodiazepines: Prescribed for agoraphobia to reduce anxiety symptoms. These are tranquilizers and sleeping pills. You have probably heard of some of the most common types of benzodiazepines which are Ativan, Xanax, Valium, and Restoril. The main drawback with benzodiazepines is that they can be habit forming and withdrawal can cause the same anxiety or agoraphobia symptoms they were meant to relieve.

2) Anti-depressants: Prescribed to people with agoraphobia because they can block panic attacks (in addition to treating depression).

SSRIs (Selective Serotonin Reuptake Inhibitors)are the most commonly used because they don't produce as many side effects as older, less frequently prescribed types of anti-depressants (Monoamine Oxidase Inhibitors and Tricyclic Anti-depressants). SSRIs include Prozac, Paxil, Zoloft.

Recently, SSNRIs (Selective Serotonin and Noreprenephrine Reuptake Inhibitors) like Effexor have increased in popularity for patients with panic-related disorders. The main difference between these drugs and SSRI's is that they effect the brain’s levels of noreprenephrine in addition to serotonin and aren't as likely to produce sexual side effects.
Although anti-depressants are not habit forming like the benzodiazepines, some of them produce undesirable side effects like weight gain and reduced sex drive. They also produce harsh withdrawal effects in many people, especially Effexor.

3) Anti-convulsants: Most commonly used for epilepsy but known to stabilize mood and reduce frequency and intensity of panic attacks.

4) Beta blockers: most commonly used to reduce high blood pressure but also known to reduce physical symptoms of anxiety.

5) Buspar: a slower acting tranquilizer with fewer side effects than benzodiazepines.

How long does agoraphobia last?

Without treatment agoraphobia can last for many years, even for a lifetime.

What can be done to help?

Discuss the issue with a doctor who is knowledgeable about the condition. Realise that the anxiety problem can be overcome. Do not use alcohol or other drugs to overcome anxiety. Learn as much as possible about agoraphobia, anxiety, and panic. Join a support group of others with similar problems, and share experiences and solutions.