Agoraphobia (cont.)

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How do physicians diagnose agoraphobia?

Interestingly, physicians often diagnose and treat agoraphobia, like other phobias, when patients seek treatment for other medical or emotional problems rather than as the primary reason that care is sought. As with other mental disorders, there is no single, specific test for agoraphobia. The primary-care doctor or psychiatrist will take a careful history, perform or refer to another doctor for a physical examination, and order laboratory tests as needed. If someone has another medical condition that he or she knows about, there may be an overlap of signs and symptoms between the old and the new conditions. Just determining that anxiety does not have a physical cause does not immediately identify the ultimate cause. Often, determining the cause requires the involvement of a psychiatrist, clinical psychologist, and/or other mental-health professional.

In order to establish the diagnosis of agoraphobia, the professional will likely ask questions to ensure that the anxiety of the sufferer is truly the result of a fear of being in situations that make it impossible, difficult, or embarrassing to escape rather than in the context of another emotional problem (for example, fear of being near people that remind one of an abuser in the case of posttraumatic stress disorder or the fear of hearing voices that have no basis in reality as occurs in schizophrenia).

What is the treatment for agoraphobia?

There are many treatments available for agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medication, is considered to be the most effective way to both relieve symptoms and prevent their return. In fact, sometimes patients respond equally as well when treated with group cognitive behavioral therapy or a brief course of cognitive behavioral therapy as they do when treated with traditional cognitive therapy. Psychotherapy for agoraphobia is effective for many people when they receive it over the Internet, which is optimistic news for people who live in areas that are hundreds of miles from the nearest mental-health professional.

Another form of therapy that has been found effective in managing agoraphobia includes self-exposure. In that intervention, the person either imagines or puts him or herself into situations that cause increasing levels of agoraphobic anxiety, using relaxation techniques in each situation in order to master their anxiety. As people gain access to the Internet, there is increasing evidence that exposure therapy can also be done effectively through that medium.

Regarding medical therapy, agoraphobia is usually treated in connection with panic disorder. Commonly, members of the serotonin selective reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups of medications are used in treatment. Examples of SSRI medications include escitalopram (Lexapro), citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of SSRI medications can vary greatly from person to person and depend on which of the drugs is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. In rare cases, some people have been thought to become acutely more anxious or depressed once on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be particularly vulnerable to this rare possibility.

Phobias are also sometimes treated using beta-blocker medications, which block the effects of adrenaline on the body. An example of a beta-blocker medication is propranolol.

Panic disorder and phobias are sometimes treated with drugs in a medication class known as benzodiazepines. This class of medications causes relaxation but is used less often these days to treat anxiety due to the possibility of addiction, increasing need for higher doses, and overdose. The risk of overdose is especially heightened if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

As anything that is ingested carries the risk of possible side effects, it is important to work closely with a doctor to decide whether medication is appropriate, and if so, which medication would be best. Further, the treating doctor will likely closely monitor for the possibility of side effects that can vary from the minor to the severe and in rare cases may even be life-threatening.

Medically Reviewed by a Doctor on 2/4/2014

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