How Do You Treat Agoraphobia?

Agoraphobia is an anxiety disorder that is treated with medication, lifestyle changes and alternative therapies.

Many people experience an intense fear of situations where they might not be able to get away quickly or get help. This fear is called agoraphobia. It affects nearly 1% of all adults and 2.4% of teenagers in the US. About 40% of adults and all of the teenagers affected feel that their agoraphobia severely impacts their lives.

Agoraphobia is an anxiety disorder. If you have agoraphobia and you find yourself in a situation that makes you fearful, you might experience symptoms like:

• Fear of being alone
• Fear of losing control in public
• Feeling detached from others
• Feeling helpless
• Feeling like your body or the environment aren’t real
• Staying at home for long periods

Your fear may show itself through physical symptoms including:

• Rapid heartbeat
• Hyperventilation (rapid breathing)
• Shortness of breath
• Chest pain
• Nausea
• Sweating

These feelings can be so overwhelming that they cause you to avoid being alone outside the home or in a crowded public place like a shopping mall or city bus. Some people with agoraphobia feel unable to leave the house by themselves.

Most of the time, agoraphobia develops from panic disorder, which causes sudden attacks of intense fear. Others get agoraphobia following a traumatic event or fear of crime, accident, or illness. 

Only a licensed healthcare professional can diagnose agoraphobia. To get the diagnosis, you must have intense fear related to at least two of the following five situations:

• Using public transportation
• Being in open areas
• Being in enclosed spaces
• Standing in lines or crowds
• Being outside of your home alone

You may get a diagnosis if all of the following apply:

• You’ve had symptoms for at least six months
• These symptoms cause you intense distress 
• You adjust your behavior to avoid that distress (ie, avoiding the situations that make you afraid)
• Your symptoms aren’t linked to another issue such as substance withdrawal

A healthcare provider will interview you to decide whether you qualify for a diagnosis. The provider may also want to talk with your family and/or friends.

Healthcare providers usually treat agoraphobia with a combination of medication and talk therapy. One commonly used type of talk therapy is cognitive-behavioral therapy (CBT).

CBT helps you to challenge and change the thoughts that cause your fear. It involves up to 20 visits with a mental health professional. You’ll analyze and work to control your anxious feelings. Some providers teach stress management, relaxation, and visualization techniques to help you succeed.

Medications

If you have agoraphobia, your provider might prescribe a medication that also treats depression. Usually, the first choice is a selective serotonin reuptake inhibitor (SSRI). SSRIs are antidepressants that affect your brain’s processing of a chemical called serotonin. Serotonin is a neurotransmitter that helps to regulate your mood and pain response, among other functions.

Neurotransmitters work by traveling from one nerve to another. An SSRI prevents the first nerve from reabsorbing the serotonin that it releases, so more of it is available to other nerves. This may help to control your mood and feelings of fear.

Another medication choice is the serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs work similarly to SSRIs. The main difference is that they act on two neurotransmitters, serotonin and norepinephrine, instead of just serotonin.

Other possible prescriptions for agoraphobia include anti-seizure medications and other antidepressants. In some cases, your provider may prescribe a sedative or hypnotic. These medications are meant for occasional use when you feel or anticipate severe symptoms.

Home care

A healthy lifestyle with plenty of exercise, rest, and nutrition may help you to control symptoms of agoraphobia.

Alternative therapies

Some providers may use exposure therapies to treat agoraphobia. Sometimes that means being slowly exposed to the fear-inducing situation in real life. 

In other cases, your provider might ask you to relax and imagine something that causes you anxiety. You usually start with the least frightening situation and work your way up. This is called systematic desensitization and exposure therapy.

If you have agoraphobia, you might feel tempted to use alcohol or other drugs to self-medicate. You may also feel isolated, depressed, or suicidal. Many people with agoraphobia find it difficult to function at work or socially.

There are also possible complications of the medications used to treat agoraphobia. If you take an SSRI or SNRI, you might experience side effects like:

• Headaches
• Insomnia
• Agitation
• Sexual dysfunction 
• Weight gain or loss

Other medications may have different side effects. Consult your healthcare provider about possible complications of any medications you might take for agoraphobia.