The most effective prescription drugs for the treatment of generalized anxiety disorder are benzodiazepines, SSRIs (Zoloft, Prozac, Paxil, etc.), SNRIs (Effexor, Cymbalta, etc.), and buspirone (BuSpar). Other drugs that may be useful are tricyclic drugs (Nortriptyline, Amitriptyline, etc.) and beta-adrenergic antagonists or blockers (Propranolol).

To treat panic disorders, selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil) are shown to be more effective and better tolerated than benzodiazepines, and monoamine oxidase inhibitors, and tricyclic and tetracyclic drugs. Some reports suggest a role for venlafaxine (Effexor) and buspirone (BuSpar). Venlafaxine is approved for the treatment of generalized anxiety disorder and may help in patients with both panic disorder and depression.

What is Agoraphobia?

Agoraphobia is a marked fear or anxiety about two or more of the following situations:

• Being in open spaces (e.g., marketplaces, parking lots, streets)
• Being in enclosed places (e.g., shops, theaters)
• Using public transportation (e.g., cars, buses, trains, ships, planes)
• Standing in line or being in a crowd
• Being outside of the home alone

The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of incontinence or fear of falling in the elderly). The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear, anxiety, or avoidance typically lasts for 6 months or more and causes significant distress or impairment in social, occupational, or other important areas of functioning.

Agoraphobia will be diagnosed irrespective of the presence of panic disorder.

Agoraphobia Epidemiology
The lifetime prevalence of agoraphobia varies between 2 to 6 percent across studies.

Agoraphobia vs. Other Disorders
Agoraphobia must be differentiated from a number of other medical conditions that produce similar symptoms. These include major depressive disorder, schizophrenia, paranoid personality disorder, avoidance personality disorder, and dependent personality disorder.

How is Agoraphobia treated?

Pharmacotherapy

Benzodiazepines have the most rapid onset of action against panic. Xanax and Ativan are the most commonly prescribed benzodiazepines. Clonazepam has also been shown to be effective.
Benzodiazepines have the potential for dependency, cognitive impairment, and abuse, especially with long-term use. However, when used appropriately under medical supervision benzodiazepines are effective and generally well-tolerated. Their most common side effects are mild dizziness and sedation, both of which are often reduced by time or by adjustment of dosing.

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line agents for the treatment of panic disorders with or without agoraphobia, and they can help reduce or prevent relapse. The main advantage of SSRIs is their improved safety profile and more tolerable side effects.

Tricyclic and tetracyclic drugs are also effective treatments, although they require careful dosing and close monitoring of side effects, which can include jitteriness, possible seizures, and potentially harmful cardiac effects.

Psychotherapy

• Behavior therapy approaches include positive and negative reinforcement, systematic desensitization, relaxation techniques, stop thought, panic control therapy, self-monitoring, hypnosis, and others.
• Cognitive therapy focuses on correcting an individual’s distorted thoughts and perceptions. Treatment is short-term and interactive with assigned homework between sessions.
• Supportive psychotherapy focuses on strengthening an individual’s adaptive defenses while discouraging maladaptive behavior.
• Insight-oriented psychotherapy focuses on uncovering and resolving a person’s internal conflicts.
• Virtual therapy with computer programs allows patients to see themselves as avatars who are placed in open or crowded spaces. Identifying with the avatars in repeated sessions enables patients to master anxiety through deconditioning.

A variety of different types of psychotherapy may be used to treat agoraphobia.