Diagnosis

Agoraphobia is diagnosed based on:

  • Signs and symptoms
  • In-depth interview with your doctor or a mental health professional
  • Physical exam to rule out other conditions that could be causing your symptoms
  • Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy

Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

You can learn:

  • What factors may trigger a panic attack or panic-like symptoms and what makes them worse
  • How to cope with and tolerate symptoms of anxiety
  • Ways to directly challenge your worries, such as the likelihood of bad things happening in social situations
  • That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
  • How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are well aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medications

Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia.

  • Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
  • Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren't a good choice if you've had long-term problems with anxiety or problems with alcohol or drug abuse.

It may take weeks for medication to relieve symptoms. And you may have to try several different medications before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication.

Alternative medicine

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. Although these supplements are available without a prescription, they still pose possible health risks.

For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.

Coping and support

Living with agoraphobia can make life difficult. Professional treatment can help you overcome this disorder or manage it effectively so that you don't become a prisoner to your fears.

You can also take these steps to cope and care for yourself when you have agoraphobia:

  • Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Communicate regularly with your therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking your medication.
  • Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. Family, friends and your therapist can help you work on this.
  • Learn calming skills. Working with your therapist, you can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
  • Avoid alcohol and recreational drugs. Also limit or avoid caffeine. These substances can worsen your panic or anxiety symptoms.
  • Take care of yourself. Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits.
  • Join a support group. Support groups for people with anxiety disorders can help you connect to others facing similar challenges and share experiences.

Preparing for your appointment

If you have agoraphobia, you may be too afraid or embarrassed to go to your doctor's office. Consider starting with a phone call to your doctor or a mental health professional, or ask a trusted family member or friend to go with you to your appointment.

What you can do

To prepare for your appointment, make a list of:

  • Any symptoms you've been experiencing, and for how long
  • Things you have stopped doing or are avoiding because of your stress
  • Key personal information, especially any significant stress or life changes that you experienced around the time your symptoms first developed
  • Medical information, including other physical or mental health conditions that you have
  • All medications, vitamins, herbs or other supplements you're taking, and the dosages
  • Questions to ask your doctor so that you can make the most of your appointment

Some basic questions to ask your doctor may include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you determine my diagnosis?
  • Is my condition likely temporary or long term (chronic)?
  • What type of treatment do you recommend?
  • I have other health problems. How best can I manage these together?
  • What is the risk of side effects from the medication you're recommending?
  • Are there options other than taking medications?
  • How soon do you expect my symptoms to improve?
  • Should I see a mental health professional?
  • Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

  • What symptoms do you have that concern you?
  • When did you first notice these symptoms?
  • When are your symptoms most likely to occur?
  • Does anything seem to make your symptoms better or worse?
  • Do you avoid any situations or places because you fear they'll trigger your symptoms?
  • How are your symptoms affecting your life and the people closest to you?
  • Have you been diagnosed with any medical conditions?
  • Have you been treated for other mental health disorders in the past? If yes, what treatment was most helpful?
  • Have you ever thought about harming yourself?
  • Do you drink alcohol or use recreational drugs? How often?
March 22, 2017
References
  1. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Dec. 27, 2016.
  2. Understanding mental disorders: A patient and family resource ― Agoraphobia. http://psychiatryonline.org/doi/abs/10.1176/appi.books.9781615370740.umd15. Accessed Dec. 27, 2016.
  3. Anxiety disorders. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Dec. 27, 2016.
  4. Ravindran AV, et al. Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review. Journal of Affective Disorders. 2013;150:707.
  5. Craske MG, et al. Anxiety. The Lancet. 2017;388:3048.
  6. Olthuis JV, et al. Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011565.pub2/abstract. Accessed Dec. 27, 2016.
  7. Anxiety disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145338. Accessed Dec. 27, 2016.
  8. McCabe RE. Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. http://www.uptodate.com/home. Accessed Dec. 27, 2016.
  9. Kava. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Jan. 10, 2017.
  10. Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 11, 2017.
  11. Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 13, 2017.
  12. Kava. National Center for Complementary and Integrative Medicine. https://nccih.nih.gov/health/kava. Accessed Jan. 19, 2017.