Medications for agorophobia treatment

Medications for agoraphobia treatment include benzodiazepine’s (klonopin, Ativan, valium, Xanax), SSRI’s (Prozac, celexa, Zoloft, paxil), Tricyclic anti-depressants (clomipramine, nortriptyline , Elavil), MAOI’s (parnate, nardil) and anti-psychotics (ability, Risperdal, Seroquel).  Using medication for agoraphobia and panic is an important piece of treatment in severe forms of the disorder, especially in agoraphobia house-bound patients.

Exposure therapy is necessary for resolution of panic and agoraphobia but in house-bound folks and debilitated people with panic, exposure therapy and proper extinction is impossible without toning down their baseline level of anxiety and panic. Benzodiazepine’s are used short-term in order to make exposure tolerable for the initial part of therapy. A person needs to be able to tolerate leaving the house for the first time or getting in the car for the first time in order to begin the desensitization process and de-conditioning of the fear. They need to build confidence by successfully proving they can complete their fear-task and tolerate it by seeing the anxiety come on and then resolve. Without medication this is not possible in severe patients.

Other medications used for agoraphobia and panic disorder in a long-term fashion include SSRI’s, TCA’s and MAOI’s. Nardil, an MAOI is underutilized severely given how effective it is and I regularly use Nardil with great success in chronic sufferers of severe panic and anxiety.

Antipsychotics have a key role in the medication treatment of agoraphobia specifically in patients who suffer severe intrusive thoughts such as : “I am going to die if I get in the car, I am going crazy and will never get over this.”  Ruminations and intrusive thoughts can prevent the ability of one to rationally process their thinking patterns and consciously correct negative irrational automatic thoughts that propagate the anxiety-panic paradigm. Thus antipsychotics are necessary in severe agoraphobic and panic patients I see in order to allow them to perform necessary cognitive therapeutic steps which are required to fully address their illness.

Being a psychiatrist who has expertise and specialization in severe panic disorder and agoraphobia in house-bound patients who does both cognitive-behavioral therapy, exposure and medication treatment, I offer a unique and extremely effective intensive program with a high-success rate regardless of the severity of symptoms.

Michael Yasinski MD

Intensive outpatient information: 480-253-0527