Panic disorder with agoraphobia

Treatment

The goal of treatment is to help you function better. The success of treatment usually depends in part how severe the agoraphobia is.

The standard treatment approach combines cognitive-behavioral therapy (CBT), which helps you understand and change the thoughts that are causing your condition, and an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs), such as Paxil, are usually the first choice of antidepressant.

Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), are another choice. Other antidepressants and some anti-seizure drugs may be used for severe cases.

Other antianxiety medications may also be prescribed. The health care provider may recommend benzodiazepines when antidepressants don't help.

Behavioral therapies that may be used together with drug therapy include:

• Cognitive behavioral therapy
• Pleasant mental imagery
• Relaxation techniques

Other counseling and therapy techniques may help you gain an understanding of the illness and the factors that protect against or trigger it.

A healthy lifestyle that includes exercise, enough rest, and good nutrition can also help reduce the impact of anxiety.

Outlook (Prognosis)

Most patients can get better with medications or behavioral therapy. However, without early and effective help, the disorder may become more difficult to treat.

Possible Complications

• Panic disorder may occur with other anxiety disorders or depression
• You may abuse alcohol or other drugs while trying to self-medicate
• You may be unable to function at work or in social situations
• You may feel isolated or lonely, depressed, or suicidal

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of panic attacks.

References

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:162-163.

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:1440.

Schneier FR. Clinical Practice. Social anxiety disorder. NEJM, 2006;355:1029-1036.

Katon WJ. Panic disorder. NEJM, 2006;354:2360-2367.

Connolly SD, Bernstein GA: Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry, 2007;46:267-283.