Posted by mattdds on August 27, 2003, at 0:41:29
In reply to Best Med for Agoraphobia, posted by AndyD on August 26, 2003, at 21:04:27
Hi Andy,
For agoraphobia, a lot of people have good luck with clonazepam (Klonopin), and I remember reading some research that sounded very promising - in terms of reducing both anticipatory anxiety and blocking panic. I'd say in general, benzodiazepines are excellent for general or anticipatory anxiety.
Many people do well on the MAO inhibitors, particularly Nardil, which is purported to have *the strongest* anti-panic effects of any med (this being in terms of blocking spontaneous panic, but not so much in reducing generalized or anticipatory anxiety).
Having panic disorder as well, I cannot personally recommend SSRI drugs from my own experience. For me, they have intensely worsened my symptoms every time I tried one. I've tried all of them except Lexapro. However, I do concede that they are very helpful for some, and it can't (permanently) hurt to give them a try.
Jon mentioned CBT, or cognitive-behavioral therapy, of which I am a strong proponent. I strongly believe that there is a large psychological component to the anticipatory anxiety. At the heart of the anticipation, I believe, are exaggerated and erroneous beliefs surrounding panic attacks (e.g. I won't be able to handle it, or I'll "freak out"). CBT can work wonders to eliminate these fears.
My own experience with panic disorder has led me to believe that the panic attacks themselves have a strong biological component which, luckily, responds extremely well to medications (I've done well on Klonopin). But I think the disabling portion of the disorder can be eliminated with CBT, and sometimes CBT alone. CBT is tough work, and will require exercises and homework assignments that will sometimes be challenging. But I can attest that they are worth it. I have maintained all my gains from CBT, and have been panic free for a long time now.
I also am convinced that the anticipation can become a "self-fulfilling prophecy", which fuels the viscious cycle of anticipatory anxiety, panic and agoraphobia. So working on the anticipation through CBT will not only reduce the anticipatory anxiety, but the spontaneous panic attacks as well. In short, if you learn to stop fearing the attacks, it will lower your overall anxiety levels, and therefore raise the threshold of your panic, so you'll wind up experiencing fewer actual attacks, as well.
I hope this makes sense and is of some use to you.
Best of luck,
Matt
poster:mattdds
thread:254507
URL: http://www.dr-bob.org/babble/20030823/msgs/254601.html