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Suggest Treatment For Agoraphobia And Anxiety

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Posted on Tue, 17 Feb 2015
Question: hello Doctor ... am suffering from anxiety and fear if travel .. symptoms are of Agoraphobia ... also i have lots of anxiety when am travelling from one place to another especially via airplanes and i am in constant fear of having a panic attack ..
could you please suggest some medication/therapy/remedy for the same as am bound to travel a lot due to my job

i used take take paxidep cr 0.5 earlier and my problem was resolved to quiet an extent ..however i discontinued the medicine due to weight gain and sexual dysfunction .. so could you suggest an alternative medicine please
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
Psychotherapy and behaviour therapy work in anxiety disorder

Detailed Answer:
Hello,

Thanks for writing to us.

I can understand your concern for anxiety.

From history and treatment it seems that you are likely suffering from Panic disorder with agoraphobia.

Pexidep CR 12.5(not 0.5) - paroxetine - is very useful in panic disorder. But yes as you mentioned it can cause weight gain sexual side effects.

Alternative medicines without significant side effects are etizolam, sertraline(less weight gain and less sexual side effect), buspirone(probably no weight gain and sexual side effects), desvenlafaxine.You can discuss with your treating doctor about them and have a prescription suitable to you after examination.

If I were your treating doctor I would like to go with Psychotherapy and behavior therapy. Specifically CBT- Cognitive Behavior Therapy is very useful in such disorder.CBT includes facing the panic attack provoking situations with cognitive restructuring.It corrects automatic thoughts and patient has to actively think about practical situation and apply that aspect in behavior.
If patient is good motivated and therapist is good at CBT , it can solve problem forever.

Medicines can control the problem completely but chances of relapse are high if medicines are stopped. While behavior therapy almost cures the disorder and relapse chances are very less.

Pharmacotherapy and psychotherapy can both applied alone or simultaneously.

With above information go back to your psychiatrist back and decide the treatment plan.
(Note:Online prescription is not valid according to law.I can not suggest specific medicine suitable to you without examination.Sorry for the limitation from our side. But I am sure a competent psychiatrist will know about what I just said and can help you)

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Chintan Solanki (10 hours later)
Hi Doctor XXXXXXX thank you for your advice and feedback... I had got my first panic attack in2009 when I was out with my friends it was very sudden and I felt as if I was going to die... subsequent panic attacks then occurred few times after that and I was always in constant fear of getting a panic attack … in 2010 I had to go to the US for an assignment which I could not deny for so I took help from a psychiatrist who advised me to take Pexidep cr 12.5 and Dienxit along with clonazepam tablets (ZICAM 0.5).. This treatment really helped me along with some relaxation techniques and I was able to fly to US without any issues and life came back on track , I lived in US for a year without any issues and came back in 2011 … I made subsequent trips to France and Hong Kong in 2012 and 2013 but always before air travel I used to take pexidep at least for a week before travel just to be safe , somehow it gave me a psychological assurance that I would be safe (of course keeping the clonazepam with me but never took it), in XXXXXXX 2014 again I went to UK and followed the same routine of taking Pexidep before air travel , I returned to XXXXXXX in Aug 2014 till then everything was smooth , however in Dec 2014 , I started feeling very anxious while travelling and this time not just air travel but even small distances exactly like the way in 2009 .. I thought it would go away however my anxiety seems to be increasing and now I feel very anxious while travelling even short distances from home I fear the occurrence of a panic attack always and I fear it could be Agoraphobia… so why has this condition replapsed after like 5 years ? Is it because of the start and stop of Pexidep over the period of time? I did visit my psychiatrist today and since Pexidep has side effects (weight gain and sexual dysfunction) he has this time suggested PROTHIADEN 25mg and LONAZEP 1M… Will these medications be affective and without any side effects?? I am slated to fly to Canada by end of Feb 2015 and am very nervous and anxious for it … I would also be taking CBT therapy soon … however I am apprehensive will the medication be effective and help me get back to a normal life 
doctor
Answered by Dr. Chintan Solanki (13 hours later)
Brief Answer:
CBT can cure your problem, prothiaden has side effects

Detailed Answer:
Hello,

Thanks for writing back.

I read your query and history thoroughly. It seems that you have been treated through a good psychiatrist with appropriate medicines.

What you thought is not actually relapse. Actually your disorder is continued. It is just under control with help of medicines as well as some psychological assurance and placebo effects. So stopping and starting medicines is going to show the symptoms again which you can call relapse.

In more than 50% of anxiety disorder chances of relapse are there if medicines are stopped. Medicines in most of the cases correct the neurochemical changes which are responsible for symptoms. Basic etiology can be cured with simultaneously applying CBT. You need to face the situation with relaxation technique. It is good that you have not taken mouth dissolving clonazepam though you had. You are good candidate for CBT.

Prothiaden is a tricyclic anti depressant. It is mostly used for depression and sometime anxiety associated with depression. In 25 mg I don't think so it will be useful. 75 mg dose is needed. At that dose common side effects are dry mouth, constipation, postural hypotension and sedation which you may have.
I personally do not prefer it in anxiety disorder.

Hope I have answered your query.
If still any query there, I will be happy to answer.

All the best
http://bit.ly/drchintansolanki

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest Treatment For Agoraphobia And Anxiety

Brief Answer: Psychotherapy and behaviour therapy work in anxiety disorder Detailed Answer: Hello, Thanks for writing to us. I can understand your concern for anxiety. From history and treatment it seems that you are likely suffering from Panic disorder with agoraphobia. Pexidep CR 12.5(not 0.5) - paroxetine - is very useful in panic disorder. But yes as you mentioned it can cause weight gain sexual side effects. Alternative medicines without significant side effects are etizolam, sertraline(less weight gain and less sexual side effect), buspirone(probably no weight gain and sexual side effects), desvenlafaxine.You can discuss with your treating doctor about them and have a prescription suitable to you after examination. If I were your treating doctor I would like to go with Psychotherapy and behavior therapy. Specifically CBT- Cognitive Behavior Therapy is very useful in such disorder.CBT includes facing the panic attack provoking situations with cognitive restructuring.It corrects automatic thoughts and patient has to actively think about practical situation and apply that aspect in behavior. If patient is good motivated and therapist is good at CBT , it can solve problem forever. Medicines can control the problem completely but chances of relapse are high if medicines are stopped. While behavior therapy almost cures the disorder and relapse chances are very less. Pharmacotherapy and psychotherapy can both applied alone or simultaneously. With above information go back to your psychiatrist back and decide the treatment plan. (Note:Online prescription is not valid according to law.I can not suggest specific medicine suitable to you without examination.Sorry for the limitation from our side. But I am sure a competent psychiatrist will know about what I just said and can help you) Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.