![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by AndyD on August 26, 2003, at 21:04:27
In regards to all of your experiences, what is the best Med for agoraphobia...but with more anticipatory type anxiety of going, rather than being there. Once I force myself to go..like far away from home say 20 miles, I will experience a Panic attack and than I am OK. But I dont want to go through the attack or the anticipatory anxiety every time I go somewhere. Whats best?
Posted by JonW on August 26, 2003, at 22:35:14
In reply to Best Med for Agoraphobia, posted by AndyD on August 26, 2003, at 21:04:27
> In regards to all of your experiences, what is the best Med for agoraphobia...but with more anticipatory type anxiety of going, rather than being there. Once I force myself to go..like far away from home say 20 miles, I will experience a Panic attack and than I am OK. But I dont want to go through the attack or the anticipatory anxiety every time I go somewhere. Whats best?
What meds have you been on? Nardil, Paxil, and Xanax are three meds that come to mind. Have you tried any of these or anything similar? CBT could be very helpful in your case as well.
Jon
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
Posted by btnd on August 27, 2003, at 1:56:18
In reply to Best Med for Agoraphobia, posted by AndyD on August 26, 2003, at 21:04:27
Two meds: Klonopin or Xanax XR
Posted by djmmm on August 27, 2003, at 7:53:23
In reply to Best Med for Agoraphobia, posted by AndyD on August 26, 2003, at 21:04:27
> In regards to all of your experiences, what is the best Med for agoraphobia...but with more anticipatory type anxiety of going, rather than being there. Once I force myself to go..like far away from home say 20 miles, I will experience a Panic attack and than I am OK. But I dont want to go through the attack or the anticipatory anxiety every time I go somewhere. Whats best?
You may want to consider a combination of a beta-blocker and a benzodiazepine
Posted by SandyWeb on October 12, 2003, at 12:42:36
In reply to Best Med for Agoraphobia, posted by AndyD on August 26, 2003, at 21:04:27
> In regards to all of your experiences, what is the best Med for agoraphobia...but with more anticipatory type anxiety of going, rather than being there. Once I force myself to go..like far away from home say 20 miles, I will experience a Panic attack and than I am OK. But I dont want to go through the attack or the anticipatory anxiety every time I go somewhere. Whats best?
I became agoraphobic earlier this year. My coping skills just went ka-put, and I couldn't even leave the apartment to walk down the hall to the garbage chute. It took MASSIVE amounts of strength to walk to the doctor's office for multiple appointments, and I nearly went through the ceiling with anxiety each time I had to sit in the waiting room. I was so bad that I couldn't even answer the phone or the door.
What did wonders for me was Neurontin. Some people have tremendous success with this med, and some people don't find that it does anything. For me, I call it a "wonder drug". I take 1600mg, splitting it with 800mg in the morning and 800mg at supper. When I return to University in January, I will probably need to add another 800mg around noon.
I am not "cured"....but I am sooo much better now. I don't really get anticipatory anxiety now, and I can do everything I used to do before I developed agoraphobia. I'm not completely comfortable around people yet, but maybe I never will be. The Neurontin helps me to at least interact with the world again! <smile>
I also began a beta-blocker (Inderal LA 80mg). It helps to block the adrenaline surges that could make me anxious. I would HIGHLY recommend a beta blocker to anyone that can tolerate one.
Good luck. Let us know how you are doing.
Sandra
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.