Which medications are used to treat agoraphobia?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
  • Print

Agoraphobia (specifically, the panic symptoms) most often responds to treatment with an SSRI. [68, 69, 70] Treatment should be started at a low dose then titrated to the minimum effective dose for controlling the patient’s panic. Benzodiazepines can be used either as an adjunct or as primary treatment; however, benzodiazepines are usually not chosen as a first-line treatment because of the potential for abuse. [71] If the patient has frequent panic attacks and no history of substance abuse, a benzodiazepine can be considered until the SSRI takes effect. Long-acting benzodiazepines (eg, diazepam, clonazepam) prescribed on a standing rather than on an as-needed basis are preferred due to a lower addictive potential; dose can be increased every 2-3 days until panic symptoms are controlled or the maximum dose is reached.

Consider using the short-acting alprazolam for short-term use to control acute symptoms of panic. If response is minimal or nonexistent after 6 weeks, the SSRI dose can be further increased every 2 weeks until response or maximal dose is reached. Partial or no response at the highest SSRI dose warrants consideration of the following alternatives: change to a different SSRI; change to a different class (venlafaxine, duloxetine); change to TCAs/TeCAs or MAOIs (both TCAs/TeCAs and MAOIs have demonstrated efficacy in controlled trials for agoraphobia).

For a patient with good response, treatment should be continued for 9-12 months before considering slowly tapering the medications. With symptom recurrence following taper, treatment should be resumed and continued indefinitely.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!