Which medications are used to treat agoraphobia?

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

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.


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