Agoraphobia Drugs: Anti-depressants

At this point, I should say that I am not personally an advocate of using medication to overcome agoraphobia or an anxiety disorder. I did use a little Xanax to help me in my recovery, but the pills mostly stayed in my pocket as a safety measure.

But...If you are taking the chemical route to treat agoraphobia and you are misfortunate enough to have panic disorder with agoraphobia, then anti-depressants might just be your drug of choice over benzodiazepines.

That's because, unlike benzodiazepines, anti-depressants put a stop to panic attacks pretty effectively (in addition to treating depression).

There are several main classifications of antidepressants:

1) MAOIs (Monoamine Oxidase Inhibitors)
2) TCAs (Tricyclic Anti-depressants)
3) SSRI's (Selective Serotonin Reuptake Inhibitors) and
4)SSNRI's (Selective Serotonin and Noreprenephrine Reuptake Inhibitors).

First off, forget MAOIs. Almost no one prescribes them anymore anyway. They have way too many potential side effects like dry mouth, blurred vision, drowsiness, dizziness, decreased sex drive, skin rash, and weight gain or loss. Plus you can't eat smoked, fermented, or pickled foods or drink certain beverages if you are taking MAOIs (which rules out wine and cheese). MAOIs also have a bad reaction with a lot of other medications and can cause high blood pressure if you mix them with the wrong thing.

Tricyclic Anti-depressants used to be a popular choice but have the same potential side effects as MAOIs. TCAs include drugs like Elavil, Norpramin, Tofranil, and Pamelor. For the most part, since the advent of SSRIs starting with Prozac, TCAs are being used less and less by medical and mental health professionals.

SSRIs became popular partly for their effectiveness and partly because they don't have as many potential side effects. The side effects of SSRIs are manageable for most people and are usually limited to indigestion and/or a reduced sex drive. SSRI's currently in vogue are Prozac, Paxil, Zoloft, Celexa, Luvox, and Lexapro. Besides countering the effects of depression, these all are known to reduce the number of panic attacks a person has.

One of the reasons that SSRIs are so widely prescribed by doctors and psychiatrists is because you can't use them to kill yourself by overdose. This is obviously a good thing because prior to SSRIs, one of the most common forms of suicide was to overdose on the very antidepressants which were meant to cure the depression.

However, there are two serious drawbacks with SSRIs:

1) SSRIs are risky to combine with other drugs. For example, SSRIs can be lethal when taken with MAOIs.

2) Even though you can't use them to kill yourself by overdose, SSRIs have actually been proven to increase suicidal thinking.

A close cousin to SSRIs which have also become popular are SSNRIs. SSNRI's include Effexor and Serzone. The main difference between these drugs and SSRI's is that they effect the brain's levels of noreprenephrine in addition to serotonin and aren't as likely to produce sexual side effects.

The bottom line is that if you are going to take an anti-depressant to stop panic attacks, try one of the newer ones (SSRIs and SSNRIs). Since there are so many choices, you may have to shop around and try several before you find the one that works for you. As you know, different drugs work differently on different people.

Paxil is the favorite of some doctors because they say it makes people a lot calmer than some of the other SSRIs. But there are so many different SSRIs and SSNRIs that if you try one that doesn't work for you, just keep trying until you find one that does.