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Agoraphobia/Panic Disorder Treatment(s)
SSRI or benzos or both? If benzos, which ones and how much is a typical amount? Same for SSRIs? I do not have health insurance but have read a lot about this illness.
There is no "one size fits all" treatment/med for anxiety. Everyone is different, and different things work differently for varying people.
The most COMMON approach to treat a moderate to severe case of panic disorder with agoraphobia is an SSRI antidepressant and therapy. Like kick said above, many times, a benzodiazepine (ie Xanax, or Ativan) is taken, usually on an "as needed" basis, as a rescue drug, for panic attacks. The use of the benzo usually is short term, until the SSRI starts doing its job.
That's exactly how things went down for me. I was started on Zoloft (1st tiome around, back when I was 18, and first diagnosed with PD), and Ativan PRN ("as needed"). About 3 months into the treatment, my need for the Ativan was almost completely eliminated. It was most DEFINITELY very helpful during the time I needed it, however.
I cannot stress enough that therapy is SO important. Even for me, while the meds helped reduce the panic attacks, and got me to a place where I could leave my house again, it was the THERAPY that taught me how to change my thinking, to not "what if", or catastrophize (imaging the worst case scenario for every situation that scares us). The things I learned in therapy, I still utilize to this day. Therapy will help on a more long term basis. Without the meds, I wouldn't have been able to even MAKE it to therapy. Without the therapy, I would have never really grown, or learned anything about the disorder, and about how to change the thinking behind it that causes most of the symptoms.
As to your benzo question. Yes, actually benzos CAN be taken long term, and many people DO take a benzo every day, for different reasons. The MOST optimal way to approach a benzo, for anxiety treatment, is to try to use it ONLY "as needed", or to limit the course of treatment to 2-3 months or less, to avoid dependency and tolerance. If a benzo is taken regularly, a person MUST be slowly and carefully tapered off under medical supervision, when it's been decided to d/c that med.
If a benzo is only used "as needed", or here and there for panic attacks, or increased anxiety, there is no issue with dependency and tolerance.
These are decisions that are going to be unique for YOU to make. Have frank discussions with your doctor, and just be open minded, be willing to accept the suggestions your doc may make. Don't try to decide ahead of time what you think you need. Also, treatment for PD takes time to see improvements. You have to try to be patient, that's so important. To be able to fairly assess the effectiveness of any one med, you typically have to give it at LEAST 4-6 weeks (sometimes longer, if you take into consideration possible dosage increases).
Don't forget to include therapy in your plan. Meds alone are NOT going to fix the problem. If you don't start working on learning how to break that anxious cycle of thinking with therapy, you'll find yourself back at the starting line at some point.
Let us know how you're doing, good luck!
The most COMMON approach to treat a moderate to severe case of panic disorder with agoraphobia is an SSRI antidepressant and therapy. Like kick said above, many times, a benzodiazepine (ie Xanax, or Ativan) is taken, usually on an "as needed" basis, as a rescue drug, for panic attacks. The use of the benzo usually is short term, until the SSRI starts doing its job.
That's exactly how things went down for me. I was started on Zoloft (1st tiome around, back when I was 18, and first diagnosed with PD), and Ativan PRN ("as needed"). About 3 months into the treatment, my need for the Ativan was almost completely eliminated. It was most DEFINITELY very helpful during the time I needed it, however.
I cannot stress enough that therapy is SO important. Even for me, while the meds helped reduce the panic attacks, and got me to a place where I could leave my house again, it was the THERAPY that taught me how to change my thinking, to not "what if", or catastrophize (imaging the worst case scenario for every situation that scares us). The things I learned in therapy, I still utilize to this day. Therapy will help on a more long term basis. Without the meds, I wouldn't have been able to even MAKE it to therapy. Without the therapy, I would have never really grown, or learned anything about the disorder, and about how to change the thinking behind it that causes most of the symptoms.
As to your benzo question. Yes, actually benzos CAN be taken long term, and many people DO take a benzo every day, for different reasons. The MOST optimal way to approach a benzo, for anxiety treatment, is to try to use it ONLY "as needed", or to limit the course of treatment to 2-3 months or less, to avoid dependency and tolerance. If a benzo is taken regularly, a person MUST be slowly and carefully tapered off under medical supervision, when it's been decided to d/c that med.
If a benzo is only used "as needed", or here and there for panic attacks, or increased anxiety, there is no issue with dependency and tolerance.
These are decisions that are going to be unique for YOU to make. Have frank discussions with your doctor, and just be open minded, be willing to accept the suggestions your doc may make. Don't try to decide ahead of time what you think you need. Also, treatment for PD takes time to see improvements. You have to try to be patient, that's so important. To be able to fairly assess the effectiveness of any one med, you typically have to give it at LEAST 4-6 weeks (sometimes longer, if you take into consideration possible dosage increases).
Don't forget to include therapy in your plan. Meds alone are NOT going to fix the problem. If you don't start working on learning how to break that anxious cycle of thinking with therapy, you'll find yourself back at the starting line at some point.
Let us know how you're doing, good luck!
Can you take benzos everyday for years? I know a woman who's been on Ataivan for 20 years and she takes it everyday. I also know some people who take Vallium every single night, mainly to help sleep. I read on some of these forums where it says taking benzos everyday for years is bad, but yet some doctors claim it's safe to do that as long as you don't abuse them.
It really depends on the person. When I first had anxiety, I was prescribed both. A lot of SSRI's actually intensify the effects of anxiety initially, so for the first few weeks, you may benefit from a benzodiazepene. I started on .25 mg of Xanax, which used to knock me out within five minutes. Now, I take .5 mg as needed, and I'm not sure they really even help much.
A doctor will likely start you on a low dose of whatever you take, just to see how your body tolerates the drug and to find the correct dosage. A dosage that is too high is just as bad for anxiety as a dosage that is too low. Since you don't have insurance, I will tell you that I've tried Celexa, Paxil, Effexor, Zoloft, and Lexapro, and Lexapro was by far the most expensive. I take the generic now and it is still over $100. I disagree with the above poster who said that "shrinks" don't know what they are doing. I have struggled with anxiety for nearly a decade and just recently began seeing a psychiatrist for my medication and she is far more knowledgeable than general practicioners about the matter. This is what they are trained to do and there are lots of combinations of drugs they can give you, it's just a matter of finding the right drug that works for you.
A doctor will likely start you on a low dose of whatever you take, just to see how your body tolerates the drug and to find the correct dosage. A dosage that is too high is just as bad for anxiety as a dosage that is too low. Since you don't have insurance, I will tell you that I've tried Celexa, Paxil, Effexor, Zoloft, and Lexapro, and Lexapro was by far the most expensive. I take the generic now and it is still over $100. I disagree with the above poster who said that "shrinks" don't know what they are doing. I have struggled with anxiety for nearly a decade and just recently began seeing a psychiatrist for my medication and she is far more knowledgeable than general practicioners about the matter. This is what they are trained to do and there are lots of combinations of drugs they can give you, it's just a matter of finding the right drug that works for you.
Have you tried therapy yet? Natural methods of relaxation? You may need meds, but they aren't a magic bullet or a cure. As to what meds, that should depend on how you respond. A conservative shrink will prescribe one med first and see how you do. Combining meds happens when one works but not completely, not that meds usually do work completely -- more often they help but don't eliminate completely your symptoms and they do nothing about the cause. If it's occasional panic attacks, an occasional benzo keeps you from becoming addicted to them. If it's a constant problem, an ssri, if it works, is a more constant relief. Shrinks often will just prescribe the two together because they don't know what they're doing, so find one who does and who will only give you as much medication as you need and not more, providing you choose to use meds.
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