DEFINITION

Agoraphobia literally means 'fear of the market place', or fear of open spaces. People with Agoraphobia fear being in a place with no help or escape available if a panic attack occurs.

DESCRIPTION

Agoraphobia affects around 4% of women and 2% of men, and usually begins in the early 20s. Despite its name, the fear associated with Agoraphobia is not exactly of "open spaces", but may include supermarkets, public transport, parties, church, driving and standing in line. Agoraphobia may occur with or without panic attacks.

Agoraphobia is often triggered by a single panic attack in a specific situation. The person then develops a fear of being in that situation again. Agoraphobia has been aptly described as "fear of fear". Often, the fear will extend to places and circumstances other than the original setting. Many people are able to control their fears and keep them hidden from others, while some are so severely affected they become completely housebound and isolated. People with Agoraphobia are mentally sound and are always aware that their fear is irrational, but find it difficult to control.

CAUSE

There may be many factors which play a part in the development of Agoraphobia. Some common triggers include loss or separation such as the death of a family member or close friend, sudden life changes that bring on emotional stress, divorce or marital separation, moving house, youngest child begins school or last child leaves home, change of job responsibility or loss of job, breakdown of family communication, postnatal depression, post operation, viral infections and other illness and the development of a depressive illness.

SIGNS AND SYMPTOMS

There are several specific symptoms that must occur to give a diagnosis of Agoraphobia. These are:
1) Feelings of anxiety about being in a place where escape or help may not be available.
2) The person either avoids the situations or endures them with great distress, or must always take a companion with them.
3) The fear is not the result of another mental illness such as post-traumatic stress disorder or obsessive compulsive disorder.
4) The anxiety is not related to substance abuse e.g. alcohol or drugs.
5) The anxiety is not related to a medical condition, or is much greater than the medical condition would cause.

Physical symptoms of a panic attack may include light-headedness, feelings of being detached or distant from surroundings or from one's own body, buzzing in the ears, blurred vision, dry mouth, tingling in the face and arms, difficulty breathing, a sudden feeling of extreme panic, heart palpitations, indigestion, aches and pains, weakness of the legs, sweating, nausea, trembling and fear of fainting or having a heart attack.

TREATMENT OPTIONS

Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a medical practitioner. Your Doctor may refer you to a specialist in anxiety disorders such as a Psychiatrist or Behavioural Therapist.

The usual approach to Agoraphobia is medication combined with behaviour therapy or counselling. Anti depressant medications are NOT a cure, but may be prescribed to relieve anxiety so the person can concentrate on behaviour therapy. Several behavioural techniques may be used to treat Agoraphobia. The most common is exposure therapy, where the person is encouraged to confront the situation in a controlled manner, often with a support person, then gradually increases the time spent in the situation until the fear resolves and they can do it alone. More than 90% of people with Agoraphobia will be helped by exposure therapy.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Your Pharmacist can help you if you have queries about any medication you are taking.
2) Anti-smoking products can help reduce cravings if you are trying to quit. Ask your Pharmacist for advice about nicotine replacement therapy.
3) Stress management programs may help. Ask your Pharmacist for a recommendation.
4) Caffeine may interact with some anti-depressant or anti-anxiety medications. Check with your Pharmacist.

VITAMINS/MINERALS/HERBS

These supplements may only be beneficial if the dietary intake is inadequate. Consult your Doctor before commencing supplements, as many have adverse interactions with other medications.
- Inositol is a substance made in the body, which may be deficient in people with Agoraphobia. It may help reduce feelings of panic, and has few known side effects.
- B Group Vitamins work in conjunction with Inositol to relieve anxiety and improve mood.
- St. John's Wort may be of benefit in mild to moderate depression, especially when associated with anxiety.
- Ginkgo biloba may be beneficial in relieving anxiety and depression.
- Valerian may be beneficial in relieving stress and promoting restful sleep.

ORGANISATIONS and SUPPORT GROUPS

See the Australian National Association for Mental Health topic on the Healthpoint.

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