I am trying to find information regarding how countries other than the United States treat panic disorders with or without agoraphobia–for example, Japan or Africa, Spain…basically wherever as long as it differs from the U.S. in some way. I’ve tried googling but have had no luck.

If you know, do you mind stating your source? I will have to cite it, as this is for a paper. I need to get a global perspective on this disorder.

Thank you!

Generally, the standard of care includes benzodiazepine drugs (Valium, Librium, Ativan, Xanax, Klonopin, etc.) along with a form of talk therapy.

In America, it is more common to use SSRI/SNRI drugs first, then sedating anti-histamines, before trying benzodiazepines. SS/N/RI drugs are anxiogenic (anxiety-creating) substances, and therefore a very poor choice for anyone with even mild anxiety or panic. In depressed patients (who also don’t gain much benefit from the drugs, sadly), "anxiety" is listed as one of the most common effects of the SS/N/RI drugs (Prozac, Paxil, Zoloft, Effexor, etc.), and depressed patients are often given a two to four week course of benzodiazepines in order to control the anxiety that the anti-depressant invoke.

Treating anxiety with SSRIs is literally homeopathy – "like cures like". Homeopathy believes that a fever-inducing substance will cure a man with a fever (in reality, it will make his fever worse), and an anxiety-inducing substance will cure a person of anxiety (in reality, it makes anxiety worse).

I believe SSRIs are used for treating anxiety because they are non-controlled substances, and therefore the doctors prescribing them draw no attention from the DEA (which, unfortunately, is trying to tell doctors how to practice medicine, and cracking down on those who don’t toe the party line – cops shouldn’t be telling doctors what to do, nor vice-versa – this is the reason that many people do not receive adequate pain management in America, nor adequate treatment for psychiatric conditions, besides schizophrenia or bipolar disorder). They are addictive, just like benzodiazepines (which is an argument put forth by many uninformed doctors: "Antidepressants aren’t addictive!" – take Effexor for two months and then quit – and tell me they’re not addictive then) and the treatment of psychiatric patients has been harmed greatly because of it.

It’s a travesty – treating anxiety with anxiety-inducing drugs. Treating depression with pills that are no more effective than placebo, and many times more harmful (cf. medical study reviewed in current Newsweek, a meta-study of EVERY WELL-CONTROLLED STUDY ever conducted on anti-depressants).

In addition to neuroleptic drugs like Abilify, Risperdal, and Seroquel, which cause depression directly through dopamine and serotonin-antagonism (if serotonin deficiency is the cause of depression, how can both serotonin-agonists and -antagonists help it? answer: neither do.), and have a whole host of deforming, disabling, possibly permanent and deadly side-effects (Parkinsonism, Diabetes, Neuroleptic Malignancy, Prolactinemia, etc.).

These drugs were approved because they were designed to sedate the acutely-agitated psychotic (hallucinating, hearing voices) and violent patient – more dangerous side-effects are considered tolerable when dealing with controlling someone who is being told to kill the psych ward staff by the television.

I know this as a psychologist who personally suffers from panic disorder, currently taking 1mg of (brand-name: don’t settle for generic in psych drugs unless you can’t afford them: the difference is sometimes over 25% active ingredient, under law, up to 20% weaker is permissible in generics) Klonopin (clonazepam, a long-acting benzodiazepine) three times a day, along with 150mg of Lyrica, three times a day, and 10mg of baclofen three times a day for panic disorder and anxiety. The only meds that have ever worked, and I have taken everything from MAOIs, TCAs, neuroleptics, both typical and atypical, SSRIs, SNRIs, sedating antihistamines, anti-epileptics, and the works – over 30 different drugs – before finding ones that worked, and will work for mostly anyone. The other shut functions through placebo effect, and all of the anti-depressants, excluding a few of the TCAs (Nortriptiline and Amitriptiline) worsen anxiety.

Along with 22mg of buprenorphine a day for my heroin addiction, all’s peachy. I’m still nuts, and don’t feel normal (the only times I have in my life were the four hours after each shot of heroin) and not yet fit to practice again, but as good as I’ve ever felt on legal, prescribed medication.

Don’t let the doctors give you bullshit for anxiety. Demand a benzodiazepine (stay away from Xanax, IMO), and if not, at least Lyrica or Neurontin. The others range from ineffective to hellish.

You’d be surprised how many headshrinks are diagnosed themselves. It’s usually why they get in to the field – at least it was for me.

I am coming to accept that my disorder is serious and while simple to treat, the recovery is far from easy. Let me share some of my experiences with you. Maybe some of what I will help and maybe not. I am no expert on agoraphobia and I am still suffering from it.

Things that have helped me:

1) Cognitive behavioral therapy (CBT) helps you look at your limiting thoughts and practice "exposure" to things you are afraid. It helps having a calm and caring professional by my side.

2) Online support at www.PanicSurvivor.com. These people have a fighters attitude when it comes to dealing with anxiety. It is by far my favorite community that deals with anxiety.

3) Turning to friends and loved ones. My friends and family have been supportive, although I let them enable me sometimes. My friends have gone on exposures with me and told me to do it.

4) Have a good cry. When I cry and get the feelings out, my anxiety lessens. I used to cry before exposures, which helped me release all the negative feelings.

5) Working with a psychiatrist. I admit medications have not worked for me yet, but I keep trying. Research has found that a combination of medication and CBT works best. However, CBT alone is pretty effective too.

6) Reading books by people who understand. Bourne’s "Anxiety and Phobia Workbook" is a classic. Also, "Wish I Were There" is a memoir about agoraphobia. What I liked about the memoir by Allen Shawn is that is realistic. The man still has agoraphobia, but he is coping with it better.

7) Spirituality. I am not religious, but I have come to believe in a Higher Power to make sense of my senseless condition. I don’t think you have to be spiritual. But it helps me to rely on something greater than myself.

Self-care. I am working to eat right and exercise and get plenty of rest. Agoraphobia is stressful and takes its toll on my nerves. When I take care of myself, I send the message that I am important and worthy of love. Love tends to displace panic.

There is a lot more that I do, but I don’t want to bore you with all the details. Google agoraphobia, panic attacks, and anxiety. There is a lot of good information out there. Good luck.

* Medication is not effective. It actually makes things worse. Research at Stanford University School of Medicine showed that test subjects taking anti-anxiety medication had ten times as many panic attacks when flying than subjects taking a placebo.
* Hypnotism is “hit or miss”. It can’t be relied on.
* Courses by pilots offer statistics on how safe flying. Great. But planes so sometimes crash. How does a person deal with the fear that your flight could be the statistic?
* Cognitive therapy works for people whose feelings develop slowly, but not for those whose feelings develop too rapidly – or too intensely – for the the mind to remain clear enough to use the cognitive “tools”. What is needed is an automatic way to control feelings.

We are born with half of the emotion regulation system in place, the half that revs us up. The half that calms us down does not exist at birth. By eighteen months a part of the brain develops that can let the child calm itself. The child memorizes the steps caregivers use to provide calming. If the steps are highly effective, the child can calm itself independently using the steps memorized.

Obviously, caregivers – regardless of how much they care – vary in their ability to tune in the child and assure the child effectively. As a result, few of us get an optimal ability to calm ourselves.

During teenage years, we tend to think bad things only happen to others. This youthful optimism gets us by for a few years without excessive anxiety. But as we mature, we realize something can happen to us. We then turn to strategies to keep anxiety when dealing with uncertainty under control. The strategies typically involve control and escape.

Control: when control of anxiety is not naturally available, we depend on control of situations to avoid anxiety. When driving a car, we believe we can make everything work out alright. Though driving is not as safe as flying, we feel safer because the wheel is in our own, not someone elses, hands.

Escape: if there is a car accident, there may be a chance of surviving. If a plane, people mistakenly believe that if something goes wrong they are doomed. In a plane, if something goes wrong, backup systems are used. Backup systems make flying safer than driving. But these systems are in the cockpit where they seem theoretical. Though backup systems provide greater safety in a plane than is available in a car, the systems are not as real to a passenger as a steering wheel is in the hands of a driver.

Since the backup systems are not concrete enough to make passengers feel safe, many try to escape psychologically by keeping their thoughts elsewhere throughout the flight. If, due to turbulence, the person cannot keep the flight out of mind, there is no way to keep feelings under control.

I need you to understand that the feelings you are troubled by are caused by stress hormones, mainly adrenalin and cortisol. They rev you up. When you get several “hits” of these stress hormones – caused by several thoughts, worries, concerns, etc. – you get claustrophobia, high anxiety or even panic.

We prevent the release of adrenalin and cortisol by causing the release of oxytocin. Oxytocin shuts down the amygdala, the part of the brain that triggers the release of the hormones that cause fear.

We cause the release of oxytocin by linking each thing that happens on a flight, and each thing you worry about, to the memory of a moment that causes oxytocin to be released. Once the links are established between an oxytocin-producing moment and troublesome moments of flight, high anxiety and panic are automatically controlled. This is an advanced way of controlling the feelings, and it was not possible to do this until research using brain scan technology showed us how the brain works.

To establish the links, a person follows step-by-step the linking sequences. Videos with more information on how this is done can be found at http://www.youtube.com/watch?v=Zcx6ZsvKHSA

everyone has threir sh*t to deal with. I have agoraphobia also, worse than yours right now. but what i dont understand is why you really feel the need to change it, just find ways to go around it.

get a at home computer job. the worst that you’ll have to face is going out for an interveiw. i did it so can you. most of them supply plenty of money for bills, living, & delivered geroceries!!!!

as for family and friends, they will come to you if they really love you. but if you want to go to them then have them pick you up 3 times and drive you to their place at different times of the day to see your ansiety, then you can choose the most comfortable time for you, then drive yourself!

you have this for a reason, """"dont change for the world, make the world change for you.""""

by diversion tactics, do you mean distraction techniques?
these can be something as simple as saying the alphabet backwards to yourself.
counting in a foreign language to yourself
trying to think of actors beginning with the letter B !!!

I find it helpful to start describing what I am looking at. It means that I am focusing on this instead of the panic inside me.

I want to get rid of my agoraphobia so that I can go out and do things without constantly being anxious. I always feel that I’m too ugly to go out in public and that everyone is watching and judging me when I go into a place with a lot of people. Outside of my job, I spend all my time at home on the computer.

Make an appointment with your doctor and seek a referral to a counselor that can help cure Agoraphobia, preferably one that specializes in anxiety disorders. The counselor will help you gain back control of your life by discussing your triggers and symptoms, and helping you understand what is happening. Ask for medications that can help with the symptoms.

Take small steps to take back control of your world. Does even thinking about going out the door starts your anxiety symptoms? Start there, at your smallest anxiety point. Stand at the door and open it. While standing there, take slow and steady deep breaths. Reassure yourself with calming affirmations such as, "Everything is fine," "I am OK" or "This is only temporary" — anything that helps make you feel better. Stay in that spot until the anxious feelings go away.

Keep pushing yourself and the anxiety. Yes, you will have to endure the panic attacks. But they will get better. The symptoms will lessen and even go away in time. Once you can go to the doorway without worry, take a step outside. Stay there until the panic attack subsides. Keep taking that step outside until you can finally do it without any anxiety.

Continue going past your comfort zone (usually your home). You will want to flee back to your comfort zone when a panic attack starts. However, you must stay where you are until the panic attack subsides. Eventually, this will cure Agoraphobia. You are teaching yourself that you will survive even after having a severe panic attack, and that the places you fear are not unsafe.
Good luck! Take care always……………..

I did do a few things to make it easier one me, though. I took someone with me, which helps a lot when I have to go out into the public. Also, I let the dentist know that I suffered from agoraphobia so he would understand if I started having a panic attack. After that, I just shut my eyes and let him do what he had to do. I thought I was going to lose it, but eventually it was over, and I was extremely happy to be out of pain.

So my suggestion — if you’re in that much pain — just do it. You may panic and it will probably be horrible, but it’s not going to kill you. Once it’s over, you’ll be glad you went.