I am Dr. Kedar Tilwe, a consultant psychiatrist and we shall be discussing this condition very common and yet very very underreported. Agoraphobia is the fear of a situation turning unsafe or from a situation where escape may not be possible. Do you feel scared of public transport, petrified of traveling across bridges, get terrified when you are in traffic jams for no possible reason; well this could be signs of Agoraphobia. A very peculiar phobia which affects about 1-2% of the people during their lifetime. Also, by its corollary, it encompasses situations in which help might not be available. So, agoraphobia is a very very common condition like I said up to 2% of the general population. So how do you handle this?
Well first you need to know the signs and symptoms. Typically, a panic attack occurs when in a situation where help might not be available this can include like we had mentioned bridges, public transport, open spaces, social gatherings, cinema halls, crowded spaces, it can also sometimes occur when you are trying to fly. There is no particular reason or precipitant but an uneasy sensation occurs. Panic attack typically consists of 15 minutes of building up, 15 minutes of maintaining and 15 minutes of disappearance of intense symptoms of ghabrahat, palpitations, coldness of the extremities, feelings as if someone is choking you, shortness of breath, giddiness; four out of all of these symptoms are acquired and they disappear without any provocation also but when they do occur it's extremely intense. Now because of these symptoms, a person starts to fear and avoid situations which could lead to a panic attack or where the agoraphobia may be precipitated. It can also lead to situations where a person might feel there will be a social embarrassment and so he will avoid or she will avoid stepping out of the house for the simple fear of social embarrassment or a panic attack occurring.
While a very very common condition, a very easily treatable condition, this causes a lot of morbidities. So, what do we do if these are the symptoms you have? Well, remember that these symptoms need to last for at least 6 months before treatment and before diagnosis. However, if the symptoms are very very debilitating we do not have to wait for that span. How do you manage it? Well, everything has to be classified, so we'll classify the treatment also.
The first thing is lifestyle alterations. Then comes things that you can do at your home, this includes relaxation exercises. We will talk about CBT and finally about medicines. Lifestyle altercations which they have to be factored in when you try and handle agoraphobia include reducing coffee intake, stopping the alcohol remember self-medicating with alcohol does not help over a long run it just disarrays your symptoms completely, avoid cigarettes and that's about it. Relaxation exercises help, known panicogens have to be avoided. Therapy including CBT and REBT can have a beneficial effect however the symptoms if they are pronounced they may require treatment with SSRIs, SNRIs and sometimes SOS treatment with benzodiazepines. So if you feel these symptoms, do reach out to a psychiatrist near you. They'll be happy to help.