Does Sertraline cure agoraphobia? (3+ tips)

In this article, we will answer the question “Does Sertraline cure agoraphobia?”. We will discuss what agoraphobia is and how Sertraline can help in managing this condition. We will also discuss what to do if medicine proves to be ineffective, and various lifestyle changes to help you in the management of agoraphobia.

Does Sertraline cure agoraphobia?

Yes, Sertraline does cure agoraphobia in some individuals. Sertraline is found to have a potential effect on the treatment and management of agoraphobia. It is generally recommended for individuals who show symptoms of agoraphobia. It may help in effectively managing such symptoms in some people (1,2).

Agoraphobia is the anxiety which occurs when a person is in a crowded place from which escape is difficult, or help may not be readily available. People suffering from this condition may stay in a constant state of fear that a panic attack may occur in such situations (3). For this reason, individuals with these symptoms are prescribed medications which can keep their anxiety at bay, providing relief from such stressful situations.

Sertraline has been found to help with agoraphobia and panic disorder in individuals who suffer from both conditions. It may take some time before you start seeing a positive response with Sertraline and improvement in your symptoms. You may also experience some discomforting symptoms at the start of treatment.

What are the different symptoms of agoraphobia?

Agoraphobia is a collection of different situations which manifest as fear in a patient as a response to them or when anticipating entering any of those situations. Two of the following five conditions must evoke fear in a patient to be diagnosed with agoraphobia (3):

• Being in open spaces
• Using public transportation
• Being in enclosed spaces
• Standing in a line or crowd
• Generally even stepping outside the home alone

Agoraphobia can also be accompanied by other depressive disorders like panic disorder which may cause these fears to worsen.

What does research suggest?

Research indicates that Sertraline can be effectively used in the management of agoraphobia. SSRIs, including Sertraline, are found to be helpful in panic disorder and agoraphobia. A research study examined the short-term effects of Sertraline and other SSRIs in the treatment of agoraphobia and associated symptoms such as depression. These medications all proved to be effective and resolved the symptoms (1).

Another research study also proves that SSRIs in general provide high rates of remission and lower adverse events when given to patients suffering from panic disorder complicated by agoraphobia. This study suggests that SSRIs are also a better treatment option for agoraphobia in comparison with other antidepressants (2).

Sertraline and other SSRIs have shown early improvement in agoraphobia alone or even when related to disorders such as panic disorder, social anxiety disorder (SAD), acute stress disorder and post-traumatic stress disorder. When given to such patients Sertraline showed promising results and improvement in symptoms (4).

One review has also assessed data from various studies concluding that when Sertraline was given to individuals with panic disorder it proved to be very effective, especially in patients predicted to have poor outcomes like the presence of agoraphobia. All patients showed clinical improvements in their symptoms and overall mental health (5).

How does Sertraline affect the treatment of agoraphobia?

The pathophysiology of agoraphobia has yet to be studied in detail. So how Sertraline manages this symptom is a bit complicated. Sertraline inhibits the reuptake of the neurotransmitter serotonin resulting in the increased concentration of serotonin in the brain. These increased levels of serotonin regulate mood, personality, depression and agoraphobia.

Another proposed mechanism is the role of the amygdala in response to emotional triggers which cause electrical and chemical stimulation. This stimulation can cause symptoms of agoraphobia. Sertraline causes a reduction in amygdala hyperactivity which can improve symptoms of panic and agoraphobia.

SSRIs, including Sertraline, generally are considered the first-line treatment for agoraphobia whether alone or with another disorder. SSRIs are preferable due to reasons like affordability, lower side effect profile, better tolerability and lower chance of substance abuse (3). SSRIs are also less liable to produce withdrawal symptoms in patients if therapy is abruptly discontinued (6). 

Agoraphobia can be effectively managed with Sertraline, but complete remission is very rare. This is because agoraphobia is commonly associated with paranoia, panic disorder, or social anxiety disorder making it hard to be completely cured (3,6,7). 

What is the dosage and duration of Sertraline for agoraphobia?

Your prescriber will most likely prescribe you the most commonly used dosage of Sertraline for the treatment of depression. The common dosage of Sertraline for depression is 50mg/day. After initiation of therapy, if optimal therapeutic response is not achieved the dose can be periodically increased to a maximum of 200mg/day. The normal duration of therapy is estimated to be around 24 weeks or can be more or less depending on the patient’s response to Sertraline (6,8).

However, your healthcare provider may prescribe you a different dose of Sertraline and for a different duration, based on your symptoms and case evaluation. But this should only be done on your doctor’s approval and you should not try changing your dosage by yourself.

What non-pharmacological approaches can be used to manage agoraphobia?

Sertraline-led pharmacological therapy can also be integrated with lifestyle changes and non-pharmacological techniques to cure agoraphobia. When used in combination with medication these techniques have seen lower relapse rates in symptoms of agoraphobia. Some of them are as follows (9):

Cognitive Behavioural Therapy (CBT)

CBT effectively targets and alleviates symptoms of agoraphobia, lessens other anxiety symptoms, and improves patient quality of life (3). It can help to cope with social anxiety by teaching different coping strategies and mechanisms. It consists of two types of therapies behaviour therapy (BT) and cognitive therapy (CT), giving it the name of CBT. Both techniques are used in combinations by therapists to achieve optimum results.

Exposure Therapy

Exposure therapy can also help people with agoraphobia confront their fear and gradually take control of the situation. It consists of habituating the patient to feared situations in the imagination and then in reality. The patient is made to confront their anxiety and fear in response to any trigger situation, and once that habit develops the individual is exposed to the same situation in real life. This helps with the coping mechanism of the individual.

Relaxation Therapy

Applied relaxation is also one technique found to be as effective as CBT in the management of agoraphobia and panic disorder. This technique consists of coping strategies and exposure treatment. Meditation and relaxation techniques are of great help in dealing with agoraphobia. Different types of breathing exercises can help relax the mind and free it from accompanying thoughts and anxiety.

It is important to note that treatment strategies for agoraphobia may vary for different individuals and proper assessment by a healthcare professional is necessary to determine which strategy will best help you with your symptoms.

What other alternative treatments are available to treat agoraphobia?

Normally SSRIs including Sertraline are the first-line treatment option for managing agoraphobia. If Sertraline and other SSRIs do not help in managing your agoraphobia and depressive symptoms then your prescriber may suggest combination therapy of medication with some non-pharmacological approaches.

However, some individuals may not respond positively to the medication or may have excessive side effects like tremors, metallic taste in mouth, muscle tension, blurred vision, insomnia, decreased sleep, nausea, weight loss, and decreased libido (10). If you experience any of these side effects then your healthcare provider may give you alternative medications like benzodiazepines, serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs) (2).

Make sure you change your medication only after your doctor has recommended to do so because your doctor is the only one who can assess the safety and efficacy of the medication.

Conclusion

In summary, we can say that Sertraline is helpful in the management of agoraphobia, panic disorder and related depressive symptoms. When used in combination with non-pharmacological approaches like CBT and exposure therapy, it can be even more beneficial. Treatment alternatives like benzodiazepines, SNRIs and TCAs are available if Sertraline fails to help with agoraphobia.

References