Agoraphobia And Depression

Introduction

Definition of agoraphobia

Agoraphobia is characterized by the avoidance and fear of places that may trigger feelings of helplessness, embarrassment, and panic. It is a type of anxiety disorder caused by a feeling of fear that you cannot escape. Agoraphobia usually develops after experiencing one or multiple panic attacks. People live with the fear of having another panic attack, so they avoid situations and places that cause them.^1,2

Definition of depression

Depression is characterized by a persistent feeling of loss of interest and sadness. It is a mood disorder that influences your behaviour, thoughts, and feelings and can lead to multiple physical and emotional problems. People who struggle with depression experience a variety of symtpoms, ranging from  completing daily activities, to having suicidal thoughts.³

Overview of the Link between agoraphobia and depression

There is a link between these two disorders as they can be experienced simultaneously. The relationship between agoraphobia and depression is complex. Agoraphobia can be a risk factor for depression since people tend to avoid certain places and situations leading to feelings of helplessness, isolation, and hopelessness.⁴

Understanding agoraphobia

Symptoms and causes

The symptoms of agoraphobia can be separated into physical, cognitive, and behavioural. Physical symptoms include:⁵

• Increased heartbeat
• Hyperventilating
• Chest pain 
• Diarrhea
• Trembling
• Tinnitus
• Feeling sick/faint
• Dizziness
• Dysphagia
• Sweatiness 

Cognitive symptoms include:⁵

• Panic attacks can cause feelings of embarrassment 
• Panic attacks can cause worry about dying
• Panic attacks can cause a loss of ability to escape a place or situation
• Losing sanity
• Losing control 
• Fear of being unable to function without help
• Monophobia
• Feeling of anxiety

Behavioural symptoms include:⁵

• Avoidance of situations that can lead to panic attacks
• Not able to leave your house
• Avoidance of being far from home
• Wanting to be with someone every time you go somewhere

Agoraphobia can be caused by panic attacks but can also occur on its own. There are multiple risk factors for developing agoraphobia such as:^1,5,6

• Other phobias
• Stressful/traumatic events
• Anxiety disorder sensitivity
• Family history of agoraphobia
• Substance abuse
• Relationships (unhappy/controlling)

Diagnosis and Treatment

If you think you have agoraphobia you should visit your GP. Your GP will ask you information about your symptoms, their frequency, and how they affect your daily life. You should try to be as honest as you can about your symptoms. Doctors use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to diagnose agoraphobia. The DSM-5 criteria state that if an individual experiences increased anxiety of fear at least two of the following situations, they can be diagnosed with agoraphobia: enclosed spaces, open spaces, crowds, public transport, being alone outside the house. Moreover, your doctor may decide to do a physical examination and carry out blood tests.^1,5,6

Understanding Depression

Symptoms and Causes

The symptoms of depression can be divided into 3 categories. Psychological symptoms include:^3,7,8

• Hopelessness and helplessness
• Low self esteem 
• Sadness
• Tearful 
• Low mood
• No enjoyment in anything
• No motivation
• Anxiety
• Worry
• Self-harming
• Suicidal ideation 
• Cannot make decisions 
• Ridden by guilt 

Physical symptoms include:^3,7,8

• Talking slowly
• Moving slowly 
• Appetite changes
• Aches
• Menstrual cycle changes
• Constipation
• No energy
• Disturbed sleep 
• Libido loss

Social symptoms include:^3,7,8

• Hobby and interest neglect
• Involvement in fewer social activities
• Avoidance of contacting friends
• Experiencing difficulties in work, home, or family

The exact causes of depression are not known, however, several factors may contribute to its development, such as:^3,7,8.9

• Changes in neurotransmitter function involved in mood stability
• Physical changes in the brain
• Family history of depression
• Changes in the balance of hormones (e.g., giving birth)
• Other health conditions (e.g., mental health conditions, cancer)
• Stress/Trauma (e.g., loss)
• Personality traits (e.g., low self-esteem)
• Loneliness (e.g., being cut off from family/friends)
• Substance abuse
• Gender identity 
• Vitamin D deficiency
• Socioeconomic status
• Sex (more common in females)

Diagnosis and Treatment

You should go to your GP if you are experiencing symptoms of depression for a long time (more than two weeks), if your symptoms are not improving, if your life is affected by these symptoms, and/or if you have suicidal thoughts. Your doctor will ask you about your symptoms and if necessary, they may order blood and urine tests to rule out other health conditions. Your mental health professional may ask you to fill out some questionnaires and will ask detailed questions about how you feel and think. The DSM-5 criteria will be used to make a diagnosis.^3,7

Depression is a mental health disorder that can be treated. It is usually treated withpsychotherapy or medication or a combination of these two. Psychotherapy refers to talking about your condition with a mental health professional. Psychotherapy encompassesdifferent types of therapeutic methods that have proven to be effective for depression, such as interpersonal therapy or cognitive behavioural therapy (CBT) ().^3,7

The medications used to treat depression are called antidepressants. There are several types of antidepressants available, such as:^3,7

• SSRIs (Selective serotonin reuptake inhibitors)
• Atypical antidepressants
• MAOIs (Monoamine oxidase inhibitors)
• SNRIs (Serotonin-norepinephrine reuptake inhibitors)
• Other medications

The Link between Agoraphobia and Depression

Shared Symptoms and Causes

Some causes and symptoms are shared between agoraphobia and depression, making it difficult to distinguish between the two and provide an accurate diagnosis. In terms of risk factors, both agoraphobia and depression can be triggered by stressful life events, traumatic experiences, genetics, substance misuse, or brain chemistry (neurotransmitters). The combination of these risk factors can account for the manifestation of each disorder. Therefore, althoughboth disorders have common risk factors, their underlying causes are more difficult to determine.  The main symptoms, such as hopelessness, helplessness, and social withdrawal are shared between agprphobia and depression, making their distinction difficult.¹⁰

Comorbidity

Besides sharing symptoms and causes, agoraphobia and depression are commonly comorbid conditions which means that they can occur together. According to research, up to two-thirds of people with depression have a current or have had an anxiety disorder diagnosis such as agoraphobia and vice versa.¹¹ The presence of one of the two disorders  is a risk factor for the other.¹²

Treatment Implications

Given the high comorbidity rate between agoraphobia and depression, the treatment implications of the two disorders are complex. The most widely used and effective treatments are psychotherapy and medications.

• Psychotherapy: this is a common treatment for agoraphobia and depression, also known as “talk therapy”. In psychotherapy, you meet with a mental health professional to discuss your feelings, thoughts, and behaviours to develop problem-solving skills and coping strategies. The most common form of psychotherapy used is CBT.^5,6,7,8Medications: either as a standalone treatment or in combination with psychotherapy, medications are a common treatment option for both agoraphobia and depression. The most common medications used for both disorders are antidepressants, mood stabilizers, and anti-anxiety medications^5,6,7,8
• Alternative therapies: apart from medication and psychotherapy, people with agoraphobia and depression can develop coping strategies as alternative therapies. Alternative therapies include exercise, meditation, yoga, and acupuncture^5,6,7,8

Coping strategies

In addition to the traditional treatments listed above, people with agoraphobia and depression may benefit from implementing coping strategies to use in their daily lifeto manage their symptoms. Some coping strategies are:^5,6,7,8

• Self-care: self-care activities such as a having nutritious diet and getting enough sleep can be very beneficial for your mental health by making you feel in control and improving your general health 
• Lifestyle changes: lifestyle changes such as exercising, avoiding drugs and alcohol, and reducing stress in your life can be helpful for managing your symptoms
• Support groups: There are several charities that are useful resources for getting information about how to manage your disorders and getting in touch with other people who have similar experiences. This can be a validating experience and provide a sense of community^13,14

Summary

Agoraphobia and depression are two mental health disorders that can co-occur and have shared symptoms and causes. The most common treatments for these two disorders are medication and psychotherapy. However, other coping strategies such as self-care, support groups, and lifestyle changes can be very beneficial. It is important that you seek professional help and develop a comprehensive treatment plan that includes a combination of these therapies.