Is There No Hope for My Treatment-Resistant Panic Disorder?

Reader’s Question

I seem to have treatment-resistant Panic Disorder with Agoraphobia. I say this because, as far as I am aware, I have tried every conceivable treatment for my anxiety disorder. This long list includes: multiple SSRIs, tricyclic antidepressants, beta blockers, off-label uses of medications such as Seroquel and Neurontin, Vistaril and other antihistamines, BuSpar, various benzodiazepines (causing a stint in the hospital detox ward), psychotherapy, Cognitive-Behavioral Therapy (CBT), EMDR, multiple psychiatrists and combinations of all the above.

I’m more than a bit weary and tired of the whole ordeal as I imagine anyone in my place would be. What does someone do that seems to have treatment-resistant anxiety? Is there something else which I have not considered? I’m in my early twenties; this seems a bit too young to settle for this style of life.

Our Clinical Psychologist’s Reply

Truly treatment-resistant anxiety disorders are rare, inasmuch as anxiety disorders enjoy some of the highest treatment success rates among the various mental conditions. The fact that you are still struggling with your disorder is of concern enough, but having been given so many medications and subjected to so many treatment modalities is of even greater concern. While it’s not possible to assess your situation remotely with any accuracy, there are a few things I might offer for your consideration.

First, Agoraphobia is not actually a true “phobia.” Literally meaning “fear of the marketplace,” sufferers hesitate to go out of secure environments, especially to unfamiliar, wide-open, or well-populated places. They don’t actually fear the marketplace, however. What they fear is having panic symptoms, which more commonly occur when they’re in a relatively insecure or unfamiliar environment. Once sufferers accept the notion (which should be an integral part of the “cognitive” component of CBT) that anxiety symptoms may be distressing but are never truly debilitating or dangerous, they can learn to “live with” the symptoms and eventually pay them so little heed that they lessen in intensity.

Second, Panic symptoms often occur as part of a vicious cycle. Although the symptoms are the result of anxiety, they also provoke a fearful response. This response often intensifies the symptom, which intensifies the anxiety, etc., ad infinitum. Breaking the vicious cycle of panic has to do with accepting the symptoms as the distressing but harmless manifestation of anxiety, thus allowing the symptoms to run their course and dissipate in intensity.

Lastly, anxiety and panic symptoms often have the “secondary gain” of helping us avoid situations we’d rather not face. These need not necessarily be situations we consciously try to avoid. They might, in fact be situations that cause us unconscious apprehension (e.g., situations in which we are functioning autonomously or without a “safety net”). The more we systematically make ourselves do the very things we hesitate to do, the more such unconscious apprehension eventually abates.

Of course none of these comments is meant to supplant your treatment. But hopefully, you have some food for thought in dealing with your symptoms. For a time, you might have to “learn to live with” a certain level of distress. But if you use CBT techniques to break the vicious cycle of panic, change your perspective on the nature of your symptoms, and reinforce yourself for doing the things your symptoms might otherwise prompt you to avoid, you should find your symptoms abating over time.