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Doctor Rao
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Category: Mental Health
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Experience:  MBBS,MD,DPM,MRCPsych
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I get irritated/anxious in crowed/loud places. what is cause

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i get irritated/anxious in crowed/loud places. what is cause and or solution?
It must be frustrating for you.
There are few causes like hyperacusis post stroke,anxiety,Migraine.
However the common cause based on your description might be Agoraphobia.
Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment to be difficult or embarrassing to escape. These situations include, but are not limited to, wide-open spaces, as well as uncontrollable social situations such as may be met in shopping malls, airports, and on bridges.
Although mostly thought to be a fear of public places, it is now believed that agoraphobia can develop as a complication of panic attacks.
It is important for you to see a Psychiatrist and get the diagnosis because that would give the Doctor an opportunity for complete assessment,rile out any possible physical causes and make a formulation to help the management.
Now coming tot he management--
Cognitive behavioral treatments
Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and sub clinical agoraphobic avoidance, and not simply of panic attacks (if present) should be the aim of exposure therapy.Similarly, Systematic desensitization may also be used. Many patients can deal with exposure easier if they are in the company of a friend they can rely on. It is vital that patients remain in the situation until anxiety has abated because if they leave the situation the phobic response will not decrease and it may even rise.
Medical treatment if required --
Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin re uptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, are also commonly prescribed for treatment of agoraphobia. Lorazepam is a type of Benzodiazepine.
You have mentioned you were taking Lorazepam 1 mg. It is helpful for anxiety but in the long term has problems like tolerance and dependence if used regularly. One option you can try is to split the dose of 1 mg to two 0.5 MSG and take twice daily when required.
Antidepressant medications are helpful in the longterm and not Addictive.
I hope you find the answer helpful.
I wish you all the best.
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Thank you
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