Clinical Focus
Anxiety Disorders
Thorough evaluation differentiating anxiety from medical mimics and overlapping psychiatric conditions.
What is it?
Anxiety disorders are a group of conditions characterized by excessive fear, worry, and related behavioral disturbances that persist beyond what is appropriate and interfere with daily functioning. They affect approximately 40 million adults in the United States each year. Despite their prevalence, fewer than 40% receive treatment.
The major anxiety disorders include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, specific phobias, and agoraphobia. They frequently co-occur with one another and with other psychiatric conditions, particularly depression and ADHD.
Clinical Presentation
Generalized anxiety disorder presents as persistent, excessive worry about multiple domains of life that the individual finds difficult to control, accompanied by muscle tension, restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbance.
Panic disorder involves recurrent, unexpected panic attacks with rapid heartbeat, chest tightness, shortness of breath, and a sense of impending doom. Many patients first present to emergency departments convinced they are having a heart attack.
Social anxiety disorder goes beyond shyness. It involves intense, persistent fear of being judged or embarrassed in social situations. Adults may avoid meetings, decline promotions, or isolate themselves. Many adults with anxiety experience primarily physical symptoms: chronic headaches, gastrointestinal distress, dizziness, and unexplained pain.
Our Approach
Approximately 60% of individuals with an anxiety disorder also have depression. Between 25% and 50% of adults with ADHD have a comorbid anxiety disorder. Anxiety is a common feature of PTSD, OCD, and bipolar disorder.
The diagnostic challenge is determining whether anxiety is the primary condition or a symptom of something else. Hyperthyroidism, cardiac arrhythmias, pheochromocytoma, and medication side effects can all mimic a primary anxiety disorder. ADHD and anxiety have a particularly complex relationship: the executive dysfunction of ADHD generates secondary anxiety, but anxiety can also produce concentration difficulties that mimic ADHD.
Treatment Approach
We begin with a comprehensive 60 to 90 minute assessment. When medication is indicated, we use evidence-based first-line agents: SSRIs or SNRIs. For acute relief, we use non-benzodiazepine options including buspirone and hydroxyzine.
We do not prescribe benzodiazepines. While effective short-term, they carry significant risks including dependence, cognitive impairment, rebound anxiety, and dangerous withdrawal. Patients referred to us on benzodiazepines will be evaluated for safe, gradual taper. We coordinate closely with therapists trained in CBT and exposure-based therapies.
Why This Is Different at Our Practice
The most important thing we do for anxiety patients is thorough differential diagnosis before prescribing. Anxiety symptoms can be caused by thyroid disorders, cardiac arrhythmias, medication side effects, and undiagnosed ADHD. We evaluate for these contributors before attributing symptoms to a primary anxiety disorder.
We are explicit about what we will not do: we do not prescribe benzodiazepines. This is a practice-wide policy. For patients currently on benzodiazepines, we offer careful, gradual tapering supervised by experienced physicians.
Psychiatrist: Dr. Lodhi, Dr. Patel, and Dr. Staley
Frequently Asked Questions
Do you prescribe benzodiazepines for anxiety?+
No. We use evidence-based alternatives including SSRIs, SNRIs, buspirone, and hydroxyzine. Patients already taking benzodiazepines will be evaluated for a safe, gradual taper.
How do you determine if my anxiety has a medical cause?+
Our evaluation considers medical conditions including thyroid disorders, cardiac arrhythmias, and medication side effects. We may order lab work or recommend medical follow-up based on your presentation.
Can anxiety and ADHD occur together?+
Yes. Between 25% and 50% of adults with ADHD also have an anxiety disorder. Our evaluation determines which condition is primary and whether both require treatment.
How long does anxiety medication take to work?+
SSRIs and SNRIs typically take 4 to 6 weeks to reach full effect. Non-benzodiazepine options like buspirone also require several weeks. We discuss timeline expectations at your first visit.