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 about 1 in 5 U.S. adults in a given year (NIMH). Despite their prevalence, fewer than 40% receive treatment (National Institute of Mental Health).
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.
Evaluation
In a large study of adults with anxiety disorders, about 6 in 10 also had depression at the same time (Lamers et al., 2011). Nearly half of adults with ADHD also have an anxiety disorder (Kessler et al., 2006). 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
We begin with a comprehensive 60-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.
Differential diagnosis before prescribing
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.
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. Nearly half of adults with ADHD also have an anxiety disorder (Kessler et al., 2006). 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.
If you take a benzodiazepine now
The appointment request form asks whether you currently take a benzodiazepine, such as Xanax, Klonopin, or Ativan. If you do, we are happy to discuss your care, including a gradual, medically supervised taper if appropriate, but we will not continue this medication class. Our office responds to appointment requests within two business days.
This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Always consult a qualified physician before making medication or treatment decisions. Content reviewed by physicians at Bay Area Neuropsychiatry who are board-certified by the American Board of Psychiatry and Neurology.