Anxiety disorders

Anxiety is the most common reason people first seek psychiatric care and the symptom most likely to be treated in isolation. In this practice it is evaluated in the context of mood, sleep and the course of your life, because that is where the answer usually lies.

Who this is for

• Generalized anxiety — persistent worry, tension and restlessness that color most days.
• Panic disorder, with or without agoraphobia.
• Social anxiety that limits work, relationships or opportunity.
• Anxiety that accompanies depression or bipolar disorder, or that appeared first and was followed by a mood disorder.
• Anxiety that has not responded to first-line treatment, or that has led to long-term reliance on sedative medication.

How I evaluate

The evaluation distinguishes primary anxiety disorders from anxiety that is a feature of a mood disorder, a medical condition, a medication effect or a sleep disorder — distinctions that change the treatment entirely. It also looks carefully at what prior treatment has and has not done, and at the role any sedative medication is currently playing.

Treatment

• Medication. First-line agents chosen for long-term tolerability, with a clear plan for how and when they will be reviewed.
• Psychotherapy. Cognitive-behavioral and exposure-based approaches, which for many anxiety disorders are as effective as medication and more durable.
• Treating the whole picture. When anxiety rides on a mood disorder, treating the mood disorder is often what resolves the anxiety.