Psychiatric Care for Anxiety

Anxiety becomes a disorder when worry or fear is persistent, hard to control, and starts to limit work, school, sleep or relationships. It can look like constant worry, restlessness, physical tension, avoidance, or a mind that will not settle. In children it often shows up as stomachaches, clinginess or reluctance to go to school.

How our physicians help

Our physicians take time to understand what drives the anxiety and how it fits into the rest of your life. Treatment can combine psychotherapy, such as cognitive behavioral approaches, with careful medication management from the same physician. For young people, we work closely with parents and, with permission, with schools.

Signs of an anxiety disorder in adults

• Your mind jumps to the worst case about health, money or family, even on good days.
• Your jaw, neck or shoulders are sore by evening.
• You feel worn out in a way that a weekend of rest does not fix.
• You put off calls, appointments or mail because of what they might bring.

How anxiety appears in children and teens

Adults usually spot it in behavior first, since young people rarely say they feel anxious.

• Asking the same what-if questions many times a day.
• Headaches or nausea on school mornings that ease on weekends.
• Spending hours on homework out of fear of making a mistake.
• In teens, dropping activities or staying alone in their room more often.

Finding out which kind of anxiety it is

Anxiety is a family of conditions, and the type guides treatment. Generalized anxiety disorder means worry about many everyday things, on most days, for months. A specific phobia is an intense fear of one thing, such as flying or needles. Separation anxiety is a fear of being apart from the people you feel safest with. We also ask about panic and social fears, which call for their own plans.

We ask when the anxiety began, what you have stopped doing because of it, and whether it runs in your family. We also look for depression, ADHD, OCD or past trauma, and ask about caffeine, alcohol and cannabis. Some medical problems can feel like anxiety, including an overactive thyroid, heart rhythm problems, and side effects from steroids, stimulants or some asthma inhalers, so your physician may suggest lab work.

Therapy and medication for anxiety

In cognitive behavioral therapy (CBT), you learn to catch anxious predictions, check them against what really happens, and slowly stop avoiding what you fear. For a phobia, the center of treatment is exposure therapy, meeting the fear in small, planned steps. With acceptance and commitment therapy (ACT), the aim is to let worried thoughts come and go while you do what matters to you. All of these take practice, and anxiety can rise for a while when you start facing what you have avoided.

The medicines used most for ongoing anxiety are SSRIs and SNRIs, two classes of antidepressants. They usually need several weeks to start helping, and side effects can include nausea, trouble sleeping and reduced sex drive. Benzodiazepines are calming medicines that work quickly, but drowsiness and dependence are real risks, so physicians use them with caution. If you already take one, stopping suddenly can be dangerous, so talk with your physician before making any change. Antidepressants carry a safety warning for children, teens and young adults about new or worse suicidal thoughts, so if one is considered for a young person, we explain what to watch for and follow up closely.

When to call us about anxiety

If anxiety has worn you down to the point of hopelessness or thoughts of suicide, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

Short of a crisis, many people improve with care, even after years of living this way. These are good reasons to call us:

• Worry has filled much of your day for several weeks.
• You are turning down work, travel or invitations to avoid feeling anxious.
• You count on alcohol, cannabis or sleep aids to settle down.
• A child is missing school, activities or sleep because of fear.

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