Do I need medication for anxiety? A psychiatrist’s perspective.

Choosing to start any psychiatric medication is a big decision, and one many people struggle with for months or years before actually doing so. While there is no cut-and-dry answer to this question, I hope that this post will offer some help to those currently dealing with a lot of anxiety.

First, let’s clarify what “medication” really means. For someone coming in for an initial appointment for anxiety, the most typical medications used are SRIs (serotonin reuptake inhibitors). Others include buspirone, beta blockers, hydroxyzine, and benzodiazepines, but these are less commonly first-line choices, especially benzodiazepines. SRIs are usually dosed once daily and take 4-6 weeks to really start working. Even then, if the dose is too low, you may need to increase the dose and then wait another 4-6 weeks. So right off the bat, I tell patients that if you are considering a medication, you should mentally prepare for a minimum of 6-12 months of treatment before we consider stopping the medication. Any less than this and you risk either not seeing the full benefit, or stopping too soon and having a relapse of symptoms.

Next, let’s nail down that word “anxiety,” because it is not really a diagnosis in and of itself. Calling anxiety a diagnosis is a bit like diagnosing a fever and stopping there. Using this analogy, if you were to give everyone with a fever Tylenol, their temperature may drop temporarily. But the underlying cause of the fever will remain untreated - sometimes a mild virus, other times a more serious bacterial or septic infection requiring antibiotics. So saying “anxiety” is certainly a place to start, but we must dig deeper to find the root cause. Examples of diagnoses I end up making for patients coming in with a chief complaint of anxiety include:

• Generalized anxiety disorder

• Panic disorder

• Major depressive disorder

• Attention-deficit/hyperactivity disorder (ADHD)

• Bipolar disorder

• Personality disorders

Giving all of these conditions the same dose of Lexapro will get you vastly different outcomes.

Not everyone requires medication to treat anxiety. Many people see great resultst from therapy alone, whether that is CBT (cognitive-behavioral therapy) or another style. That said, if you are someone who has been in therapy for months or years and are still not seeing any relief from your anxiety, then you may benefit from seeing a psychiatrist to start a medication. Similarly, if you have already tried multiple medications but have not seen any benefit, I would encourage you to not give up hope. If you have only seen your primary care doctor for this and tried a string of SRIs (an extremely common scenario), you may have been simply taking Tylenol for your fever all this time. Reach out today to schedule your first appointment if you are ready to approach your anxiety differently.