Anxiety

While this sounds simple, it is often the missing piece of the puzzle.  Anxiety can stem from several different underlying problems.  Some examples include: a combination of recent events, previous life experience, childhood experience, genetics, lifestyle, personality traits, nutrition, substance use, supplements, and insomnia. All the relevant factors need to be identified and subsequently addressed over time.

After we identify all the contributing factors, we work together on a treatment plan that takes a step-by-step approach to eliminating your symptoms of anxiety while also addressing the underlying causes.  I have to get you feeling comfortable before starting to tackle some of the other pieces, so I start with making sure your symptoms are relieved.

Medication is a valuable tool that can offer relief of the more severe symptoms of anxiety.  It can often be used short-term while working on the underlying causes of your anxiety.  Some people genuinely need medication in the long-term, especially when there appears to be a strong family history of anxiety or a genetic component. In my experience however, I find that the vast majority do not require medication long-term, and the medication is weaned off very carefully as your anxiety resolves.

In terms of specific medication, I have found SSRI's to work well for anxiety and panic disorder. There seem to be a subset of patients who do not respond to SSRI’s.  In these people I find great success with an older class of medication called MAOI’s.  I find a trial of 2 SSRIs as an adequate first step and when someone does not find relief, I often quickly shift strategies and utilize an MAOI.  In more severe cases I combine more than one medication but typically try to avoid doing that if possible.