Anxiety and panic treatment

Everyone feels anxious sometimes. An anxiety disorder is different: NIMH explains that the fear or worry does not go away, can get worse over time, and gets in the way of work, school and relationships. The most common forms are generalized anxiety disorder, panic disorder and social anxiety disorder. Symptoms can include:

• Worry that is hard to switch off, often about several things at once
• Feeling restless, keyed up or on edge
• Tiring easily and having trouble concentrating
• Irritability, muscle tension, headaches or stomach upset
• Difficulty falling or staying asleep
• Intense fear of being judged or embarrassed in social situations
• Avoiding places, people or activities because of the anxiety they trigger

Anxiety often travels with depression. If low mood is also part of the picture, see our page on depression treatment.

A panic attack is a sudden surge of fear that peaks within minutes. According to NIMH, it can bring a pounding heart, sweating, trembling, shortness of breath, chest pain, and a feeling of doom or of losing control. Many people's first attack sends them to an emergency room convinced it is a heart attack.

Panic disorder is diagnosed when attacks keep happening unexpectedly and you begin to fear the next one — avoiding driving on the Palisades, crowded stores or anywhere escape feels hard. The good news is that panic disorder responds well to treatment. Cognitive behavioral therapy teaches you to recognize the physical sensations and stop the fear-of-fear cycle, and antidepressant medication lowers how often attacks happen.

Because panic symptoms overlap with heart, lung and thyroid problems, we make sure a medical cause has been ruled out — usually through your primary-care doctor or a recent emergency visit — before treating the attacks as panic disorder. Once that is settled, knowing that the racing heart is anxiety rather than danger is itself the first step in treatment. Some people with panic also develop agoraphobia, gradually shrinking the places they feel safe going; therapy addresses this directly with small, planned steps back into those places.

Your first appointment is a 45-to-60-minute psychiatric evaluation. We ask what triggers your anxiety, how often panic attacks happen, what you avoid, and how you have coped so far. We use short rating scales such as the GAD-7 to measure severity and track progress.

We also screen for physical contributors — overactive thyroid, heavy caffeine use, certain decongestants or asthma inhalers, and alcohol — and for conditions that can look like anxiety, including OCD, ADHD and trauma-related disorders.

If you are searching for an anxiety medication psychiatrist near you, it helps to know the main options and how they differ. NIMH and the American Psychiatric Association describe these as the usual choices:

• SSRIs (for example sertraline, escitalopram) — usually the first-line medication for generalized anxiety, panic and social anxiety. They take several weeks to work and are taken daily.
• SNRIs (for example venlafaxine, duloxetine) — another first-line option, especially if pain or low energy are also present.
• Buspirone — a non-habit-forming medicine used for generalized anxiety, alone or added to an SSRI.
• Benzodiazepines (for example lorazepam, clonazepam) — they work fast, but the FDA requires a boxed warning about misuse, dependence and withdrawal. We use them rarely, at the lowest dose, for short periods, and usually only while a long-term medication takes effect.

Some patients also benefit from hydroxyzine or propranolol for specific situations. Every prescription comes with ongoing medication management so doses are adjusted and side effects are caught early.

Cognitive behavioral therapy (CBT), including gradual exposure to feared situations, is the most studied talk therapy for anxiety. Our therapists see patients in New City and Middletown, and many people do a mix of in-person and video sessions.

When anxiety comes with major depression, TMS may be an option: in 2021 the FDA cleared TMS to reduce anxiety symptoms in adults with depression (sometimes called anxious depression). TMS is not FDA-cleared for anxiety disorders on their own, and we will tell you plainly if it is not a fit. Learn more about TMS for anxious depression.

Treatment works best when the skills you learn in sessions get practiced in everyday life. Alongside therapy and medication, NIMH points to habits that can ease anxiety symptoms: regular physical activity, a consistent sleep schedule, and cutting back on caffeine, which can trigger or worsen panic-like sensations in some people. Alcohol may calm nerves in the moment but tends to make anxiety and sleep worse the next day.

Your therapist may give you short exercises — slow breathing, writing down worries at a set time, or a planned step toward something you have been avoiding. If anxiety spikes between visits, call the office rather than waiting; a brief check-in or an earlier video appointment is often possible. Our clinicians speak English, Punjabi, Hindi, Urdu, Gujarati and French, and you can meet them on our team page or check insurance we accept.

• First visit: evaluation, GAD-7 baseline, and an agreed plan — therapy, medication, or both.
• Weeks 1–4: weekly therapy begins; if a medication was started, a follow-up at two to four weeks checks side effects and dose.
• Weeks 4–8: you practice skills between sessions and start facing avoided situations in small steps. Medication doses are adjusted based on your scores.
• Weeks 8–12: we review progress together. If you have improved, visits space out; if not, we change the medication, adjust therapy, or look again at the diagnosis.