Anxiety treatment for Boca Raton — SSRI dosing done right, CBT that works.

RECO Integrated Psychiatry is a Delray Beach outpatient psychiatry practice — eleven miles and twenty minutes up Federal Highway from Mizner Park and Downtown Boca. Anxiety treatment here is diagnostic clarification with GAD-7, PDSS, LSAS, and Y-BOCS; SSRI or SNRI titration to anxiety-appropriate target doses rather than depression doses; augmentation with buspirone or low-dose aripiprazole where indicated; and coordinated referral into exposure-based CBT or ERP. Benzodiazepines are used narrowly, with a written taper plan when they are used at all.

From Mizner Park or Royal Palm Place, RECO Integrated Psychiatry’s Delray Beach office is about eleven miles up Federal Highway — a twenty-minute drive that lets a Boca Raton adult keep a job, a marriage, and a household intact while treating an anxiety disorder in specialist outpatient care. The practice is built for people whose symptoms are severe enough that primary-care prescribing has stalled, but who do not need residential treatment. Anxiety treatment here is diagnostic clarification, medication management to target dose, and coordinated referral into disorder-specific cognitive behavioral therapy — not brief supportive counseling.

The disorder distinctions that change treatment

Casual conversation collapses generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder into a single word: anxiety. Many primary-care visits do the same, and the resulting prescription — usually a low starting dose of an SSRI — is aimed at an average rather than a diagnosis. These conditions respond to different therapy protocols, tolerate different medication classes, and require different target doses.

Intake at RECO Integrated Psychiatry names the DSM-5-TR primary diagnosis in the note. That decision is anchored to structured measures: GAD-7 for generalized anxiety, PDSS for panic disorder, LSAS for social anxiety, and Y-BOCS when obsessions or compulsions appear on the history. The scales are re-administered at follow-up so response is measured, not estimated.

Comorbidity is the rule, not the exception. Panic disorder overlaps with agoraphobia; social anxiety often sits beneath a depressive presentation; OCD frequently coexists with generalized anxiety and with tic disorders. The treatment plan sequences targets by severity and functional impact — usually treating the disorder keeping the patient out of work or out of relationships first, then addressing the others once the pharmacologic floor is stable.

SSRI dosing for anxiety versus depression

The doses that treat anxiety disorders are typically higher than the doses that treat depression. Sertraline for generalized anxiety or OCD often lands at 150 to 200 mg. Escitalopram for panic disorder or GAD is frequently a 20 mg drug. Paroxetine for social anxiety runs 40 to 60 mg. A patient who came off primary-care sertraline 50 mg convinced that “SSRIs don’t work” has usually never seen a full trial.

The mechanics on the initiation side are the opposite. Anxious patients are frequently activated by SSRIs in the first two weeks — jitteriness, insomnia, and a paradoxical worsening of the very symptoms the medication is meant to treat. Starting at half the usual antidepressant starting dose, sometimes a quarter, and holding there for a week before the first titration step reduces dropouts. A short course of hydroxyzine or gabapentin can bridge the initiation window without introducing a benzodiazepine.

Getting to the therapeutic window is one of the more common failure points in outpatient anxiety care. Titration schedules are written into the plan at the first visit with dose-change dates that do not require another appointment to execute. Follow-up intervals of two to four weeks in the initiation phase catch nonresponse early rather than at a three-month check.

Augmentation and second-line options

When a patient reaches a full SSRI dose and remains symptomatic, the augmentation strategy depends on the diagnosis. Generalized anxiety partial responders are commonly augmented with buspirone at 20 to 60 mg per day; the combination has evidence and a favorable side-effect profile. An SNRI switch — venlafaxine XR to 225 mg or duloxetine to 120 mg — is an alternative when tolerability of the SSRI has been marginal.

Panic disorder partial responders do better with the addition of cognitive behavioral therapy that includes interoceptive exposure than with further medication changes. That is a referral, not a prescription, and RECO Integrated Psychiatry maintains a network of CBT clinicians familiar with the protocol. Situational performance anxiety — a musician’s audition, a public-speaking obligation — is a legitimate indication for propranolol 10 to 40 mg PRN.

OCD partial responders warrant a different logic. The evidence for augmentation with low-dose aripiprazole or risperidone in OCD is stronger than the evidence for switching between SSRIs and stronger than the evidence for SNRI substitution. Exposure and response prevention remains the therapy protocol with the durable effect. Hydroxyzine and gabapentin cover PRN needs across the anxiety spectrum without introducing the dependence and cognitive risks of a benzodiazepine.

Benzodiazepines — when we do and don’t prescribe

Benzodiazepines have a defined role in short-term crisis management and in a narrow set of chronic indications, such as panic disorder that has failed adequate SSRI trials and a full course of CBT. Outside those indications, the risks — tolerance, dependence, cognitive impairment, and blunting of the extinction learning that makes exposure-based CBT work — outweigh the benefit for most patients.

For any patient with a substance use history, the practice’s default is not to prescribe. Alcohol use disorder, opioid use disorder, and prior benzodiazepine misuse all shift the risk-benefit sharply. In those cases the plan uses hydroxyzine, gabapentin, propranolol, and behavioral strategies during acute distress, and treats the underlying anxiety disorder with an SSRI or SNRI at target dose.

When a benzodiazepine is prescribed, it is prescribed with a taper timeline written into the note, defined non-benzodiazepine alternatives named for the post-taper period, and a follow-up cadence that matches the schedule. Patients who arrive on longstanding benzodiazepine regimens from prior prescribers are not abruptly discontinued; the taper is negotiated, paced with symptom monitoring, and paired with CBT so the extinction learning stays intact as the drug comes off.

What to expect on the first visit

The initial psychiatric evaluation runs sixty to ninety minutes. It includes a structured diagnostic interview, symptom rating scales — GAD-7, PHQ-9, PDSS, LSAS, or Y-BOCS as indicated — a medication and prior-treatment history, and a review of any records forwarded from primary care or prior prescribers. The output is a written DSM-5-TR diagnosis, a medication plan with a titration schedule and target dose, and a therapy referral where a specific CBT protocol is indicated.

Follow-up cadence in the initiation phase is two to four weeks. Once the target dose is reached and response is measured on rescaling, visits typically move to every six to twelve weeks for maintenance. Telepsychiatry is available for follow-up visits for Boca Raton residents who prefer to skip the Federal Highway or I-95 drive on a workday afternoon.

Insurance and admissions from Boca Raton

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans commonly held by Boca Raton employers and retirees. Benefits are verified before the first visit so the copay for the psychiatric evaluation and the coinsurance for follow-up medication management are known in writing rather than estimated at check-in.

Scheduling from Boca is straightforward. The Delray Beach office is eleven miles north of Downtown Boca and Mizner Park via Federal Highway or I-95, twenty minutes in ordinary traffic. Highland Beach and Boca West patients typically split their care between in-person evaluations and telepsychiatry follow-up. Same-week evaluation slots are the norm rather than the exception.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.