Anxiety treatment for Highland Beach — SSRI dosing done right, CBT that works.

RECO Integrated Psychiatry sits 12 minutes south of Highland Beach along A1A, closer than most Boca Raton behavioral-health practices and with narrower clinical focus. The prescribers here treat anxiety at anxiety-appropriate SSRI doses — sertraline pushed to 150-200 mg for GAD or OCD when tolerated, not stalled at 50 mg — and refer to disorder-specific CBT rather than generic supportive therapy. For residents of Bel Lido Isle or Toscana, the clinical density on one Delray campus replaces the fragmented workup common in general psychiatry.

Highland Beach occupies a three-mile stretch of A1A between Delray Beach and Boca Raton, and for its residents the closest outpatient psychiatric practice with specialist-level anxiety expertise sits a twelve-minute drive south. RECO Integrated Psychiatry sees adults from Bel Lido Isle, Toscana, Boca Cove, Ocean Cove, and Penthouse who have exhausted general behavioral-health options and want a structured workup for generalized anxiety, panic disorder, social anxiety, or OCD. The practice is outpatient only — medication management, TMS, Spravato, telepsychiatry — with clear referral pathways to disorder-specific CBT rather than open-ended supportive therapy.

The disorder distinctions that change treatment

General practitioners and even some psychiatrists lump generalized anxiety, panic disorder, social anxiety, and obsessive-compulsive disorder under a single label and prescribe the same low-dose SSRI to all four. Each disorder has a distinct treatment profile. GAD responds to worry-focused CBT; panic disorder to interoceptive exposure; social anxiety to in-vivo exposure; OCD only to exposure and response prevention. Mismatching the therapy referral is a common reason clients report years of “therapy that didn’t help.”

At intake, RECO administers validated screeners — GAD-7 for generalized anxiety, PDSS for panic, LSAS for social anxiety, Y-BOCS for obsessive-compulsive symptoms — and the primary DSM-5-TR diagnosis is named explicitly in the note. Comorbid anxiety disorders are the rule rather than the exception; roughly half of clients with panic disorder also meet criteria for GAD, and a substantial minority carry OCD features that will not surface without direct questioning.

When comorbidities are present, the treatment plan sequences them by severity and functional impact rather than treating everything at once. A client with severe OCD and moderate GAD is treated for OCD first — the SSRI dose target is higher and the therapy protocol more specific — with the expectation that GAD symptoms often improve as the OCD burden falls.

SSRI dosing for anxiety versus depression

The effective SSRI dose for an anxiety disorder generally sits at the upper end of the depression range, and this is one of the most common failure points in outpatient anxiety care. Sertraline reaches its full anxiolytic effect at 150-200 mg for GAD or OCD; escitalopram at 20 mg; paroxetine at 40-60 mg; fluoxetine at 60-80 mg for OCD. Clients who plateau at a 50 mg sertraline or 10 mg escitalopram dose are not treatment-resistant — they are undertreated.

Anxious clients are also exquisitely sensitive to SSRI activation on initiation. Nausea, jitteriness, and paradoxical worsening of anxiety in the first two weeks are the norm, and if not anticipated they cause discontinuation before the medication has had a fair trial. The RECO protocol is to start at half the standard starting dose — sertraline 25 mg, escitalopram 5 mg — for seven to ten days, then step up. Adjunctive hydroxyzine or a short course of propranolol during initiation reduces early attrition.

Titration continues on a slower schedule than for depression, with visits every two to four weeks. Symptomatic response on the GAD-7, PDSS, or Y-BOCS is tracked visit-to-visit, and the dose is pushed until symptoms remit or the client cannot tolerate further increase. Under-dosing is the more common mistake.

Augmentation and second-line options

For partial responders to an adequately dosed SSRI, the augmentation strategy is disorder-specific. In GAD, buspirone at 20-60 mg per day divided is first-line and has evidence for additive benefit. In panic disorder, the strongest evidence supports adding CBT with interoceptive exposure rather than a second medication; the pharmacologic ceiling is reached earlier and residual panic is more responsive to behavioral intervention.

In OCD, partial responders are augmented with low-dose aripiprazole (typically 5-10 mg) or risperidone; the evidence base for antipsychotic augmentation in OCD is stronger than the evidence for switching between SSRIs. Clomipramine remains a reasonable third-line option when SSRIs plus augmentation fail. For social anxiety with a performance component, propranolol 10-40 mg situationally covers autonomic symptoms without daily medication.

Gabapentin (300-900 mg) and hydroxyzine (25-50 mg) provide PRN coverage without the dependence profile of benzodiazepines, and both are compatible with concurrent exposure-based therapy. For treatment-resistant depression with prominent anxious distress, rTMS delivered as 3000 pulses per session at 120% of motor threshold is FDA-cleared, and Spravato (esketamine) is available for the TRD indication when anxiety is a prominent feature.

Benzodiazepines — when we do and don’t prescribe

Benzodiazepines have a defined role in short-term crisis management and in a narrow subset of chronic indications — for example, panic disorder that has not remitted after adequate SSRI trials plus CBT with interoceptive exposure. They do not have a role as first-line, open-ended therapy for generalized anxiety, social anxiety, or OCD. The concern is not primarily addiction risk; benzodiazepines blunt the extinction learning that exposure-based CBT depends on, and clients on chronic benzodiazepines often do not consolidate the therapy gains that untreated clients do.

For any client with a personal or family history of substance use disorder, the default is not to prescribe. When benzodiazepines are used, the prescription is time-limited, tied to a taper schedule, and paired with non-benzodiazepine alternatives — hydroxyzine, gabapentin, propranolol, or short-course clonidine — so discontinuation is not destabilizing. The taper itself uses long-half-life agents (diazepam or clonazepam) at roughly 10 percent of total dose every one to two weeks, adjusted for tolerance.

Clients arriving on chronic benzodiazepines from prior prescribers are not summarily discontinued. The initial conversation covers whether the prescription is achieving a defined clinical goal, whether cognitive side effects are being tolerated, and whether the client wants to taper. When a taper is chosen, it is scheduled and paced, not imposed.

What to expect on the first visit

The initial evaluation runs approximately 60 minutes and covers current symptoms, prior medication trials with doses and durations, prior therapy history, medical and family psychiatric history, and a substance use screen. Structured scales — GAD-7, PDSS, LSAS, Y-BOCS as indicated — are administered so response is tracked numerically over subsequent visits rather than by clinical impression. If the presentation suggests bipolar or ADHD comorbidity that would change treatment, the MDQ and ASRS are added.

For clients arriving on medications from a previous prescriber, the first visit does not usually involve stopping or starting anything. The prescriber’s job at intake is to understand what has and has not been tried at what dose for what duration, and to identify the most likely reasons prior treatments failed — under-dosing, wrong therapy referral, undiagnosed comorbidity, or medication-induced worsening. Formal medication changes come at the second visit once prior records are in hand.

More detail is available on the anxiety disorders treatment service page, and the intake team can arrange telepsychiatry visits for Highland Beach residents who cannot easily travel to Delray.

Insurance and admissions from Highland Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS commercial plans. Copays for outpatient medication management visits typically range from $20 to $60 depending on the plan and deductible status; the front desk verifies benefits before the first appointment and quotes the specific number in writing. The practice does not currently accept Medicaid or Medicare.

The Delray Beach campus sits at the north end of Delray, roughly seven miles and twelve minutes south of Highland Beach via A1A or Federal Highway. On-site parking is available at the clinic entrance. For clients in Bel Lido Isle, Toscana, Boca Cove, Ocean Cove, or Penthouse, the drive is shorter and less congested than the trip to most Boca Raton behavioral-health practices, and telepsychiatry follow-ups are offered after the initial in-person evaluation so weekly medication visits do not require the drive.

Serving residents of: Bel Lido Isle, Boca Cove, Ocean Cove, Toscana, Penthouse.