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

Hollywood clients drive 50 minutes up I-95 to RECO Integrated Psychiatry's Delray Beach office for the initial psychiatric evaluation and any TMS or Spravato work, then transition most medication follow-ups to secure telepsychiatry. Anxiety intakes use structured scales — GAD-7, PDSS, LSAS, Y-BOCS — to name a specific DSM-5-TR diagnosis rather than treating undifferentiated "anxiety," and SSRIs are titrated to anxiety-appropriate doses (sertraline 150-200 mg, escitalopram 20 mg) instead of being left at depression starting doses. When ERP, interoceptive exposure, or in-vivo exposure is indicated, the referral is disorder-specific rather than a generic hand-off to "a therapist."

Hollywood sits 35 miles down I-95 from RECO Integrated Psychiatry’s Delray Beach office — about 50 minutes outside of rush, longer if you are leaving Hollywood Beach at 7:45 a.m. For an anxiety disorder the drive is rarely the barrier it can be for daily programming: after the initial evaluation, medication follow-ups run every two to four weeks and much of the maintenance work is delivered by secure telepsychiatry. Clients from Emerald Hills, Hollywood Lakes, Hollywood Hills, and Oakwood typically come north in person for the intake and any TMS or Spravato sessions, then move to a hybrid schedule for the rest of care.

The disorder distinctions that change treatment

Generalized anxiety disorder, panic disorder, social anxiety disorder, and OCD get lumped together as “anxiety” in casual conversation and in most primary care visits, but they respond to different therapy protocols and often to different medication dosing. Intake at RECO uses structured scales to distinguish them: GAD-7 for generalized worry, PDSS for panic frequency and functional impairment, LSAS for social anxiety across performance and interaction domains, and Y-BOCS for OCD symptom severity and time consumed by obsessions and compulsions. Comorbid depression is screened with PHQ-9; adult ADHD, which frequently presents as anxiety in high-functioning clients, is screened with ASRS.

Comorbidity is the rule, not the exception. GAD with social anxiety, OCD with panic attacks, anxiety layered on ADHD or on a bipolar spectrum illness — the treatment plan sequences interventions by severity and functional impact rather than treating every symptom simultaneously. Which diagnosis is blocking sleep, blocking work, driving avoidance, that is what gets the first move.

The primary diagnosis is named against DSM-5-TR criteria in the note, not left as generic “anxiety NOS.” That specificity drives referral: OCD to exposure and response prevention, panic disorder to interoceptive exposure, social anxiety to in-vivo exposure with cognitive restructuring, GAD to structured CBT with worry postponement. The anxiety treatment program is built around getting that diagnostic call right before the prescription pad opens.

SSRI dosing for anxiety versus depression

Effective SSRI doses for anxiety disorders sit at the upper end of the depression range. Sertraline 150-200 mg for GAD or OCD, escitalopram 20 mg for GAD or panic disorder, paroxetine 40-60 mg for social anxiety, fluoxetine 40-80 mg for OCD. Getting the target dose right is one of the most common failure points in outpatient anxiety care — a client stalled at sertraline 50 mg after six weeks is not an SSRI failure, they are an under-titration.

Anxious clients are often started at half the usual starting dose because initial serotonergic activation can worsen anxiety, insomnia, and GI symptoms in the first one to two weeks before improvement begins. Sertraline 25 mg, escitalopram 5 mg, fluoxetine 10 mg; follow-up scheduled at two weeks rather than four; and explicit psychoeducation that the medication often feels worse before it feels better. That framing prevents the mid-activation self-discontinuations that account for most “failed trials” in the outside history.

Full effect on anxiety symptoms typically requires 8 to 12 weeks at therapeutic dose, so premature switching is the other common error. When an SSRI truly is not working — target dose sustained, adherence confirmed, no meaningful response by week 12 — the next step is a within-class switch or a move to an SNRI (venlafaxine XR 150-225 mg, duloxetine 60-120 mg), not a fifth trial at subtherapeutic doses.

Augmentation and second-line options

SSRI partial responders in GAD are augmented with buspirone 20-60 mg per day in divided doses. Buspirone has no benzodiazepine cross-tolerance, no dependence liability, and modest but replicable evidence for GAD augmentation. Panic disorder partial responders benefit more from adding CBT with interoceptive exposure than from a fourth medication — breakthrough panic on an adequate SSRI dose is an exposure problem, not a pharmacology problem.

OCD partial responders are augmented with low-dose aripiprazole 5-15 mg or risperidone 0.5-2 mg. The evidence base for antipsychotic augmentation in OCD is stronger than the evidence for switching to an SNRI, and the default in a partial responder with an adequate SSRI trial and concurrent ERP is augmentation before switch. Metabolic monitoring — weight, lipids, fasting glucose — is built into the plan from the first prescription.

Beta-blockers such as propranolol 10-40 mg have a defined role in situational performance anxiety where somatic symptoms drive avoidance. For daily PRN needs, gabapentin 300-900 mg or hydroxyzine 25-50 mg cover the space benzodiazepines used to fill without the dependence or cognitive risk profile. Neither replaces adequate SSRI dosing and CBT.

Benzodiazepines — when we do and don’t prescribe

Benzodiazepines have a real but narrow role: short-term crisis stabilization, refractory panic disorder in clients who have already failed SSRIs, SNRIs, and adequate CBT, and specific procedural indications. They also blunt the extinction learning that makes exposure-based CBT work, which is why a client actively engaged in ERP or interoceptive exposure is not a candidate for standing alprazolam.

For clients with any substance use disorder history — active or in recovery — the default is not to prescribe. This is risk stratification, not a moral position: dependence liability, interaction with opioids and alcohol, and disinhibition risks are real. Alternatives are laid out at intake so the decision does not read as arbitrary.

When benzodiazepines are prescribed, the note includes a taper timeline, the target endpoint, and the non-benzodiazepine alternatives that will replace them — not open-ended monthly refills. Clonazepam is preferred over alprazolam in the rare chronic case because of its longer half-life and lower inter-dose withdrawal.

What to expect at the first visit

The initial psychiatric evaluation runs 60 to 90 minutes. It includes the scales matched to the presentation (GAD-7, PHQ-9, Y-BOCS, PDSS, LSAS, ASRS where indicated), a full history of prior medication trials with doses and durations, a substance use screen, and a review of medical conditions and current medications that can present as or amplify anxiety — thyroid disease, stimulant load, beta-agonists, caffeine intake, cannabis use.

Clients leave the first visit with a named DSM-5-TR primary diagnosis, a medication plan (start dose, target dose, titration schedule, expected onset, side effect profile, red flags), a disorder-specific therapy referral, and a follow-up scheduled within two to four weeks. If benzodiazepines or stimulants are already part of the picture, the reconciliation plan is discussed at the first visit, not deferred to visit three.

Insurance and admissions from Hollywood

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits are verified before the first appointment so Hollywood clients know their copay, deductible status, and any prior authorization requirements — this matters particularly for TMS and Spravato, which typically require documented failure of two adequate antidepressant trials. Out-of-network superbills are provided for other carriers on request, and telepsychiatry is available across Florida once the in-person intake is complete.

Serving residents of: Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, Oakwood.