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

For adults in Jupiter, Abacoa, Tequesta, or Admirals Cove, RECO Integrated Psychiatry is 45 minutes south on I-95 — close enough for an in-person intake, far enough that Delray offers separation from local triggers. The practice targets SSRI dosing at the upper end of the anxiety-appropriate range (sertraline 150-200 mg, escitalopram 20 mg), refers to disorder-specific CBT (ERP for OCD, interoceptive exposure for panic, in-vivo exposure for social anxiety), and does not use open-ended benzodiazepine maintenance. Follow-up is telepsychiatry-first once the plan is set, which removes most of the drive after the intake.

Jupiter sits 32 miles north of RECO Integrated Psychiatry’s Delray Beach office — a 45-minute drive down I-95 outside of rush hour. For adults in Abacoa, Jupiter Inlet Colony, Tequesta, and the Admirals Cove and Jonathan’s Landing corridor, the distance is workable for medication management and short enough to make in-person intake practical when the anxiety picture is complex. This page describes how the practice approaches anxiety treatment — the diagnostic distinctions that change the plan, the SSRI dosing that separates effective care from partial response, and the second-line strategies when first-line pharmacotherapy is not enough.

The diagnostic distinctions that change the treatment plan

Generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder are all commonly described as “anxiety” in casual conversation and in many primary care notes. Clinically, they are distinct conditions with different natural histories, different response profiles to medication, and different first-line therapy protocols. Treating them interchangeably is one of the more common reasons patients arrive at RECO after a year of partial response elsewhere.

Intake at RECO uses standardized measures to distinguish them: the GAD-7 for generalized anxiety, the Panic Disorder Severity Scale (PDSS) for panic, the Liebowitz Social Anxiety Scale (LSAS) for social anxiety, and the Y-BOCS for OCD. The note names the DSM-5-TR primary diagnosis rather than defaulting to “anxiety, unspecified,” because that label determines the therapy protocol as much as it determines the pharmacotherapy.

Comorbid anxiety disorders are the rule rather than the exception — GAD and social anxiety, OCD and depression, panic and agoraphobia. When more than one diagnosis is present, the treatment plan sequences them by severity, functional impact, and treatment interaction. A patient with severe OCD and moderate GAD is treated with the OCD-first algorithm; the GAD scores typically improve as the OCD improves.

SSRI dosing for anxiety is not SSRI dosing for depression

Effective SSRI doses for anxiety disorders typically sit at the upper end of the depression range. Sertraline for GAD or OCD often requires 150 to 200 mg. Escitalopram commonly needs 20 mg. Paroxetine sits in the 40 to 60 mg range for panic disorder and social anxiety. These are not maximum doses reserved for treatment resistance — they are the doses at which the medication starts to work.

The paradox is that anxious patients frequently cannot tolerate the standard starting dose. SSRIs and SNRIs produce transient activation on initiation, and in someone with panic disorder or GAD, that activation feels indistinguishable from the illness getting worse. RECO’s default is to start at half the usual starting dose — sertraline 25 mg, escitalopram 5 mg, venlafaxine XR 37.5 mg — and titrate every one to two weeks based on tolerability and GAD-7 or Y-BOCS trend.

Under-dosing is one of the most common failure points in outpatient anxiety treatment. A patient stuck on sertraline 50 mg for eighteen months with a persistent GAD-7 of 14 has not failed sertraline; the trial has not yet been adequate. A large part of the intake conversation is a careful reconstruction of prior trials — what dose, for how long, at what tolerability — to distinguish inadequate trials from true non-response.

Augmentation and second-line pharmacotherapy

When an adequately dosed SSRI produces partial response, the next step depends on the diagnosis. In GAD, buspirone at 20 to 60 mg per day is a well-tolerated augmentation with independent anxiolytic effect, no sedation, and no dependence liability. Hydroxyzine and gabapentin are useful adjuncts for breakthrough symptoms and sleep disruption without the risks of scheduled anxiolytics.

In panic disorder, evidence for pharmacologic augmentation is thinner than the evidence for adding structured CBT with interoceptive exposure. A patient with residual panic on adequate paroxetine is more likely to benefit from twelve sessions of interoceptive work than from a second agent. RECO refers to CBT clinicians trained in the Barlow panic protocol rather than generalist supportive therapy.

OCD partial response is managed differently. The evidence for low-dose antipsychotic augmentation — aripiprazole 2 to 5 mg, risperidone 0.5 to 2 mg — is stronger in OCD than the evidence for switching between SSRIs or moving to an SNRI. Exposure and response prevention (ERP) remains the durable treatment; medication makes ERP tolerable. Propranolol has a defined role in situational performance anxiety and is not used as a general anxiolytic.

Benzodiazepines: the narrow indications and the reasons for restraint

Benzodiazepines have legitimate roles in psychiatric practice — short-term crisis management, catatonia, alcohol withdrawal, and a narrow set of chronic indications including some cases of panic disorder that remain refractory to adequate SSRI trials and CBT. They are not first-line for GAD, they are not first-line for social anxiety, and they are not compatible with exposure-based therapy for OCD or panic.

The clinical problem with chronic benzodiazepines in anxiety disorders is that they blunt extinction learning. Exposure-based CBT works by allowing the fear response to activate, peak, and habituate in a controlled setting; benzodiazepines suppress the activation and prevent the habituation. A patient doing ERP on standing clonazepam is completing the exposures without the neural learning they are meant to produce.

For patients with any history of alcohol or sedative use disorder, RECO’s default is not to prescribe. When a benzodiazepine is prescribed, the plan documents a taper timeline, a defined dose ceiling, and named non-benzodiazepine alternatives — hydroxyzine, gabapentin, propranolol for situational use. Open-ended benzodiazepine maintenance is not the practice standard.

What to expect at the first appointment

Intake is a 60-minute session with a psychiatric provider. The visit covers the presenting symptoms in structured detail, prior medication trials with specific doses and durations, prior therapy history, medical comorbidities and current medications, family psychiatric history, and substance use screening. The GAD-7, PDSS, LSAS, or Y-BOCS is completed depending on the presenting picture, and PHQ-9 is added when depressive symptoms are present.

By the end of the visit, the patient leaves with a named DSM-5-TR primary diagnosis, a written medication plan with a target dose and titration schedule, and — where indicated — a referral to a therapist trained in the disorder-specific protocol (ERP for OCD, interoceptive exposure for panic, in-vivo exposure and cognitive restructuring for social anxiety). Follow-up is typically two to four weeks out during early titration, then monthly, then quarterly once the patient is stable.

Insurance and getting to Delray from Jupiter

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and other Blue Cross Blue Shield plans. Benefits verification is completed before the first appointment, and the intake team confirms the specialist copay, deductible status, and any prior authorization requirements for specialty services such as TMS or Spravato before the visit is scheduled.

The drive from Jupiter is 32 miles south on I-95 — roughly 45 minutes outside of rush hour and closer to an hour during weekday commute windows. For patients in Abacoa, Tequesta, or Jonathan’s Landing, the practical model is one in-person intake in Delray followed by telepsychiatry for the majority of follow-ups, with in-person visits reserved for TMS, Spravato, or clinical situations that benefit from a face-to-face review.

Serving residents of: Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, Jonathan's Landing.