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

RECO Integrated Psychiatry is 50 miles north of Miami — about 65 minutes from Brickell or Coral Gables up I-95. The outpatient practice specializes in specialist-level anxiety pharmacology (SSRIs titrated to anxiety-range targets, buspirone augmentation for GAD, low-dose aripiprazole for OCD partial responders) with direct referral to therapists trained in protocol-matched CBT — ERP for OCD, interoceptive exposure for panic disorder. Follow-ups run by telepsychiatry, so most Miami clients drive up for the initial 60-90 minute evaluation and complete the rest of care from home.

The drive from Brickell or Coral Gables to RECO Integrated Psychiatry’s Delray Beach office runs roughly 50 miles up I-95 — about 65 minutes without traffic, closer to 90 in the afternoon. For Miami adults whose anxiety has stopped responding to a primary-care SSRI, or who have never had a psychiatrist unpack the difference between panic disorder, generalized anxiety disorder, and OCD, that hour buys specialist-level outpatient care without a residential admission. RECO Integrated Psychiatry runs medication management, TMS, Spravato, and telepsychiatry from one Delray Beach office, and structured anxiety treatment is one of the practice’s core pathways.

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 often in primary-care visits, but they are separate DSM-5-TR diagnoses with distinct treatment algorithms. RECO’s intake distinguishes them using the GAD-7 for generalized anxiety, the Panic Disorder Severity Scale (PDSS), the Liebowitz Social Anxiety Scale (LSAS), and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The primary diagnosis is named in the chart — not “anxiety NOS” — because the therapy protocol changes with the diagnosis.

Exposure and response prevention (ERP) is the evidence-based therapy for OCD; interoceptive exposure is the specific mechanism for panic disorder; in-vivo exposure with cognitive restructuring is the target for social anxiety; and GAD responds to CBT with worry exposure and applied relaxation. Referring a client with contamination-focused OCD to a generic CBT therapist without ERP training will not produce remission. The written plan includes a referral to a therapist trained in the correct protocol.

Comorbid anxiety disorders are the rule, not the exception. When a client screens positive for two or three anxiety disorders plus depression, RECO sequences the treatment plan by severity and functional impact — treating the diagnosis driving the most impairment first, then reassessing before adding the next intervention rather than stacking interventions in parallel.

SSRI Dosing for Anxiety Versus Depression

Effective SSRI dosing for anxiety disorders sits at the upper end of the depression range, not the middle. Sertraline for GAD or OCD frequently requires 150-200 mg to reach remission; escitalopram 20 mg; paroxetine 40-60 mg; fluoxetine 60-80 mg for OCD. Anxious clients discharged from primary care on sertraline 50 mg for six months and told “it isn’t working” have often not received a therapeutic anxiety dose at all.

Titration for anxious patients moves slowly in the direction of a higher endpoint. Activation on SSRI initiation — jitteriness, insomnia, transient worsening of anxiety in the first two weeks — is common and predictable, so RECO starts most clients at half the standard starting dose (sertraline 12.5-25 mg, escitalopram 2.5-5 mg) and titrates every one to two weeks based on tolerability. The target dose window is higher; the path to it is slower.

Duration matters as much as dose. Anxiety disorders take 8-12 weeks at target dose to demonstrate full response, longer for OCD (often 10-12 weeks minimum). Declaring a medication a failure at four weeks or at a subtherapeutic dose accounts for a large share of the “treatment-resistant anxiety” referrals the practice sees from Miami-Dade and Broward.

Augmentation and Second-Line Options

When a full SSRI trial produces partial response, the next step depends on the diagnosis. GAD partial responders are augmented with buspirone 20-60 mg/day divided BID or TID, which adds serotonergic tone without sedation or dependence risk. SNRI switches (venlafaxine XR 150-225 mg, duloxetine 60-120 mg) are considered when tolerability rather than efficacy is the limiting factor.

OCD partial responders receive low-dose antipsychotic augmentation — aripiprazole 2-15 mg or risperidone 0.5-2 mg — because the evidence for antipsychotic augmentation in OCD is stronger than for SNRI switching. Panic disorder partial responders benefit more from CBT with interoceptive exposure than from further pharmacologic augmentation; the RECO plan explicitly reroutes to therapy at that point rather than stacking medications.

Adjuncts have specific and narrow roles. Propranolol 10-40 mg covers situational performance anxiety without daily dosing. Hydroxyzine 25-50 mg and gabapentin 300-600 mg TID handle PRN needs without benzodiazepine liability. For severe treatment-resistant depression with anxious features, Spravato (esketamine) is available on-site at Delray Beach under REMS supervision.

Benzodiazepines — When We Do and Don’t Prescribe

Benzodiazepines work fast for acute anxiety, and that is the problem. They blunt the extinction learning that makes exposure-based CBT effective, they carry tolerance and physical dependence within weeks of daily use, they impair driving and memory, and their withdrawal is medically dangerous. For any client with a substance use history — alcohol, opioids, stimulants, or benzodiazepines themselves — RECO Integrated Psychiatry’s default is not to prescribe.

There is a narrow legitimate indication. Short-term crisis management (typically two to four weeks while an SSRI is titrating) and a small subset of panic disorder cases genuinely refractory to SSRIs plus adequate CBT trials do warrant benzodiazepines. When they are prescribed, the chart documents an indication, a taper timeline, and defined non-benzodiazepine alternatives (hydroxyzine, gabapentin, propranolol, buspirone) — not open-ended monthly refills.

Clients transferring in on high-dose or long-term benzodiazepines are not tapered abruptly. RECO uses a staged reduction — typically 10-25% of the total daily dose every two to four weeks, with the last quarter of the taper slowest — while stabilizing an SSRI and connecting the client to protocol-matched CBT.

What to Expect at Your First Visit

The initial evaluation runs 60-90 minutes with a psychiatric provider. It covers the full DSM-5-TR anxiety differential, mood and psychotic screens, ADHD screening with the ASRS, substance use screening, medical and medication history, family psychiatric history, and functional impact on work, sleep, and relationships. Standardized scales — GAD-7, PHQ-9, Y-BOCS, PDSS, LSAS — are administered at intake and repeated at follow-up to track response objectively.

The visit ends with a written plan: named primary diagnosis, initial medication with dose and titration schedule, target response window, side-effect counseling, referral to a therapist trained in the correct CBT protocol, and a follow-up appointment inside two to three weeks. Medication starts on the first visit are common when clinically appropriate; they are not required. Telepsychiatry is available for follow-ups from Miami; initial evaluations are typically in person unless clinical circumstances justify telehealth intake.

Insurance and Admissions from Miami

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Admissions verifies benefits before the first visit and provides a written estimate of copay, coinsurance, and deductible responsibility. Out-of-network and self-pay options are available with published pricing.

For clients in Brickell, Coral Gables, Coconut Grove, Aventura, or Pinecrest, the practical logistic is scheduling the in-person initial evaluation at Delray Beach and running the majority of medication follow-ups by telepsychiatry. Spravato and TMS require in-person visits; medication management and therapy referrals do not. Admissions can be reached by phone or by callback request through the anxiety treatment page.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.