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

RECO Integrated Psychiatry is a 35-minute drive down I-95 from PGA National, Mirasol, and BallenIsles. The practice runs measurement-based anxiety care — GAD-7, PDSS, LSAS, and Y-BOCS at intake, SSRI titration to therapeutic dose rather than starting dose, and disorder-matched CBT referral (ERP for OCD, interoceptive exposure for panic). TMS and Spravato are on-site for treatment-resistant presentations. Telepsychiatry follow-up is available once the initial evaluation is complete, so the drive is a one-time event for most Gardens clients.

Palm Beach Gardens sits 25 miles north of RECO Integrated Psychiatry’s Delray Beach office — a 35-minute drive down I-95 that puts BallenIsles, Frenchman’s Reserve, Mirasol, Old Palm, and PGA National residents inside reach of a psychiatry practice organized around measurement-based care for anxiety disorders. Northern Palm Beach County has strong primary care and a handful of solo psychiatric prescribers, but concentrated outpatient anxiety treatment — with GAD-7 tracking, protocol-driven SSRI titration, and structured CBT referral — remains scarce. This page describes how RECO approaches anxiety treatment for adults driving in from the Gardens.

The disorder distinctions that change treatment

Generalized anxiety disorder, panic disorder, social anxiety disorder, and OCD are routinely collapsed into “anxiety” in casual conversation and in many primary care visits. The problem is clinical: each disorder responds to a different first-line psychotherapy protocol and often to a different medication dose. Exposure and response prevention is the CBT protocol with the strongest evidence for OCD; interoceptive exposure — deliberate induction of somatic symptoms — is central to panic disorder treatment; in-vivo graded exposure carries social anxiety disorder; standard cognitive restructuring plus applied relaxation carries GAD. Prescribing an SSRI without naming the disorder means prescribing without a therapy pathway.

RECO’s intake uses GAD-7 for generalized anxiety, PDSS for panic disorder, LSAS for social anxiety, and Y-BOCS for OCD. The initial psychiatric evaluation documents the DSM-5-TR primary diagnosis, any comorbid anxiety diagnoses, and the differential — including trauma-related disorders and bipolar spectrum illness, both of which change the medication plan. Comorbid anxiety disorders are the rule rather than the exception; the treatment plan sequences them by severity and functional impact rather than treating whichever surfaced first.

SSRI dosing for anxiety versus depression

Effective SSRI doses for anxiety disorders typically sit at the upper end of the depression range. Sertraline for GAD or OCD frequently requires 150–200 mg. Escitalopram for GAD often requires 20 mg. Paroxetine for panic disorder often lands at 40–60 mg. Fluoxetine for OCD is dosed higher than for depression, commonly 60–80 mg. Underdosing is one of the two most common failure points in outpatient anxiety pharmacotherapy — the client is labeled a non-responder at 50 mg of sertraline when the actual failure was a stalled titration.

The other common failure point is starting too high. Anxious clients experience initiation-phase activation — jitteriness, worsened sleep, transient increase in anxiety symptoms — more intensely than depressed clients, and they discontinue accordingly. RECO defaults to half the standard starting dose (sertraline 25 mg, escitalopram 5 mg) for at least the first week, with slower step-ups and explicit anticipatory guidance about the activation window. The target dose window is higher; the path to it is slower. Full response is typically evaluated at 10–12 weeks at therapeutic dose, not at four weeks at starting dose.

Augmentation and second-line options

SSRI partial responders in GAD are augmented with buspirone at 20–60 mg per day divided BID or TID. Pregabalin and low-dose quetiapine are additional evidence-supported augmentation options when buspirone is inadequate or not tolerated. SNRI switching — venlafaxine XR or duloxetine — is a reasonable next step for GAD non-responders, less so for OCD.

OCD partial responders receive antipsychotic augmentation, typically low-dose aripiprazole (2.5–10 mg) or risperidone (0.5–2 mg). The evidence for antipsychotic augmentation in SSRI-refractory OCD is stronger than the evidence for SNRI switching. Clomipramine remains an option for treatment-resistant OCD, with the tricyclic side-effect profile factored in. Panic disorder partial responders benefit more from adding CBT with interoceptive exposure than from medication augmentation — the medication has done what it can, and the residual symptoms are extinction-learning targets, not pharmacology targets.

Beta-blockers — propranolol 10–40 mg — have a defined role in situational performance anxiety and no meaningful role in generalized anxiety. Gabapentin and hydroxyzine cover PRN needs without the dependence profile of benzodiazepines and are often the right tool for breakthrough symptoms during SSRI titration.

Benzodiazepines — when we do and don’t prescribe

Benzodiazepines have a role in short-term crisis management and in narrow chronic indications, including some cases of panic disorder refractory to SSRIs and adequately delivered CBT. Two clinical facts constrain their use. First, benzodiazepines blunt the extinction learning that exposure-based CBT depends on; a client on standing clonazepam is being treated with two therapies that partially cancel each other. Second, they carry dependence, tolerance, cognitive, and — in older adults — fall risks that grow with duration.

For clients with any substance use history, RECO’s default is not to prescribe benzodiazepines. When they are prescribed, the plan is written with a defined taper timeline, an identified non-benzodiazepine alternative (hydroxyzine, gabapentin, propranolol, or PRN buspirone), and a review date. Open-ended maintenance without a stop-plan is not offered. Clients arriving on long-standing benzodiazepine regimens from prior prescribers are managed with slow, symptom-guided tapers rather than abrupt discontinuation.

What the first visit looks like

The initial evaluation is a 60-minute appointment. It covers the DSM-5-TR interview, the relevant self-report scales (GAD-7, PDSS, LSAS, Y-BOCS as indicated), a review of prior psychiatric trials with doses and durations, medical and family history, substance use screening, and safety assessment. Clients leave with a working diagnosis, a written medication plan, a therapy referral matched to the disorder, and a follow-up interval — typically two weeks during titration, then monthly.

Telepsychiatry follow-up is available for stable maintenance visits, which meaningfully reduces the drive burden for Palm Beach Gardens clients once the initial in-person evaluation is complete. Prescription workflow uses e-prescribing to the client’s preferred pharmacy in the Gardens.

Insurance and admissions from Palm Beach Gardens

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans. Benefits verification is completed before the first visit; the client is informed of the specific copay, deductible status, and any preauthorization requirements before the appointment is confirmed. TMS and Spravato benefits are verified separately when those treatments enter the plan, since both carry medical-benefit rather than pharmacy-benefit adjudication and both require prior authorization.

• Location: Delray Beach, 25 miles south of Palm Beach Gardens
• Drive time: 35 minutes via I-95 in typical traffic
• Modalities: Medication management, TMS, Spravato (esketamine), telepsychiatry follow-up
• Assessment scales used routinely: GAD-7, PHQ-9, PDSS, LSAS, Y-BOCS, ASRS

Serving residents of: BallenIsles, Frenchman's Reserve, Mirasol, Old Palm, PGA National.