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

RECO Integrated Psychiatry is 28 minutes south of West Palm Beach on I-95, offering specialist-level outpatient anxiety care — SSRI titration to anxiety-appropriate targets, buspirone or low-dose aripiprazole augmentation where indicated, and referral to ERP for OCD or interoceptive exposure for panic disorder. Benzodiazepines are used narrowly, with defined taper timelines rather than open-ended maintenance. In-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS, with telepsychiatry available for follow-up visits after the initial in-person evaluation.

West Palm Beach sits 18 miles north of RECO Integrated Psychiatry’s Delray Beach office — a 28-minute run down I-95 or Federal Highway outside of rush hour. For residents of El Cid, Flamingo Park, Northwood Hills, SoSo, and Downtown WPB who need specialist-level outpatient psychiatric care rather than a residential program, the Delray campus is the nearest practice offering integrated medication management, Deep TMS, Spravato, and telepsychiatry under one clinical roof.

The disorder distinctions that change treatment

“Anxiety” is used as a single label in casual conversation and in many primary care visits, but generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder respond to different therapy protocols and often to different medication targets. RECO’s intake distinguishes them with structured instruments — GAD-7 for generalized worry and somatic tension, the Panic Disorder Severity Scale (PDSS) for spontaneous and cued panic attacks, the Liebowitz Social Anxiety Scale (LSAS) for performance and interaction fear, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for obsessions and compulsions. The DSM-5-TR primary diagnosis is named in the intake note rather than left as “anxiety, unspecified.”

Comorbidity is the rule, not the exception. A client presenting for panic attacks may screen positive on the LSAS for social anxiety they have accommodated for years, or on the Y-BOCS for compulsions they were previously embarrassed to disclose. The treatment plan sequences targets by severity and by functional impact — the disorder keeping the client out of work, out of school, or out of relationships is addressed first, with the others staged behind it. Getting the diagnostic sequencing right is what makes the medication plan and the CBT referral coherent instead of scattershot.

SSRI dosing for anxiety versus depression

Effective SSRI doses for anxiety disorders typically sit at the upper end of the range used for depression. Sertraline for GAD or OCD often lands at 150-200 mg. Escitalopram runs to 20 mg. Paroxetine for panic disorder or social anxiety is frequently dosed at 40-60 mg. Fluoxetine for OCD reaches 60-80 mg in guideline-based practice. Undertreatment — parking a client at 50 mg of sertraline for a year and calling it a nonresponse — is one of the most common failure points in outpatient anxiety treatment.

Initiation matters as much as target dose. Anxious clients are frequently started at half the usual starting dose (sertraline 25 mg, escitalopram 5 mg) because SSRI activation on initiation can worsen anxiety, insomnia, and gastrointestinal symptoms for the first one to three weeks before the anxiolytic effect emerges. Titration is slower and the target dose window is higher than in depression. RECO’s anxiety treatment plans document the target dose, the titration schedule, and the expected response window in advance so that the client knows what an adequate trial looks like rather than discontinuing at week two of a subtherapeutic dose.

Augmentation and second-line options

For SSRI partial responders in GAD, buspirone is the standard augmentation, typically dosed 20-60 mg per day in divided doses. It has no dependence liability and does not interact with the exposure component of CBT. Hydroxyzine covers PRN anxiety without benzodiazepine risk, and gabapentin can address breakthrough anxiety and sleep in patients with substance use histories where benzodiazepines are contraindicated.

Panic disorder partial responders already on a therapeutic SSRI dose usually benefit more from CBT with interoceptive exposure — deliberate induction of feared physical sensations such as breath-holding, spinning, or hyperventilation — than from medication augmentation. The evidence for adding a second agent in panic disorder is thinner than the evidence for completing an exposure protocol.

OCD is a distinct pharmacologic problem. SSRI partial responders in OCD are augmented with low-dose second-generation antipsychotics — aripiprazole 5-15 mg or risperidone 0.5-2 mg — where the evidence for antipsychotic augmentation outperforms switching to an SNRI. Referral to ERP (exposure and response prevention) is the therapy standard; medication is adjunctive. Beta-blockers such as propranolol 10-40 mg have a narrow but real role in situational performance anxiety where the physiologic symptoms are the impairment.

Benzodiazepines — when we do and don’t prescribe

Benzodiazepines have a defined role in short-term crisis management and in narrow chronic indications, including some cases of panic disorder that have failed adequate SSRI trials and a completed course of CBT with interoceptive exposure. They are not a first-line outpatient anxiety treatment. They blunt the extinction learning that exposure-based CBT depends on, they carry dependence and cognitive risks, and their long-term use is associated with worse anxiety outcomes than the disorders they are prescribed for.

For clients with any personal or family substance use history, RECO’s default is not to prescribe benzodiazepines. When they are prescribed, the plan includes a taper timeline, a defined set of non-benzodiazepine alternatives (buspirone, hydroxyzine, gabapentin, propranolol), and a scheduled review — not open-ended maintenance refills. Clients arriving on benzodiazepines from a previous prescriber are not abruptly discontinued; a structured taper with concurrent SSRI optimization and CBT referral is standard.

What to expect on your first visit

The initial evaluation is 60 minutes with a psychiatric provider. It covers current symptoms, prior medication trials with dose and duration, substance use history, medical history and current medications, family psychiatric history, and functional impact across work, school, sleep, and relationships. Screening instruments — GAD-7, PHQ-9, PDSS, LSAS, Y-BOCS, and ASRS as clinically indicated — are administered and scored during the visit.

The intake ends with a DSM-5-TR primary diagnosis, a written medication plan with target dose and titration schedule, a therapy referral matched to the diagnosis (ERP for OCD, interoceptive exposure for panic disorder, in-vivo exposure for social anxiety, protocol-based CBT for GAD), and a follow-up scheduled at two to four weeks. Telepsychiatry is available to Florida residents for follow-up visits after the initial in-person appointment.

Insurance and admissions from West Palm Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Benefits are verified before the first visit and the patient receives a written estimate of copay, coinsurance, and deductible status. Out-of-network coverage and self-pay rates are also available.

For West Palm Beach residents, the Delray campus is a straight 28-minute drive south on I-95 to Atlantic Avenue, with free on-site parking. First-visit appointments are typically scheduled within one to two weeks. Same-week appointments are available for acute presentations — panic attacks progressing to agoraphobic avoidance, OCD that has taken over the day, or SSRI-related adverse effects requiring an urgent medication review.

Serving residents of: El Cid, Flamingo Park, Northwood Hills, SoSo, Downtown WPB.