Clinical overview
Anxiety is a syndrome, not a personality. GAD requires excess worry more days than not for six months plus associated somatic features. Panic disorder is recurrent unexpected attacks plus one month of concern or change in behavior. Social anxiety is fear of scrutiny, not generic shyness. We will not relabel a pheochromocytoma workup, thyrotoxicosis, arrhythmia, or benzodiazepine withdrawal as 'just anxiety' because a GAD-7 is elevated.
How we evaluate
The interview times attacks (expected vs unexpected), avoidance, caffeine and cannabis, alcohol withdrawal, SSRI activation, and trauma. GAD-7 scores severity; it does not replace the differential. Chest pain, syncope, or focal neurologic signs are medical first. Hormone-informed care is relevant when panic clusters with perimenopause or when hyperthyroidism is plausible — not as a default cortisol saliva kit.
Treatment stance
First-line pharmacologic options often include an SSRI or SNRI, with buspirone or hydroxyzine as adjuncts in selected cases. Benzodiazepines are short-horizon tools with a documented taper plan, not a lifestyle. We refer for CBT, exposure work, and, when indicated, a sleep or cardiac evaluation. Massage and breathing drills can down-regulate somatic tension; they do not diagnose or treat panic disorder by themselves.
When to seek care
Book an evaluation when worry, panic, or avoidance is shrinking work, driving, or relationships. Emergency care is appropriate for chest pain with cardiac features, first-seizure-like events, or inability to stop a panic cluster with suicidal thinking.