Do You Need a Psychiatrist for Anxiety?

Summary: You need a psychiatrist for anxiety if you consider the various treatment modalities available and choose to incorporate prescription medication into your treatment plan.

Key Points:

• Anxiety disorders can be extremely disruptive but are highly responsive to treatment.
• Most people with anxiety disorders can learn to manage their symptoms and minimize functional impairment.
• Psychiatrists, clinical psychologists, and mental health counselors can help people with anxiety with talk therapy.
• You need a psychiatrist to receive prescription medication and for medication management, i.e. monitoring progress, dosage, and any medical complications.

Anxiety Treatment: Comprehensive and Holistic, Tailored to You

When you receive a clinical diagnosis for an anxiety disorder from a mental health treatment professional, it can be a relief.

You may feel understood for the first time in years. And for possibly the first time ever, someone listened to the worries you have – constantly – and took what you have to say seriously. They understand your anxiety is more than daily worries you can easily let go of and/or get over. You found a compassionate mental health professional who knows the thoughts and feelings you experience are associated with a very real clinical mental health disorder. They understand anxiety disorders, and they know how to help.

And finally, you can hope. You can begin to believe that treatment and support from a qualified psychiatrist, therapist, or counselor can help you learn practical skills to manage your symptoms, reduce the amount of disruption they cause in your daily life, and get back to living the life you want to live, rather than one dominated by the symptoms of anxiety.

If you’ve been living with worry and anxiety for years without the awareness you have a mental health disorder, we’ll help you here by providing a definition of clinical anxiety, sharing the symptoms of clinical anxiety, listing the various, evidence-based treatments for anxiety, and elaborate on the question we pose in the title in order to explain why or why not you need a psychiatrist for anxiety.

What is Anxiety? What are Anxiety Disorders?

Here’s a good intro to anxiety and anxiety disorders provided by the American Psychiatric Association (APA)

“Anxiety refers to anticipation of a future concern and is associated with muscle tension and avoidance behavior. Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, school, work and personal relationships can be affected. In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must be out of proportion to the situation, age-inappropriate, and hinder the ability to function normally.”

Here’s an excellent definition of anxiety disorders that’s more clinical, provided by mental health experts at Merck Manuals:

“Anxiety disorders are characterized by persistent and excessive fear, worry, and the dysfunctional behavioral changes a patient may use to mitigate these feelings. Anxiety disorders are differentiated from one another based on specific objects or situations that induce fear, anxiety, and associated behavioral changes.”

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) identifies ten (10) distinct anxiety disorders, each with a unique set of excessive fear and worry symptoms. Here are the five most common types of anxiety disorder in the DSM-5:

1. Generalized anxiety disorder (GAD): characterized by ongoing and excessive worry about everyday situations.
2. Panic disorder: identified by the presence of repeated, unanticipated panic attacks, characterized by intense fear and severe physical symptoms/sensations such as chest pain, hyperventilation, and elevated heart rate. In some cases, the physical symptoms of a panic attack can be so powerful people mistake them for a heart attack and go to the emergency room.
3. Specific phobias: diagnosed when a person shows an excessive and persistent fear of one thing over others, when most people consider that thing generally harmless, or mostly safe. People with specific phobias spend significant energy avoiding their phobia, which may include things like fear of insects, flying in an airplane, shots at the doctor, heights, and public speaking.
4. Agoraphobia: characterized excessive and persistent fear of being in a situation in/during which there may be no way to manage symptoms of panic, with the fear disproportionate to the actual situation and responsible for significant disruption. People with agoraphobia may fear:

• • Public transportation
  • Crowds
  • Open spaces
  • Enclosed spaces
  • Standing in line
  • Being outside of home, alone

5. Social anxiety disorder: defined by experiencing excessive, persistent fear of judgment, embarrassment, failure, or rejection in social situations. People with social anxiety disorder will go to extreme lengths to avoid negative experiences in public, and may avoid meeting new people, eating/drinking in public, and/or public speaking.

Those are the five primary types of anxiety and their defining features. Next, we’ll share the core symptoms of anxiety and the basics of anxiety treatment.

What are the Symptoms of Anxiety?

The symptoms of anxiety vary by the specific disorder diagnosed and various factors unique to the individual. Mental health experts identify three main categories of symptoms: emotional, physical, and behavioral.

Emotional symptoms may include:

• Constant and excessive worry and/or fear
• Persistent restlessness, feeling on edge
• Problems with memory
• Problems with concentration

Physical symptoms may include:

• Elevated heart rate
• Hyperventilation, i.e. shortness of breath
• Excess tension, i.e. tight muscles in neck, jaw clenching
• Persistent fatigue
• Sleep problems: too much or too little

Behavioral symptoms may include:

• Extreme efforts to avoid situations that trigger symptoms
• Constantly seeking reassurance from others
• Problems with daily function
• Declining performance at work and school

When symptoms are mild or moderate, treatment for anxiety is most often conducted in an outpatient setting with a combination of psychotherapy, education, lifestyle changes, and medication, if needed. When symptoms are severe, they can create significant disruption and prevent patients from engaging in the basic activities – and meeting the basic responsibilities – of daily life. People with severe anxiety may require more immersive care, such as intensive outpatient programs, partial hospitalization programs (PHP), or residential treatment.

However, at all levels of care, the core approaches to treatment do not change. The most effective treatment for anxiety involves an intentional combination of the following modalities.

Reminder: You need a psychiatrist for anxiety if medication is part of your treatment plan. Psychiatrists may also provide psychotherapy, while counselors and/or therapists provide the majority of psychotherapy for people with anxiety disorders.

We’ll share additional details about treatment for anxiety below.

Anxiety Treatment: Significant Symptom Reduction, Can Restore Full Functioning

First, let’s quickly review the prevalence of anxiety.

The World Health Organization (WHO) estimates that almost 360 million adults worldwide have a clinical anxiety disorder, making it the most common mental health disorder we know about. Data from the National Institutes of Health (NIH) show the following prevalence of anxiety among adults in the U.S.:

Past Two-Week Anxiety: Adults 18+

• None: 78.3%
• Mild: 14.3%
• Moderate: 4.7%
• Severe: 2.7%
• Moderate or Severe: 7.4%

Ever Diagnosed With Anxiety: Adults 18+

• None: 68.9%
• Any diagnosis: 31.1%
• Mild/moderate: 23.6%
• Severe: 8.3%

Ever Diagnosed With Anxiety, By Type of Anxiety: Adults 18+

• Generalized anxiety disorder (GAD): 5.7%
• Specific phobias: 12.5%
• Panic disorder (PD): 4.7%
• Social anxiety disorder (SAD): 12.1%
• Agoraphobia: 0.1%

Translating the data above into individua figures shows that close to 40 million adults report mild anxiety, over 12 million report moderate symptoms, and around 7 million report severe symptoms. For these millions of people, we have an important message

Evidence-based treatment works. You need a psychiatrist for anxiety if you want or need medication and medication management. If not, you can engage in the therapies below with a psychiatrist, clinical psychologist, therapist, or counselor.

Now let’s take a look at what works for anxiety, based on decades of research and clinical knowledge:

Psychotherapy (individual or group):

• Cognitive behavioral therapy(CBT)
• Dialectical behavior therapy(DBT)
• Trauma-focused cognitive behavioral therapy (TF-CBT)
• Eye movement desensitization & reprocessing (EMDR) therapy
• Prolonged exposure (PE) therapy
• Cognitive remediation therapy (CRT)
• Acceptance & commitment therapy (ACT)
• Family therapy

Medication:

• Anxiolytics, such as benzodiazepines, if indicated
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Education:

• Nutrition and healthy eating
• Relationships skills
• Communication skills
• Conflict resolution

We’ll discuss these treatments further, below.

Professional Support for Anxiety: Effective and Accessible

We’ll summarize the treatment information with insight from an article published in the Journal of the American Medical Association (JAMA) called “Anxiety Disorders: A Review”:

“Anxiety disorders affect approximately 34% of adults during their lifetime* in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.”

*prevalence estimates may vary by source*

When seeking treatment for anxiety, it’s essential to get a full psychiatric evaluation, and the best person to do that is a psychiatrist. They can give you an accurate diagnosis and a referral for the appropriate level and type of care, based on the outcome of your evaluation. Depending on your symptoms, severity, and treatment history, you may need a psychiatrist for anxiety. However, in some cases, after your initial evaluation, your treatment may include psychiatry, but you may spend the majority of you therapeutic time with a therapist or counselor.