Anxiety
Anxiety medication, without the benzo trap.
Most anxiety medication fails in one of two directions: a daily medication abandoned at week two because nobody said it would take a month, or a benzodiazepine refilled for years because it works in twenty minutes and nobody wanted to discuss the bill coming due. Medication management here builds the slower, sturdier kind of calm: a daily medication chosen carefully, measured with the GAD-7 at every follow-up, and adjusted on evidence, with honest answers about Xanax and a real taper path for anyone already on a benzo.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
First, the pattern
Which anxiety is this?
Anxiety is not one thing, and the medication follows the pattern. The 60-minute evaluation maps yours before anything is prescribed.
The constant hum
Generalized worry that never fully powers down: the braced shoulders, the 3 a.m. rehearsals, the catastrophe always loading. This pattern answers best to a daily medication given enough weeks to work.
The spike
Panic: sudden, physical, terrifying, and then gone, leaving dread of the next one. Panic needs the baseline lowered and the fear-of-fear treated as its own target, not just a pill for the moment itself.
The performance window
Presentations, interviews, flights, the boardroom: anxiety with an address and a schedule. A narrower problem that sometimes earns a narrower, situational tool instead of a daily one.
The body underneath
Thyroid trouble, caffeine arithmetic, alcohol rebound, and other medications can all manufacture anxiety symptoms. Labs through LabCorp and an honest substance history come before we call it a brain problem.
The daily shelf
Four tools that lower the baseline
SSRIs
The first-line daily medications for most anxiety disorders. They take weeks, not days, and the early stretch can feel like nothing is happening or briefly like more is. You will know that timeline before you start, because most people quit in exactly that gap.
SNRIs
The close cousins, sometimes the better fit when pain, fatigue, or a partial SSRI response is part of the picture. Same slow build, same need for a fair trial at a real dose.
Buspirone
Built for anxiety and only anxiety, non-habit-forming, and gentle on everything else in your life. It asks for patience and consistent dosing, and it rewards both. Often added when an SSRI has done half the job.
Propranolol
A blood-pressure medication borrowed for its side benefit: it quiets the physical symptoms, the racing heart, the shaking hands, the voice that will not steady, without touching your thinking. For the performance pattern, it is often the whole answer.
The Xanax question, answered straight
Why benzodiazepines are generally not started here
People ask, reasonably, whether an online psychiatrist can prescribe Xanax. The honest answer has two parts. The legal part: benzodiazepines such as alprazolam (Xanax) and clonazepam are controlled substances, and prescribing them carries the same federal and DEA structure as any controlled medication, including an in-person visit, typically once a year. The clinical part matters more: benzodiazepines work fast and wear off fast, and the brain keeps the receipts. Tolerance builds, the dose that calmed you in March whispers by June, anxiety between doses can climb higher than the anxiety you started with, and stopping after long use is genuinely hard and, done abruptly, genuinely dangerous. Prescribing one for daily anxiety is usually borrowing calm from your future self at a steep rate. So they are generally not started here, and if that is the one thing you came for, it is better to hear it on this page than after an intake fee.
Already on one? That is a different conversation, and a kinder one. Plenty of careful people ended up on a benzo because a prescriber years ago reached for the fastest tool. Getting off is not a willpower exercise; it is a taper: slow, paced by symptoms, supported at every step, with the rest of the anxiety plan built underneath first so there is something holding you when the dose drops. That work has its own page, because it deserves more than a paragraph: deprescribing and tapering.
Measurement, adjustment, and subtraction
Calm you can chart
The GAD-7, the standard seven-question anxiety measure, is taken at intake and repeated at follow-ups, so "feeling a bit better" becomes a number with a direction. Dose decisions follow the line: a partial response at a fair dose argues for adjusting or augmenting, a flat line argues for switching, and nobody learns anything from a medication quit at day nine. When the body might be part of the story, labs come before the next prescription rather than after the next failure; the functional psychiatry page explains that workup. And anxiety medications are deprescribed here too, on purpose: an SSRI that has held you steady through a hard season and beyond gets a planned, gradual exit conversation when life allows, because a medication that did its job has earned a review, not a lifetime sentence by default.
Labs before the next prescription
Thyroid, B12, vitamin D, and the rest of the physical picture, checked first.
The supplement shelf, graded
Magnesium glycinate, L-theanine, and NAC, reviewed like prescriptions, not wellness candy.
Before the dose goes up
When anxiety has a physical author
Some anxiety is manufactured outside the brain's worry circuits, and raising an SSRI dose at it is a category error. The audit at intake and at any stall covers the usual manufacturers. Caffeine, in quantities the patient often describes as normal, because normal for a coffeehouse is not normal for a nervous system. Alcohol the night before, repaying its calm with interest by morning. Decongestants, steroids, thyroid medication set a notch too high, stimulants timed too late, and energy supplements whose labels read like a dare. Sleep apnea earns its mention again: a brain starved of oxygen at night is an anxious brain by day, and no anxiolytic fixes a blocked airway. Each of these has a fix that is not a bigger dose, and finding one is worth more than any prescription on this page.
Panic gets its own paragraph because it follows its own rules. Panic attacks are brief, brutal, and survivable, and the fear of the next one usually does more damage than the attacks themselves. Scheduled medication earns its keep here by lowering the frequency and voltage of attacks over weeks, which is why the plan leans on it. The fast acting sedative, by contrast, teaches the brain that escape was necessary, and the lesson generalizes. When a rescue medication is part of a plan at all, it is small, counted, and reviewed like any other controlled substance in this practice, with the same annual in-person structure and the same taper thinking when the scheduled treatment has taken hold.
Progress is reviewed against your GAD-7 line and your own list of reclaimed things: the drive you can make again, the meeting you can sit through, the phone call that no longer needs rehearsing. Scores matter here, but they are the instrument panel, not the destination.
The practical upshot: bring everything to the intake, the supplements, the energy drinks, the sleep schedule, the other prescribers and what they have added. Anxiety care fails quietly when the prescriber is working from a partial list, and it succeeds the same way it fails: one unexamined input at a time, found and fixed.
“Calm that has to be re-bought every few hours is not calm. We build the slower kind, and we measure it.”
Start with a 60-minute evaluation of the pattern, not just the symptom