Anxiety

Anxiety is a normal human signal: it shows up before a job interview, a difficult conversation, or any uncertainty that matters. An anxiety disorder is anxiety that is out of proportion to the situation, that lasts longer than the trigger, and that interferes with work, relationships, sleep, or daily function. The DSM-5 framework recognizes several specific anxiety disorders (generalized anxiety, panic disorder, social anxiety, specific phobias, agoraphobia), each with different patterns and different treatment implications.

A reasonable threshold is when anxiety has lasted more than a few weeks, is interfering with how you sleep, work, or relate to people, or is driving avoidance of things you would otherwise want to do. Acute panic attacks, anxiety with thoughts of self-harm, or anxiety that started after a traumatic event are reasons to seek care sooner. There is no threshold of severity required to ask for help.

The strongest evidence is for cognitive behavioral therapy, especially exposure-based work for panic, social anxiety, and specific phobias. Medication (typically an SSRI or SNRI) is also effective and is often the right choice when symptoms are severe enough to interfere with engaging in therapy. The combination of medication and therapy beats either alone for moderate to severe presentations. The right starting point depends on severity, history, preference, and what is available.

SSRIs and SNRIs are the first-line medication class for most anxiety disorders. They are well-studied for long-term use, with side effects that are usually manageable and reversible. Benzodiazepines (alprazolam, lorazepam, clonazepam, diazepam) work quickly and reliably for acute anxiety, but they carry meaningful risks with daily long-term use: tolerance, dependence, withdrawal, cognitive side effects, and falls in older adults. Cognia uses benzodiazepines sparingly and prefers strategies that resolve the underlying anxiety rather than mask it.

A first visit at Cognia is 60 to 90 minutes. It covers the history of the anxiety itself, the conditions that frequently coexist with it (depression, ADHD, trauma history, substance use, thyroid problems, sleep disorders), medical history and medications, family psychiatric history, and what you want a good outcome to look like. The session ends with a working diagnosis, a treatment plan, and a clear sense of what the next visit will involve.