General Practitioners (GPs), or primary care providers, frequently serve as the first line of defense for anxiety management. Anxiety disorders are among the most prevalent mental health conditions, making their initial assessment and treatment a routine part of general practice. Your GP is authorized to diagnose and prescribe medication for anxiety, acting as the primary entry point for most patients seeking help.
The Scope of General Practice Prescribing
Anxiety treatment is effectively handled within the primary care setting, particularly through the use of pharmacotherapy. GPs typically prescribe first-line medications, which are generally antidepressants that also possess anti-anxiety properties. These include Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).
SSRIs, such as escitalopram or sertraline, and SNRIs, like venlafaxine or duloxetine, modulate neurotransmitters in the brain. They are the preferred choice for long-term management because they are not habit-forming and are effective for various anxiety disorders, including generalized anxiety disorder, panic disorder, and social anxiety disorder. Patients typically start with a low dose, which is slowly increased over several weeks to minimize initial side effects, such as nausea or agitation.
While GPs prescribe these first-line agents, they approach the use of fast-acting anxiolytics, such as benzodiazepines (e.g., lorazepam or alprazolam), with caution. Benzodiazepines provide rapid relief but carry a risk of tolerance and dependence. Guidelines recommend prescribing these only for the short-term relief of severe or disabling anxiety, typically for a duration not exceeding two to four weeks. The primary care strategy focuses on initiating a long-term treatment like an SSRI, sometimes using a benzodiazepine briefly to manage acute distress until the primary medication begins to take effect.
The Initial Screening and Diagnosis Process
When you visit your GP regarding anxiety symptoms, the process begins with a comprehensive medical evaluation to exclude physical causes. Conditions such as thyroid dysfunction, cardiac issues, or substance withdrawal can mimic anxiety. Your doctor will discuss the duration, intensity, and specific nature of your symptoms, including how they interfere with your daily life, work, and relationships.
The initial assessment often involves using standardized, validated screening tools. A common example is the Generalized Anxiety Disorder 7-item (GAD-7) scale, a quick questionnaire asking you to rate the frequency of specific anxiety symptoms over the past two weeks. Scores of 5, 10, and 15 represent cut-off points for mild, moderate, and severe anxiety, respectively. This objective measurement helps the GP gauge the severity of the condition and determine the appropriate level of intervention.
If a diagnosis is confirmed, prescribing medication is usually presented as part of a broader treatment plan. The GP will typically integrate pharmacological treatment with recommendations for lifestyle adjustments, such as exercise and sleep hygiene, and suggest therapeutic options. Cognitive Behavioral Therapy (CBT) is widely regarded as an effective psychotherapeutic approach for anxiety disorders, and your doctor may recommend starting therapy alongside medication. Establishing a monitoring plan for side effects and treatment efficacy is also essential.
When Specialist Referral Becomes Necessary
The GP’s ability to manage anxiety is extensive, but there are specific circumstances where a referral to a mental health specialist, such as a psychiatrist or specialized psychotherapist, is warranted. One indicator is the severity or complexity of the condition. Patients presenting with severe anxiety symptoms, a high risk of self-harm, or co-occurring complex mental health disorders, like bipolar disorder or schizophrenia, require specialized psychiatric expertise.
A common reason for referral is a lack of adequate response to first-line treatments. If a patient has tried two or more standard antidepressant medications (SSRIs or SNRIs) at therapeutic doses for a sufficient period without significant improvement, the case is considered treatment-resistant. A psychiatrist can offer more advanced treatment strategies, including augmentation with other medication classes, or prescribing medications that fall outside the typical primary care scope.
Referral is necessary when the patient requires specialized psychotherapy that the GP cannot provide. While primary care providers may offer basic counseling, conditions that benefit from intensive, specific therapies, such as Exposure and Response Prevention for Obsessive-Compulsive Disorder, are best managed by a specialized mental health professional. The decision to refer is a collaborative one, based on the patient’s individual needs and the complexity of their clinical picture.