Anxiety affects nearly 20% of U.S. adults, and many patients initially seek help from their primary care physician (PCP). Since mental health concerns are often intertwined with physical health, the PCP’s office is a natural starting point for treatment. Understanding the scope of a primary care doctor’s ability to manage anxiety, including prescribing medication and determining when a specialist is needed, helps patients take a confident first step toward feeling better.
The PCP’s Authority to Prescribe Anxiety Medications
Primary care physicians (PCPs) are authorized to prescribe most psychiatric medications for anxiety, treating a significant portion of patients with mild to moderate mental health conditions. State medical licensing boards and the Drug Enforcement Administration (DEA) grant this authority. However, the PCP’s role focuses on less complex cases and first-line treatments.
PCPs can prescribe controlled substances, such as benzodiazepines (e.g., alprazolam or lorazepam), which are used for acute anxiety symptoms. Because these Schedule IV substances carry a risk of dependence and abuse, PCPs typically prescribe them sparingly or for short-term situations, preferring non-controlled options for long-term management.
Medication Classes Commonly Used by Primary Care
For the long-term management of anxiety, PCPs typically start with medications that have a lower risk profile and are not habit-forming. Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line treatment for many anxiety disorders. These drugs, such as escitalopram (Lexapro) and sertraline (Zoloft), work by increasing serotonin in the brain to help regulate mood and reduce symptoms.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are another common first-line choice. SNRIs, including duloxetine (Cymbalta) and venlafaxine (Effexor), work on both serotonin and norepinephrine to improve mood and energy regulation. These antidepressants are favored because they address the underlying biology of anxiety without the dependency concerns associated with controlled substances.
Benzodiazepines are generally reserved for acute, short-term relief of severe anxiety or panic attacks because they work quickly. Due to the risk of developing tolerance and physical dependence, PCPs limit prescriptions of these controlled substances to brief periods. Other non-addictive options a PCP might use include buspirone (BuSpar), which requires consistent use for several weeks to become effective, or beta-blockers to manage physical symptoms like a rapid heart rate.
Initial Diagnosis and Treatment Monitoring
The initial assessment for anxiety includes ruling out medical conditions that can mimic symptoms, such as thyroid issues, anemia, or side effects from other medications. Once physical causes are excluded, the PCP uses standardized screening tools to quantify the severity of the anxiety. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated questionnaire commonly used in the primary care setting.
GAD-7 scores guide treatment decisions: 5-9 indicates mild anxiety, 10-14 moderate, and 15 or greater suggests severe anxiety. After medication is prescribed, patient monitoring is crucial and involves regular follow-up appointments to assess effectiveness and manage side effects. Patients are typically asked to return in four to six weeks after starting treatment to allow time for the medication to take effect and determine if a dosage adjustment is necessary.
When to Seek Consultation with a Mental Health Specialist
While PCPs effectively treat mild to moderate anxiety, they refer patients to a mental health specialist, such as a psychiatrist, when the case becomes more complex. One clear trigger for referral is treatment resistance, defined as a lack of response after trying two different first-line anxiety medications. A psychiatrist is better equipped to manage this situation, which may require specialized medication strategies or combination therapies.
Referral is also necessary for patients presenting with severe symptoms, such as panic disorder significantly impacting daily life, or when the diagnosis is uncertain. The presence of complex co-occurring mental health conditions, like bipolar disorder, psychosis, or an active substance use disorder, warrants the expertise of a specialist. Even while waiting for the specialist appointment, the PCP can often begin initial treatment to provide support.