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Podcast Recap | Curbsiders: Anxiety 2.0 with Dr. Jessi Gold

March 14, 2024

Hosts Matthew Watto, MD, FACP, and Paul Williams, MD, FACP, discuss the complexities of treating and managing anxiety with guest Jessi Gold, MD, a psychiatrist and mental health expert. They provide guidance on counseling patients about a new anxiety diagnosis, as well as second- and third-line medication recommendations and non-pharmacological treatment options.

Podcast Length: 1 hr., 29 min.

5 Key Takeaways

1. Anxiety can be a symptom and a diagnosis.

Anxiety as a diagnosis means the patient has had symptoms for a certain period, while anxiety as a symptom could mean something else entirely. Primary care clinicians (PCPs) can evaluate and assess patients to ensure that what they are experiencing is anxiety. A thorough assessment of a patient that states they have anxiety would include primary medical history, family history, lab work, and the generalized anxiety disorder-7 (GAD-7) questionnaire.

For PCPs, questionnaires ensure they ask each question without missing anything. Psychiatric clinicians have longer appointments with patients, providing more opportunities to explore each question and answer provided. Clinicians in the primary care setting often lack time to explore answers thoroughly. Dr. Gold suggests having a brochure with information about anxiety and treatment options to give to patients during their visit.

2. Clinicians can offer non-pharmacologic anxiety management alternatives prior to pharmacologic options.

Hobbies are an effective way to minimize anxiety symptoms. Even if people don’t have specific hobbies, they can try new activities to see what helps them. The important thing to tell patients is that if they don’t enjoy doing something, it isn't going to work.

Various mobile apps can also benefit patients who would like to attempt to self-manage anxiety before using medications. Dr. Gold recommends the Calm and Headspace apps to her patients. These apps can be helpful for patients who want to use mindfulness or meditation to reduce anxiety. They are also readily available and can provide a low-cost option. Still, Dr. Gold advises caution when using apps for therapy because their quality may not be the best. The chances of someone with a PhD working on a therapy app are slim. These apps can act as a bridge to formal therapy while patients wait to see a psychiatrist.

After seeing a psychiatrist, patients can participate in psychotherapy or cognitive behavioral therapy. If these therapies don't work, they can start discussing medication options.

3. Pharmacologic management of anxiety involves a lot of trial and error; there is no algorithm for medication options.

After patients have tried various self management options, the next step is medication. PCPs can begin medication management for their patients when they first note symptoms of anxiety. The preferred medications for clinicians can vary as they treat more and more patients with anxiety.

Dr. Gold shares that her preferred class of medications to start with is SSRIs because the adverse effects of missing a dose are not as harmful as with other medicines. Determining which medications work for patients takes time; clinicians may try several options. When patients do not respond to the medications their PCP prescribes, it's time to refer them to a psychiatrist.

4. Using cannabis to manage anxiety symptoms is not recommended.

There isn't enough reliable evidence to support the use of cannabis for any mental illness. Psychiatrists like Dr. Gold recommend that patients stop the use of cannabis during treatment for anxiety to help minimize variables while trying out different medications. If patients are set on continuing the use of cannabis, clinicians can counsel them to use the same strain from the same store each time to reduce as many variables as possible.

5. Treating anxiety early on can reduce the risk of it disrupting patients’ lives.

PCPs are in a position to begin a patient's treatment for anxiety early because they see their patients more frequently or on a routine basis. There is also less stigma associated with seeing a PCP for mental health treatment than seeing a psychiatrist. However, if clinicians feel they cannot help a patient because it is beyond their scope, they should refer their patient to a psychiatrist.

As a clinician, consider counseling patients on their options and understand any hesitancies they may have about using medication. Having brochures on hand to provide to patients during their visit allows them to review options and suggestions for managing anxiety. Developing a plan that patients will adhere to is the only treatment management that works.

Any views, thoughts, and opinions expressed in this podcast recap are solely that of the host and guests and do not reflect the views, opinions, policies, or position of epocrates and athenahealth.

Source:

Jyang, E. (Writer and Producer). (2024, March 4). Anxiety 2.0: with Dr. Jessi Gold. (No. 429) [Audio podcast episode]. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/curbsiders-podcast/429-anxiety-2-0-with-dr-jessi-gold