What we treat
Evidence-based psychiatric care for anxiety disorders, from generalized anxiety to panic disorder
Anxiety is one of the most common mental health conditions, and one of the most treatable. It affects people of every background and age, and it looks different from person to person.
Everyone feels stress. An anxiety disorder is different: persistent, excessive fear or worry that continues after the original stressor has passed and gets in the way of work, relationships, sleep, or simply feeling at ease. When the brain's threat-detection system stays on high alert, the body responds as if danger were present even when it is not. That is why anxiety so often shows up physically.
At MindMED Behavioral Health, we treat anxiety as a human experience, not a personal failure. It is a treatable condition.
Dr. Fredes evaluates and treats the full range of anxiety disorders, including:
Anxiety shows up in the body (racing heart, chest tightness, shortness of breath, dizziness, muscle tension, stomach upset, trouble sleeping), in thinking (catastrophizing, racing thoughts, trouble concentrating, indecision, worry that will not switch off), and in behavior (avoiding triggers, seeking reassurance, procrastinating, withdrawing from people, over-preparing, using alcohol to cope). The physical symptoms are real and can be frightening, but they are not dangerous. Avoidance brings short-term relief and keeps the cycle going.
Usually a combination of factors: family history, early stress or trauma that sensitizes the threat response, chronic stress, and major life transitions. Some medical conditions (thyroid disorders, heart rhythm problems, low blood sugar, sleep apnea) and some substances (caffeine, energy drinks, stimulants, certain blood pressure medications) can produce or worsen anxiety symptoms, and alcohol or benzodiazepines can make anxiety worse over time. Part of a good evaluation is ruling these contributors out.
Treatment starts with a 60-minute initial evaluation. Dr. Fredes reviews your symptoms, medical and family history, previous treatments, lifestyle, and goals, and that picture shapes the plan.
SSRIs and SNRIs: First-line medications for anxiety disorders (sertraline, escitalopram, venlafaxine, duloxetine, and others). They act on serotonin and norepinephrine, chemical messengers involved in mood and anxiety. Most people notice little change for 2–4 weeks, and full effect can take 6–8 weeks, so consistent daily use matters.
Buspirone: An option for generalized anxiety that works differently from SSRIs and is usually well tolerated. It takes 2–3 weeks to start working.
Benzodiazepines: Medications like lorazepam and alprazolam relieve acute anxiety quickly, but they carry a risk of dependence. Dr. Fredes uses them cautiously and, when she does, for short periods while a longer-acting medication takes effect. They are not a long-term solution for anxiety disorders.
Beta-blockers: Propranolol blunts the physical side of anxiety (racing heart, trembling) without affecting the worry itself, which makes it useful for specific situations like public speaking.
Other options: Depending on your situation, Dr. Fredes may discuss hydroxyzine for situational anxiety or, in select cases of severe anxiety, other medication classes.
Many people notice some improvement within 4–6 weeks of starting treatment, and the first 2–3 weeks can feel unchanged or briefly worse before they get better. Early side effects like mild headache, nausea, or sleep disruption usually settle within 1–2 weeks. Full benefit often takes 3–6 months, depending on the type of anxiety, how long you have had it, and other medical factors. Take your medication as prescribed; stopping suddenly can cause rebound anxiety. If side effects bother you, talk with Dr. Fredes before making changes. There are often options that do not involve stopping.
When to call between appointments: Contact the office right away for severe anxiety or panic that feels unbearable, thoughts of self-harm, or side effects that interfere with daily functioning. Routine questions and mild side effects can wait for your next visit.
Normal stress typically feels manageable and goes away once a stressor is resolved. Anxiety disorders persist even when the trigger is gone, interfere with daily functioning, and cause physical or emotional symptoms that feel excessive or hard to control. If worry or fear is affecting your sleep, work, relationships, or quality of life, a professional evaluation can help clarify what's happening.
Medication decisions are highly individual and depend on the severity of your symptoms, your personal history, and your goals. Some people benefit significantly from medication, while others find that therapy, lifestyle changes, or a combination approach works best. Dr. Fredes will discuss all options during your evaluation and work with you to determine the right treatment plan.
Many people notice some improvement within 4-6 weeks of starting evidence-based treatment, though medication typically takes 2-4 weeks to reach full effectiveness. Full remission of symptoms often takes 3-6 months or longer, depending on the type of anxiety, underlying factors, and individual response. Regular follow-up appointments help track progress and adjust treatment as needed.
Yes. Anxiety activates the body's fight-or-flight response, triggering real physical sensations including racing heart, chest tightness, shortness of breath, dizziness, muscle tension, stomach issues, and fatigue. These symptoms are not imaginary or dangerous, but they can feel frightening. Part of anxiety treatment involves understanding these physical responses and learning to manage them.
Psychiatrists are medical doctors trained to diagnose mental health conditions, prescribe medication, and manage the biological aspects of anxiety. Therapists or counselors specialize in talk therapy and behavioral strategies. Many people benefit from both, medication management from a psychiatrist combined with therapy. MindMED provides psychiatric care; we can recommend therapists if you need additional support.
Anxiety does run in families, suggesting a genetic component. However, genetics are not destiny. Environmental factors like stress, trauma, and life experiences also play significant roles. Understanding your family history and personal triggers helps us develop a treatment plan tailored to your situation.
Untreated anxiety can intensify over time, especially if avoidance behaviors develop or if anxiety triggers are regularly encountered without support. Early intervention typically leads to better outcomes and can prevent secondary issues like depression or substance use. If you're struggling, reaching out for help is one of the most important steps you can take.
Dr. Fredes treats patients ages 16 through 65, which includes older adolescents and adults. For children under 16, we recommend a child and adolescent psychiatrist who specializes in that age group. Anxiety in young people is highly treatable, and early intervention can prevent long-term difficulties.
We are in-network with:
Self-pay pricing is posted, and we provide superbills for out-of-network reimbursement. View full pricing details →
Schedule a consultation with Dr. Fredes to discuss your care.