SILVA PSYCHIATRIC CARE
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how anxiety
sabotages 
treatment

ANXIETY IS, BY DEFINITION, A SYMPTOM (I.E., EXCESSIVE AND PROBLEMATIC).  

IT OFTEN INCLUDES AN IRRATIONAL FEAR OF TREATMENT ITSELF, IN INDIVIDUALS WITH GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND OTHER FORMS OF ENDOGENOUS ANXIETY.  

UNCHECKED, IT LEADS TO DELAYS IN TIME TO REMISSION DUE TO A FAILURE TO INCREASE DOSAGES WHEN INDICATED AND AS PRESCRIBED, AND OFTEN THREATENS TO SABOTAGE TREATMENT ALTOGETHER WHEN IT RESULTS IN NON-ADHERENCE AND ABORTED (I.E., NON-THERAPEUTIC) TRIALS, ESPECIALLY IN PATIENTS WHO EXPERIENCE TRANSIENT EXACERBATION OF THEIR ANXIETY UPON INITIATION OF TREATMENT WITH SEROTONERGIC AGENTS, OR UPON INITIAL DOSAGE TITRATION (INCREASES).  

BENZODIAZEPINES, SUCH AS XANAX, VALIUM, ATIVAN AND KLONOPIN,  ARE EXTREMELY EFFECTIVE AND USEFUL ADJUNCTS, IMMEDIATE-ACTING "BAND-AIDS," FOR THOSE PATIENTS WHO WILL TAKE THEM (SEVERELY ANXIOUS PATIENTS OFTEN UNDER-UTILIZE THESE MEDICATIONS DUE TO EXAGGERATED CONCERNS ABOUT PHYSICAL DEPENDENCE AND WITHDRAWAL, WHICH, IRONICALLY, THIS ANXIETY ESSENTIALLY PRECLUDES).  TAKEN CHRONICALLY, BENZODIAZEPINES AND OTHER SEDATIVES AND TRANQUILIZERS CAN BE HABIT-FORMING AND HAVE ABUSE POTENTIAL AT HIGHER DOSES, BUT PANIC ATTACKS AND INSOMNIA SHOULD ALWAYS  BE PREVENTED AND TREATED IN THE SHORT-TERM WITH ANXIOLYTIC (ANXIETY-REDUCING) MEDICATIONS UNTIL SEROTONERGIC (SEROTONIN-BOOSTING) MEDICATIONS TAKE EFFECT, SEVERAL WEEKS AFTER INITIATING TREATMENT.  

​THE TREATMENT OF ANXIETY REQUIRES HIGHER DOSES AND FULL REMISSION CAN TAKE 6-12 WEEKS OR LONGER, AND SYMPTOMS TEND TO RECUR, REQUIRING FURTHER TITRATION OF DOSAGES, AND/OR PROVE SOMEWHAT REFRACTORY TO TREATMENT.  PANIC ATTACKS ALWAYS CEASE, BUT SOCIAL ANXIETY AND OCD SYMPTOMS IN PARTICULAR, WHILE SIGNIFICANTLY ATTENUATED IN MOST PATIENTS TAKING ADEQUATE, CONSISTENT DOSES OF SEROTONERGIC MEDICATIONS OVER TIME,  CAN BE STUBBORN.  ALCOHOL, BENZODIAZEPINES, AND OTHER SEDATIVES ARE THE ONLY AGENTS THAT ARE 100% EFFECTIVE AGAINST SOCIAL ANXIETY, BUT ONLY FOR BRIEF PERIODS (A FEW HOURS) AFTER DOSING AND REQUIRE PRUDENCE.


RETURN TO ARCHIVES

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SERVICES

  • Comprehensive Psychiatric Evaluations
  • Psychotropic Medication Management
  • Brief Counseling Sessions
  • Competency/Guardianship determinations
  • Pre-Surgical Clearances (elective bariatric and plastic surgery procedures)
  • Court-Mandated Evaluations
  • DOT Clearances
  • + other fitness-for-duty and focused psychiatric evaluations
  • Emotional Support Animal Documentation
  • + other medical endorsements

ABOUT SPC

  • Dr. Silva, M.D.
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Suicide Prevention Hotline

SUPPORT

  • Contact Me
  • Set Up/How To
  • Telemed App
  • ZOOM Download
  • GoodRx/$4.00 Meds
  • Medical Record Copies
  • Medication Prior Authorizations
  • Patient Portal
  • FORMS
  • FAQ

RESOURCES

  • Dr. Silva's Blog (2009)
  • S. Stahl, Prescriber's Handbook (7th Ed.)
  • American Psychiatric Association (APA)
  • Alcoholics Anonymous
  • Centers For Disease Control
  • La Hacienda Treatment Center
  • NAMI (National Alliance on Mental Illness)
  • Narcotics Anonymous
  • Physician's Desk Reference
  • MEET DR. SILVA
  • NEW PATIENTS
    • COST OF TREATMENT
    • Patient Reviews
    • REQUEST AN APPOINTMENT
    • ADULT ADD/ADHD?
    • Frequency of Visits
    • Frequently Asked Questions
  • THE CONCIERGE MODEL
    • WHAT IT IS
    • Concierge Reviews
  • TELEMEDICINE
    • WHAT IT IS
    • HOW IT WORKS
    • PATIENT REVIEWS
  • TREATMENT PHILOSOPHY
    • INFORMATION FOR PATIENTS & THEIR FAMILIES
    • ARCHIVES
  • CONTACT
  • ABOUT
    • PAYMENTS
    • REFILL POLICY
    • CANCEL/NO-SHOW
    • PRIVACY
    • FORMS
    • RECOMMENDED