A patient sat across from me last spring convinced she was having heart trouble. Racing pulse, tight chest, a sense that something terrible was about to happen — usually around 3 p.m., usually at her desk. Her EKG was normal. Her labs were normal. What she had was an anxiety disorder, and once we named it, her shoulders actually dropped an inch.
That moment happens more than you'd think. Anxiety wears a physical costume so convincingly that people come in worried about their heart, their stomach, or their breathing long before they suspect their nervous system is the culprit.
So let me walk you through what I look for, and what we can actually do about it.
What does an anxiety disorder actually feel like?
An anxiety disorder feels like worry that won't switch off and a body that stays on high alert even when nothing is wrong. Everyone gets nervous before a flight or a big meeting — that's normal and useful. The line gets crossed when the worry is out of proportion, hard to control, and sticking around for weeks or months.
In my practice, the symptoms patients describe most often include:
- A restless, keyed-up feeling or trouble concentrating
- Muscle tension, especially in the neck and jaw
- A racing heart, shortness of breath, or stomach upset with no clear cause
- Trouble falling or staying asleep
If several of those sound familiar and they're getting in the way of work, relationships, or rest, it's worth a conversation.
How do I know if my anxiety needs treatment?
Your anxiety probably needs attention when it starts shrinking your life — avoiding situations, dreading the day, or losing sleep over it. A good rule of thumb I share with patients: if you're rearranging your choices around the worry, that's a signal, not a character flaw.
I often use a short, validated questionnaire called the GAD-7 to put a number on it. It takes about two minutes and gives us a baseline we can track over time. It also helps separate everyday stress from something that will respond to treatment.
One more thing I always check: the overlap. Anxiety and depression travel together remarkably often, and poor sleep makes both worse. When someone comes in with anxiety, I'm also quietly screening for low mood and for insomnia, because treating only one piece rarely fixes the whole picture.
What are the treatment options for anxiety?
Anxiety is treated through a combination of therapy, sometimes medication, and changes to sleep, movement, and daily habits — and the right mix is different for every person. There's no single correct path, which is honestly good news. It means we have options.
For many people, talk therapy is the foundation. Cognitive behavioral therapy, in particular, teaches concrete skills for interrupting the worry loop, and I'm happy to make a thoughtful CBT referral to a therapist who fits your needs and schedule.
When symptoms are more intense or persistent, medication can help. The first-line options are typically SSRI or SNRI medications — the same family used for depression. They're not sedatives and they're not habit-forming. They take a few weeks to work, which is exactly why I like to start the conversation early rather than wait for a crisis.
And then there's the unglamorous stuff that genuinely moves the needle: regular movement, cutting back on the third afternoon coffee, protecting your sleep, and limiting alcohol. None of it is a cure on its own. Together, they change how reactive your body is.
Why anxiety care is different in a direct primary care practice
The biggest difference is time. In a rushed seven-minute visit, anxiety gets a prescription and a pat on the shoulder. In my membership-based practice here in Los Angeles, we have room to actually understand your history, rule out the medical mimics — thyroid issues, certain heart rhythms, medication side effects — and build a plan you helped design.
I can also follow up. We'll recheck that GAD-7, adjust course if the first approach isn't landing, and coordinate with a therapist or, when needed, a Cedars-Sinai specialist. You're not managing this alone between appointments.
Whole-person care isn't a slogan to me. Your anxiety, your sleep, your blood pressure, and your stress at work are all connected, and I'd rather treat the person than chase one symptom at a time.
If your mind feels like it's running laps and you're tired of being told it's "just stress," I'd genuinely like to hear from you. Reach out and let's talk it through together — there's a lot we can do, and the first step is just naming what's going on.