When I think about anxiety disorders, I’m always struck by how common they are and how often they go untreated. As a psychiatrist working with anxious patients for years, I’ve seen how these conditions can turn someone’s life upside down when not properly recognized or treated with appropriate therapy for anxiety. Here in Montana, we face special challenges with mental health care. With our wide-open spaces, scattered towns, and few psychiatric providers, many patients struggle to get quality mental health treatment. That’s why we started Frontier Psychiatry - to tackle these problems through online psychiatry and bring quality mental health services to everyone who needs it, no matter where they live.

The Scope of Anxiety Disorders

The numbers are eye-opening. About 34% of adults in the US will have an anxiety disorder during their lifetime. More recent data shows about 12.7% of people had anxiety in a single year. These numbers likely went up during COVID-19, with studies suggesting about 25% of adults reported anxiety symptoms between 2019 and 2020.

What’s really troubling is how many people don’t get help. Up to 97.8% of patients with anxiety disorders aren’t correctly diagnosed, and about 41% don’t get any mental health treatment. I see this all the time - people suffering for years without knowing what’s wrong or getting proper depression treatment, even though anxiety and depression often occur together.

The impact goes beyond just feeling uncomfortable. Anxiety disorders lead to:

• More doctor visits
• Poorer quality of life
• Problems at work and home
• More than 4.6 missed work days per month
• Over $4 billion in workplace costs

The human cost is huge and not fully captured by these statistics.

Understanding Different Anxiety Disorders

When we talk about anxiety disorders, we’re actually talking about several different conditions that share some features but look different:

Generalized Anxiety Disorder (GAD) affects about 6.2% of people during their lifetime. It involves excessive worry about many things (work, school, future, relationships) plus at least three symptoms like restlessness, tiredness, irritability, trouble concentrating, muscle tension, or sleep problems. These symptoms happen most days for at least six months.

Social Anxiety Disorder is more common than many realize, with 13% of people experiencing it in their lifetime. It involves strong fear about social situations, which people either avoid completely or endure with intense anxiety. These symptoms last at least six months.

Panic Disorder affects about 5.2% of people during their lifetime. It involves repeated, unexpected panic attacks (sudden episodes of intense fear with at least four physical or thinking symptoms that peak within minutes) plus ongoing worry about future attacks, fear of what the attacks might cause, or behavior changes because of them. Panic disorder may occur with agoraphobia, which involves avoiding places where escape might be hard or help unavailable if panic symptoms happen.

Across all anxiety disorders, women are more affected than men (40% vs 26% lifetime rates), and the average age when symptoms start is 11 years. This early start, combined with anxiety’s long-term nature, means many patients struggle silently for years before seeking behavioral health services.

Diagnosis: Challenges and Solutions

One of the biggest roadblocks to proper treatment is getting an accurate diagnosis. In primary care, where about 20% of patients have an anxiety disorder, correct detection rates are very low - only about 44.5%.

Many factors contribute to this problem:

• Short patient visits
• Focus on physical symptoms
• Patients’ reluctance to discuss mental health
• Lack of regular screening

Thankfully, this is changing. Short screening tools like the Generalized Anxiety Disorder-7 (GAD-7) can be very effective, with accuracy between 60.6%-89%. These questionnaires take less than five minutes to complete and can greatly improve detection rates.

At Frontier Psychiatry, we’ve built these screenings into our intake process to catch anxiety disorders early and accurately. We believe that understanding the specific diagnosis is crucial for choosing the most appropriate mental health care that research shows works.

Treatment Approaches: What Works

When it comes to treating anxiety disorders, research clearly shows two approaches stand out:

Medications: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) remain the first-choice medications for most anxiety disorders. Medications like sertraline (Zoloft) and venlafaxine extended-release (Effexor XR) have strong research supporting their effectiveness. Studies show these medications produce significant improvements compared to placebo across anxiety disorders.

While benzodiazepines like clonazepam (Klonopin) can provide quick relief, they come with important risks including dependence, thinking problems, and other side effects. That’s why we typically limit their use to short-term treatment while waiting for antidepressants to start working.

Therapy: Cognitive Behavioral Therapy (CBT) has the strongest evidence for anxiety disorders. Studies show that CBT produces substantial improvements compared to both psychological and pill placebos. For generalized anxiety disorder, studies show a large effect, while for social anxiety disorder and panic disorder, the effects are small to medium but consistently positive.

CBT works through several methods including:

• Education about anxiety symptoms
• Changing anxiety-related thoughts
• Facing feared situations/sensations
• Learning skills for managing physical symptoms

What’s particularly encouraging is that the benefits of CBT often last long after treatment ends, with improvements maintained up to 12 months later.

Our Approach at Frontier Psychiatry

At Frontier Psychiatry, we’re committed to bringing these research-backed treatments to people across Montana, Idaho, and Alaska - places where getting psychiatric care has historically been difficult or impossible.

We launched our telehealth practice in March 2020 (coincidentally just as COVID was starting), though we’d been planning this approach well before the pandemic. We saw firsthand the challenges patients faced - driving four hours for a 30-minute appointment wasn’t just inconvenient; it was a major barrier to care. Parents had to take time off work, kids had to miss school, and the cost of travel was substantial.

Today, our team includes about 30 providers - about half are psychiatrists and the other half are advanced practice providers like nurse practitioners and physician assistants. We focus on the medical side of mental health, offering expertise in child psychiatry, adult psychiatry, addiction treatment, geriatric psychiatry, and pregnancy-related psychiatry.

When we founded Frontier, we had a clear vision: to make access to high-quality psychiatric care available to everyone, no matter where they live. And we’re making good progress. In 2023, we were caring for patients in all 56 Montana counties, and we’ve since expanded into Idaho and Alaska.

Our online psychiatry model has proven very effective. Research we’ve conducted shows that our patients are hospitalized 30% less often than psychiatric patients who don’t work with us. While correlation doesn’t necessarily equal causation, these results encourage us that we’re on the right track.

Managing Anxiety: Practical Tips

If you’re struggling with anxiety, here are some important things to consider:

Start with assessment: Getting a proper diagnosis is critical. Short screening tools can help identify if you’re experiencing an anxiety disorder, but follow-up with a mental health professional is essential.

Consider your options: Both therapy for anxiety and medication can be effective, either alone or together. Your preference matters here - some people prefer to start with therapy, while others feel medication is the right first step. Either way, it’s important to work with providers who respect your preferences while offering treatments backed by research.

Understand medication expectations: If you choose medication, know that antidepressants typically take 2-4 weeks to begin working, with full effects often taking 6-8 weeks. Starting at lower doses can help reduce side effects during this beginning period. Face your fears gradually: Whether you’re taking medication or not, gradually facing feared situations is crucial for recovery. Avoiding things may provide temporary relief but makes anxiety worse long-term.

Consider lifestyle factors: Exercise, good sleep habits, and limiting caffeine and alcohol can all support anxiety management alongside formal treatments.

Final Thoughts

Living with an anxiety disorder can be incredibly challenging, but it’s important to remember that effective treatments exist. At Frontier Psychiatry, we’ve seen countless patients transform their lives once they receive proper mental health treatment. If you’re in Montana, Idaho, or Alaska and struggling with anxiety, PTSD treatment, or need addiction recovery support, reach out to us. Our virtual psychiatrist services means you can access expert psychiatric care from your home, eliminating the barriers of distance and travel. We’ll work with you to develop a treatment plan tailored to your specific needs and preferences. No one should have to suffer through anxiety alone, especially not when we have the technology and treatments to help. That’s the heart of our mission at Frontier Psychiatry - bringing high-quality behavioral health services to everyone who needs it, no matter where they call home.