What SSRIs do, what CBT is, what a psychiatric visit involves.
There is no single right answer. For mild-to-moderate anxiety with access to a skilled CBT therapist, therapy alone is reasonable and produces durable results. For severe anxiety, anxiety with co-occurring depression, or limited access to therapy, medication is reasonable to start. Combined treatment tends to work faster for moderate-to-severe symptoms. The choice is made with a clinician who can match the approach to the picture.
Most SSRIs and SNRIs take four to six weeks at a therapeutic dose to show clear effect. Side effects in the first one to two weeks are common, nausea, jitteriness, mild headaches, sleep changes, and tend to settle. About 60 to 70 percent of patients respond well to the first SSRI tried. Those who don't usually respond to a different SSRI or a different class.
Not necessarily. For a first episode of anxiety that responds well to medication, a common approach is to continue treatment for 12 months past the point of meaningful improvement, then taper slowly under clinician guidance. For recurring anxiety or for patients with multiple prior episodes, longer-term treatment is often appropriate. The decision is made over time, with a clinician who knows the picture.
Yes. Cognitive behavioral therapy is the most-studied psychotherapy for anxiety disorders and produces substantial improvement in most patients who complete a course. For panic disorder, OCD, social anxiety, and specific phobias, the evidence base is particularly strong. The single biggest predictor of outcomes in CBT is whether the patient does the work between sessions.
Common, and usually fixable. The first SSRI doesn't work for everyone; a different SSRI or a different class often does. The first therapist isn't always the right match; switching is reasonable and not a failure. Most people who keep adjusting find a combination that works within several months.