Anxiety is one of the most common mental health concerns, but it’s also one of the most misunderstood. Many people see it only as a problem to “get rid of,” yet anxiety itself plays an important role in keeping us safe and motivated. The real challenge is learning when anxiety is healthy—and when it’s interfering with your life.

As a psychiatric mental health nurse practitioner, my approach centers on coming alongside individuals to focus on brain and mental health in a holistic way. I look at the whole person—everything from sleep and nutrition to lab values—because optimizing multiple areas often creates the greatest improvement.

Normal vs. Problematic Anxiety

Some anxiety is normal and necessary. Without it, we might feel unmotivated or take unsafe risks. For example, anxiety helps us prepare for a big presentation or look both ways before crossing the street.

Anxiety becomes a problem when it interferes with daily functioning or quality of life. Signs include:

• Struggling to get out of bed in the morning
• Fear of leaving the house
• Avoiding conversations or social interactions
• Decline in overall well-being

When anxiety starts to limit these areas, it’s time to take action.

Holistic Foundations for Managing Anxiety

Before considering medication—or alongside it—I emphasize strengthening key lifestyle foundations:

• Sleep: Aim for at least 7 hours per night. Poor sleep makes it harder for the brain to regulate stress, which can increase anxiety.
• Nutrition: Consistent, balanced meals help reduce anxiety and prevent brain fog.
• Mindfulness & Meditation: Research shows that mindfulness meditation calms the brain and reduces anxious thoughts.

These strategies are often underestimated but can make a profound difference.

Medication Options

When anxiety significantly impacts functioning, medication may be appropriate. Common options include:

• SSRIs (Zoloft, Prozac, Lexapro): First-line treatments that increase serotonin to ease anxiety and improve mood.
• Buspirone (BuSpar): Targets anxiety specifically and works differently than SSRIs.
• Gabapentin: Prescribed off-label, helps increase GABA in the brain and may provide benefits within 1–2 weeks.

PRN (as needed) options for acute anxiety or panic include:

• Propranolol: Helpful for performance anxiety (e.g., public speaking).
• Hydroxyzine: An antihistamine that can reduce heightened anxiety throughout the day.

I avoid prescribing benzodiazepines (e.g., Xanax, Ativan) due to their addictive potential and negative impact on brain health.

Supplement Support

For individuals who prefer a gentler approach or have sensitivities to medications, supplements can be supportive. Some of my frequent recommendations include:

• L-theanine: Supports relaxation and sleep.
• Magnesium glycinate: Helps regulate GABA, improving mood, sleep, and anxiety.
• Other options: Ashwagandha, saffron, L-lysine, and L-arginine.

Supplements should always be monitored by a provider to ensure safety and avoid interactions with medications.

Choosing Between Medication and Supplements

The choice often depends on severity and impact:

• Severe anxiety (e.g., unable to work, leave home, or engage socially): Medication may be necessary to stabilize the brain.
• Milder anxiety (e.g., able to function but still struggling): Supplements and lifestyle changes may be a good starting point.

Medications are generally more powerful and fast-acting, while supplements provide a gentler, supportive effect. Both can take 4–6 weeks to reach full benefit.

Treatment Duration and Tapering

For daily medications like SSRIs, I recommend staying on them for at least 6 months to give the brain time to stabilize. Many people benefit from ongoing treatment for a year or more, depending on life stressors.

If tapering is appropriate, it should be done slowly and collaboratively with a provider. Stopping too quickly often leads to a return of symptoms.

Proactive Care

Ultimately, anxiety management should be proactive, not reactive. Having a daily baseline—whether that’s a medication, supplement, or mindfulness practice—creates steadier brain chemistry and prevents being constantly thrown off by anxiety spikes.

By addressing sleep, nutrition, mindfulness, supplements, and medication options together, we can build a strong foundation for brain health and long-term well-being.