Anxiety is not one condition, and that is the practical reason a diagnostic appointment can be worth paying for. Treatment that works well for panic disorder is not the same as treatment for health anxiety, and someone who has spent two years doing the wrong kind of self-help often concludes that nothing works.
Four problems that get called “anxiety”
| Diagnosis | What it looks like | What usually helps first |
|---|---|---|
| Generalised anxiety disorder | Worry about many different things, most days, hard to switch off, lasting months | CBT; an SSRI if therapy is not enough or not accessible |
| Panic disorder | Sudden attacks of intense fear with physical symptoms, then fear of the next one | CBT aimed specifically at panic; an SSRI licensed for panic disorder |
| Social anxiety | Lasting fear of being watched, judged or humiliated, affecting work and relationships | CBT, which the NHS says is generally the best treatment; SSRIs such as escitalopram or sertraline |
| Health anxiety | Preoccupation with having a serious illness, checking the body, searching symptoms, seeking reassurance | CBT close to that used for OCD; medication has a smaller role |
Mind’s guide to anxiety disorders describes each in more detail, and notes that health anxiety sits closer to OCD than to the other anxiety disorders. That is not a technicality: it changes which therapy to ask for.
When paying for an assessment makes sense
The NHS route for anxiety is genuinely good, and the NHS page on generalised anxiety disorder sets out the standard order: talking therapy first, medication if that is not enough, specialist referral after that. If you have not yet tried CBT, a psychiatric assessment is probably premature.
It becomes worth considering when one of these applies.
- Therapy has been done properly and anxiety is still running your week. Not two sessions that clashed with work, but a completed course.
- Nobody has pinned down which anxiety problem you have. “Anxiety and depression” on a record can hide undiagnosed panic disorder, social anxiety, OCD or ADHD, each of which has a different first treatment.
- You have had several medicines and none has been given a fair run. A common history is three SSRIs, each stopped within ten days because the first fortnight felt worse.
- You want a considered second opinion on whether to start medication at all, or how to come off something you have taken for years.
- Anxiety has arrived alongside something else — low mood, alcohol creeping up, insomnia, burnout — and the order of treatment is unclear.
Ruling things out before treating
A good assessment spends part of its time on what this is not. Anxiety symptoms are physical as much as mental, and several physical conditions produce them. An overactive thyroid, anaemia, heart rhythm disturbances and, less commonly, other endocrine problems can all present as anxiety or panic. The NHS notes on its panic disorder page that most panic attack symptoms “can also be symptoms of other conditions or problems, so you may not always be experiencing a panic attack”.
Medicines and substances matter too. High caffeine intake, salbutamol inhalers, steroids, decongestants, some ADHD medication, cannabis, cocaine and, very commonly, alcohol withdrawal in the early hours all produce anxiety that no antidepressant will fix. So does an SSRI started at too high a dose. A consultant psychiatrist will ask about all of this, which is why the appointment covers your physical health and every medicine you take, not only the psychiatric ones.
Where a physical cause looks possible, the sensible outcome is investigation through your GP rather than a psychiatric prescription.
Medication, in outline
Decisions are individual, so what follows is the shape of the thinking rather than a recommendation for you.
For generalised anxiety disorder, NICE guidance says to offer an SSRI, and to “consider offering sertraline first because it is the most cost-effective drug”. If sertraline is ineffective or not tolerated, it says to offer an alternative SSRI or an SNRI, and if those cannot be tolerated, to consider pregabalin. For panic disorder, the same guideline says an SSRI licensed for panic disorder should be offered. For social anxiety, the NHS names escitalopram and sertraline as examples of SSRIs used.
Two practical points come up constantly in appointments. First, anxiety often needs a lower starting dose and a slower increase than depression, because early jitteriness is what makes people abandon a medicine that would have worked. Second, an adequate trial is measured in weeks: the NHS says antidepressants take two to four weeks to begin working and up to eight weeks to work fully, so judging a medicine at day ten tells you about side effects, not about benefit.
Propranolol, a beta blocker, is sometimes used for the physical symptoms of performance-related anxiety. It does nothing for worry itself, and it is not suitable for everyone, particularly people with asthma.
The benzodiazepine problem
Diazepam, lorazepam and similar drugs work quickly, which is exactly why they cause trouble. Tolerance builds, the dose creeps, stopping produces rebound anxiety worse than the original, and withdrawal can take months. NICE is unusually blunt: for generalised anxiety disorder, do not offer a benzodiazepine “in primary or secondary care except as a short-term measure during crises”, and for panic disorder, benzodiazepines “are associated with a less good outcome in the long term and should not be prescribed”. The same guideline says not to offer an antipsychotic for generalised anxiety disorder in primary care.
If you are already on a long-term benzodiazepine or a Z-drug for sleep, that is a reasonable thing to bring to a psychiatrist: planning a slow, tolerable reduction is skilled work and rushing it is worse than not starting.
Medication and therapy are not rivals
Happy Clinic does not provide psychological therapy. It can tell you which therapy is likely to help and why, and that advice is part of the treatment plan, but the therapy has to come from elsewhere.
In England, you can refer yourself to NHS talking therapies without seeing a GP through the NHS find a service page. Those services treat generalised anxiety, panic disorder, social anxiety, phobias, OCD and PTSD, and offer CBT and guided self-help among other therapies. Elsewhere in the UK your GP is the fastest route to whatever the local equivalent is.
For many people the useful combination is medication that takes the edge off the physical fear, making it possible to do the therapy that produces lasting change. Medication alone tends to leave the avoidance untouched, and avoidance is what keeps anxiety going.
What follow-up looks like
Anxiety treatment is a sequence of reviews, not a single decision. NICE advises reviewing the effectiveness and side effects of medication “every 2 to 4 weeks during the first 3 months of treatment and every 3 months thereafter”.
At Happy Clinic, follow-ups are 20-minute video appointments. The first is usually a few weeks after any change, to check tolerability and whether the dose needs moving. Later reviews cover how long to continue and how to stop safely, which for anxiety usually means staying on a medicine for a good while after you feel well, then reducing gradually. Once treatment is stable, a medication review or a handover to your GP is normally the better long-term arrangement, and the clinical summary is written with that in mind.
Fees and next steps
An initial psychiatric assessment is £400 for 60 minutes, and follow-up or review appointments are £200 for 20 minutes. Fees are paid in advance. Prescriptions issued during an appointment are included; pharmacy charges are not. Repeat prescription requests for existing patients are £150, subject to clinical review. Fees checked September 2026 — see the fees page for the current list.
Consultations are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC), by video with GMC-registered consultant psychiatrists, for adults aged 18 and over anywhere in the UK. If you want to know what the appointment itself is like, read the first appointment page; if anxiety sits alongside low mood, the depression page covers the medication decisions that come with that. When you are ready, book an appointment.
If you are in crisis, this is not the right service. Call 999 or go to A&E if a life is at risk, call NHS 111 and choose the mental health option for urgent help in England, or call Samaritans free on 116 123, at any hour.
Speak to a Consultant Psychiatrist
Book a secure video consultation with Happy Clinic, for adults aged 18 and over anywhere in the UK. No GP referral is needed and appointments are often available within days.
This page is general information and is not a substitute for personal medical advice. Consultations, diagnosis and prescriptions are provided by Happy Clinic, which is registered with the Care Quality Commission (CQC). If you are in crisis, call 999, go to A&E, call NHS 111 or call Samaritans free on 116 123.