When creative energy turns into constant worry
Asheville runs on ideas. Painters in the River Arts District, musicians on Lexington Avenue, chefs and brewers downtown — a lot of people here live by their imagination. The same mind that dreams up something new can also dream up every way things might go wrong. When that turns into a loop you cannot stop, it is not a quirk of being creative. It may be an anxiety disorder, and it is very treatable.
People across western North Carolina also carry stress that visitors never see. Many families are still rebuilding homes, studios, and businesses after Hurricane Helene in 2024. Rising rent and a changing city add more weight. It makes sense if your body has stayed on high alert.
Signs worth paying attention to
Anxiety does not always look like panic. For a lot of our patients it shows up as:
- Lying awake rehearsing tomorrow, then waking up tired
- A tight chest, shaky hands, or a stomach that will not settle
- Putting off calls, emails, or gigs because they feel too big
- Snapping at people you love, then feeling guilty
- Avoiding the crowds on Biltmore Avenue that you used to enjoy
If several of these sound familiar and they have lasted for weeks, an evaluation can sort out what is going on.
How we figure out what kind of anxiety it is
"Anxiety" is a family of conditions. Generalized anxiety, panic disorder, and social anxiety each have their own pattern, and the right plan depends on which one you have. Your provider will ask about your history, your sleep, caffeine and alcohol, and your health. Standard tools like the GAD-7 help put numbers to how you feel, so we can track change over time. We also check for things that mimic anxiety, such as thyroid problems or side effects from other medicines.
If you want the full picture first, start with a psychiatric evaluation.
A medication plan built around your life
Most people with an anxiety disorder start with an SSRI such as sertraline or escitalopram, or an SNRI such as venlafaxine XR or duloxetine. These are not habit-forming. They usually take a few weeks to start helping, and the full effect can take two months or more, so we plan for that together. Early side effects, like an upset stomach or feeling a bit jittery, often fade in the first week or two.
Other options include buspirone for ongoing worry and hydroxyzine for short-term relief. We are careful with sedatives like benzodiazepines because they can cause dependence. If you are an artist or musician worried that medication will dull your edge, tell us. That concern shapes which medicine and dose we choose, and we adjust until you feel like yourself again.
OCD and intrusive thoughts
Obsessive-compulsive disorder is its own condition, but it often travels with anxiety. It can look like checking the stove ten times, needing things to feel "just right" before you can leave, or unwanted thoughts that feel scary and sticky. Many people hide OCD for years because they are embarrassed. You do not need to. SSRIs help OCD too, often at higher doses than for worry alone, and they can take longer to work. Your provider will explain the plan and the timeline clearly.
When medicines have not worked before
If you have tried two or three medications and none fit, a GeneSight test can show how your genes may affect the way your body handles certain medicines. It is one tool among many, not a crystal ball, but it can help narrow the next choice.
Care that stays with you
Starting a medicine is only step one. We check in on how you are sleeping, eating, and working, and we change the plan when your life changes. Our office is at 16 Biltmore Ave downtown, and we see people from Montford, West Asheville, North Asheville, and across the mountains.
If you are ever in crisis or thinking about suicide, call or text 988 any time, or call 911.
What to bring to your first visit
A little prep helps your provider see the full picture fast. Jot down:
- When the worry started and anything that made it spike, like a move, a breakup, or storm damage
- How many cups of coffee or energy drinks you have on a normal day
- Every medicine and supplement you take, including anything for sleep
- Past anxiety medicines, the dose, and why you stopped
- Your work rhythm, whether that is gigs, studio hours, or restaurant shifts
Many of our patients keep irregular schedules. Tell us yours, and we will build a plan around it rather than asking you to change your whole life first.
If someone you love is the worrier
Partners and roommates often notice anxiety before the person living with it does. Pacing, constant reassurance-seeking, or canceling plans at the last minute can all be clues. You cannot fix it for them, but you can say what you see without judgment and offer to help them book a visit.
Ready to feel steady again?
You do not need a referral. Become a patient and our team will find a time that works for you. We are accepting new patients ages 15 and older.
Why Choose Asheville Psychiatry and Mental Health?
- Providers across Asheville and western North Carolina who actually listen and take their time
- Now accepting new patients because waiting makes everything harder
- We accept most major insurance, Medicaid, and Medicare — and work with you on costs
- A practice that treats you like a person, not a number