Anxiety and depression are among the most common mental health conditions in the United States — and among the most undertreated. According to the National Comorbidity Survey, the 12-month prevalence of major depressive disorder is approximately 6.6% and lifetime prevalence is 16.2%. Anxiety disorders are the most common mental health conditions overall, with generalized anxiety disorder, social anxiety, panic disorder, and phobias affecting tens of millions of Americans. In Miami-Dade County, access to mental health services — particularly for Spanish-speaking patients and uninsured or underinsured individuals — has historically been inadequate. Primary care plays a critical role: most patients with depression and anxiety first present to and are managed in the primary care setting. Early identification and treatment significantly improves outcomes and quality of life. At Viva Medical Center in Doral, FL, our physicians screen all patients for anxiety and depression, provide evidence-based first-line treatment, and coordinate psychiatric referrals when specialist involvement is warranted. Our bilingual team creates a safe, non-judgmental environment where mental health is treated with the same seriousness and compassion as physical health.
Conditions We Evaluate and Treat
Our primary care team evaluates and provides first-line treatment for:
- Major depressive disorder — persistent depressed mood, loss of interest, sleep and appetite changes, fatigue, difficulty concentrating
- Generalized anxiety disorder (GAD) — excessive, difficult-to-control worry about multiple areas of life
- Panic disorder — recurrent, unexpected panic attacks with persistent anticipatory anxiety
- Social anxiety disorder — intense fear of social or performance situations
- Persistent depressive disorder (dysthymia) — chronic, lower-grade depression lasting 2 or more years
- Adjustment disorders — emotional or behavioral symptoms in response to an identifiable stressor
- Postpartum depression — depression occurring during pregnancy or after delivery
- Anxiety and depression co-occurring with chronic medical conditions (diabetes, cardiovascular disease, chronic pain)
Screening and Diagnosis
All patients at Viva Medical Center are screened for depression and anxiety using validated tools:
- PHQ-9 (Patient Health Questionnaire) — gold-standard depression screening and severity measurement
- GAD-7 (Generalized Anxiety Disorder scale) — validated anxiety screening tool
- Edinburgh Postnatal Depression Scale — for postpartum depression screening
- Columbia Suicide Severity Rating Scale — for safety assessment when indicated
- Complete medical evaluation to rule out medical causes of mood symptoms (thyroid disease, anemia, vitamin deficiencies, medication side effects)
Treatment Options
Evidence-based treatment for anxiety and depression includes a combination of approaches:
- SSRIs (sertraline, escitalopram, fluoxetine) — first-line antidepressant medications for both depression and anxiety; safe, effective, and well-tolerated
- SNRIs (venlafaxine, duloxetine) — effective for depression, anxiety, and comorbid pain conditions
- Buspirone — non-addictive anxiolytic for generalized anxiety
- Cognitive-behavioral therapy (CBT) referral — evidence-based psychotherapy with the strongest evidence base for anxiety and depression; we coordinate referrals to trusted CBT therapists
- Lifestyle interventions — aerobic exercise demonstrated comparable efficacy to antidepressants for mild-to-moderate depression in multiple studies; sleep hygiene, stress reduction
- Collaborative care — coordination between primary care, therapy, and psychiatry for complex cases
- TMS (transcranial magnetic stimulation) referral — for treatment-resistant depression
- Psychiatry referral — for complex presentations, treatment-resistant cases, bipolar disorder, psychotic features, or medication management beyond primary care scope
When We Refer to Psychiatry
While primary care manages mild to moderate depression and anxiety effectively, we refer to psychiatry when:
- Active suicidal ideation with plan or intent
- Psychotic features (hallucinations, delusions) are present
- Bipolar disorder is suspected or confirmed
- Treatment-resistant depression not responding after two adequate medication trials
- Complex medication management requiring specialist expertise
- Severe eating disorders or OCD requiring specialist treatment protocols
- Substance use disorder significantly complicating psychiatric management