Hurricane Season Anxiety: Coping Before, During and After the Storm

Hurricane season opens on June 1, and for a lot of people in our service area, so does a six-month stretch of low-grade dread. The cone of uncertainty, the spaghetti models, the gas lines, the shutters that may or may not go up, the question of whether to leave and where to go. Then the storm, or the near miss. Then, sometimes, months of blue tarps, insurance calls and the feeling that it could happen again next week.

Stedfast Psychiatry has offices from Jacksonville to Fort Lauderdale and from Hilton Head Island to Goose Creek. Every one of them is in a place that has been hit or nearly hit in the last decade. Hurricane anxiety is not a niche complaint for us; it is a seasonal rhythm in our clinics. Here is what it looks like, what helps, and when it needs more than coping strategies.

What hurricane anxiety looks like

Some level of anxiety about hurricanes is appropriate. They are dangerous, and anxiety is what gets the water bought and the shutters checked. The problem is anxiety that outruns the threat, that persists when no storm is near, or that paralyzes rather than motivates. Common patterns include:

• Checking the National Hurricane Center or a weather app many times a day, including in the off-season or when nothing is forecast.
• Insomnia and vivid storm dreams whenever a system forms in the Atlantic, even thousands of miles away.
• Panic attacks triggered by wind, heavy rain or the sound of a generator.
• Irritability and conflict with family over whether and when to evacuate.
• Inability to make basic decisions, or over-preparing to the point of exhaustion and financial strain.
• Avoiding the news entirely, which produces its own anxiety about being unprepared.
• Flashbacks, intrusive memories or physical reactions tied to a previous storm.

People who have lived through a direct hit, lost a home, been trapped during flooding or watched a loved one in danger are at the highest risk. So are people with pre-existing anxiety disorders, those caring for children or frail parents, and those whose finances cannot absorb another loss.

Before the storm: June through the first watch

Prepare early, then stop

Much of pre-storm anxiety comes from unfinished tasks that resurface with every forecast. The fix is to finish them in June, when there is no storm: supplies, documents in a waterproof folder, a written evacuation plan with a destination and a route, medications refilled with a 30-day buffer, the shutters tested. Then the plan exists, and when a storm appears, the task is to execute it rather than invent it. Anxiety that has a job to do is less corrosive than anxiety that has nothing to do.

Limit forecast exposure

Checking a forecast more than two or three times a day adds no information; the National Hurricane Center updates its advisories on a fixed schedule, every six hours for a named storm, with intermediate updates when watches or warnings are in effect. Pick a single reliable source, check it at advisory times, and close the app. Spaghetti models and social media speculation are the worst offenders for driving anxiety without improving decisions.

Keep your medication plan intact

If you take psychiatric medication, hurricane season is not the time to run low. Florida law allows pharmacies to dispense early refills of most medications when a state of emergency is declared, and most insurers follow suit. Ask your prescriber for a prescription with enough refills to carry you through a disruption, and keep a week's supply in your go-bag. Abruptly stopping an antidepressant or benzodiazepine during an evacuation is a common and avoidable cause of crisis.

During the storm

The hours when a storm is passing are the hardest for people with anxiety, because there is nothing left to do. A few things help.

Structure the time. Set a schedule for meals, checking on neighbors, and sleep attempts. Boredom and formlessness feed anxiety.

Use the breathing you practiced. Slow exhalation, longer than the inhalation, for a few minutes at a time, lowers physical arousal. It does not stop the wind, but it stops the body from acting as if it is in mortal danger every minute.

Ration the radio. Continuous storm coverage is a feed of alarm. Check at advisory times and switch to music, a book or a card game between.

Keep children busy and keep adults honest. Children take their cues from adult faces; a calm routine protects them more than reassurance does. If you are not calm, say so to another adult, not to the child, and swap roles.

If panic rises past what you can manage, and you have a rescue medication prescribed for that purpose, this is what it is for. If you do not, and you feel you are in danger from yourself, 988 operates through storms and can be reached by text when voice lines are overloaded.

After the storm

The aftermath is where the psychiatric burden actually peaks, and where it is most often ignored. Research after Katrina, Sandy, Harvey and Ian found that rates of depression, anxiety and PTSD rose substantially in affected communities in the months after landfall, with the highest rates among people who lost housing, experienced flooding or were displaced. The stressors are concrete: insurance disputes, contractors, mold, schools closed, jobs disrupted, neighborhoods emptied. Sleep collapses. Alcohol use rises. Relationships strain.

What helps in the first weeks is basic: restore sleep first, with a fixed wake time and daylight exposure, even in a shelter or a relative's spare room. Restore routine second, especially for children. Accept help, which people in our region are often bad at. Limit alcohol, which worsens sleep and mood and is widely available at every post-storm gathering. Stay connected to neighbors; isolation after a disaster is one of the strongest predictors of lasting problems.

Then watch the calendar. Acute stress in the first month after a storm is expected. Symptoms that persist past a month, including intrusive memories, nightmares, avoidance of reminders, feeling constantly on guard, emotional numbness or a sense of foreshortened future, meet the threshold for post-traumatic stress disorder and warrant evaluation. So does a depression that settles in, or anxiety that does not lift when the tarps come off.

When to get help

You do not need to wait for a diagnosis. Reasons to call during any phase of hurricane season include anxiety that interferes with work, sleep or relationships for more than two weeks; panic attacks; a return of symptoms from a prior storm; using alcohol or sedatives to get through; or any thought that you would rather not be here for the next one.

Treatment is effective. Cognitive behavioral therapy and, for PTSD, trauma-focused therapies such as prolonged exposure, cognitive processing therapy and EMDR have strong evidence. SSRIs treat both anxiety disorders and PTSD. A short-term plan for the anxious weeks of an approaching storm is also reasonable, and telehealth makes it possible to keep appointments when roads are closed or you have evacuated within Florida or South Carolina.

How Stedfast Psychiatry handles storms

Our offices follow county emergency declarations and close when the county does. Telehealth visits continue whenever clinicians and patients have power and connectivity, and we move in-person appointments to video when a storm approaches. Patients are contacted about rescheduling as soon as offices reopen. We ask patients on controlled or essential medications to keep a buffer supply during the season, and we will issue early refills when a state of emergency allows it. If you are a current patient and evacuated out of state, call us; we can advise on bridging medication until you are back within Florida or South Carolina, where our clinicians are licensed to see you.

Hurricane anxiety is not a weakness, and preparing for the psychological side of the season is as practical as buying water. If this season already has you checking the tropics at midnight, a conversation with a clinician now is worth more than one in September. We see patients at 13 offices and by telehealth; the self-pay new-patient visit is $185, and most insurance and Medicare are accepted.

Related reading

• Seasonal Depression in Florida: Yes, It Happens6 min
• Telepsychiatry in Florida: How It Works and Who It Is Right For6 min
• Anxiety or ADHD? How to Tell the Difference5 min
• What Happens at Your First Psychiatrist Appointment6 min

This article is educational and does not replace evaluation by a licensed clinician. If you are in crisis, call or text 988.