Xanax, also known by its generic name alprazolam, is a benzodiazepine, and is used to treat anxiety disorders such as panic disorder. Benzodiazepines modulate GABA receptors, which have inhibitory effects on the CNS (Central Nervous System). The problem with Xanax, as with all the benzodiazepines, is that there is an addictive potential when taking this medication.
Although Xanax is highly effective for eliminating panic attacks as it has a fast onset of action, it is also potentially addictive. You can develop tolerance to the effects of Xanax, meaning you need more and more of the Xanax to get the same clinical effect of anxiety relief. Another problem with Xanax is that it has a short duration of action, so you can develop rebound symptoms in between doses, which is a result of the blood levels of the Xanax dropping suddenly. These rebound symptoms can take the form of worsening panic attacks, so the symptom you are trying to treat may actually get worse when the blood level drops between doses.
This is why I do not recommend Xanax for panic disorder, as it has a short duration of action and has potential problems with rebound symptoms. And even worse may be when you miss doses of Xanax, then you might develop withdrawal symptoms of anxiety, irritability, trembling, sweating, nausea and fatigue. These withdrawal symptoms then may foster dependence on the Xanax, as you need to keep taking the drug to prevent the withdrawal symptoms.
These withdrawal and rebound symptoms associated with Xanax can be avoided by not taking Xanax at all…if a benzodiazepine needs to be prescribed for immediate relief of panic attacks, then the best choice for a benzodiazepine is long-acting Klonopin (clonazepam). And even if you do take Klonopin, your doctor will have prescribed an SSRI (Selective Serotonin Reuptake Inhibitor) concurrently, then eventually taper and discontinue the Klonopin when the SSRI becomes effective for panic disorder weeks later. Benzodiazepines are rarely prescribed alone as a treatment for panic disorder.
If you must take Xanax (although I highly recommend NOT taking Xanax), then it can be started at 0.5mg three times daily for panic disorder. It can be increased to 1mg three times daily if needed. Again, I do not recommend that you start Xanax, as it is associated with withdrawal and rebound symptoms, and has a high abuse potential. Klonopin is the benzodiazepine of choice to start concurrently with an SSRI for treatment of panic disorder, given its long duration of action and less propensity for withdrawal and rebound symptoms when compared to Xanax. And when the SSRI becomes effective weeks later, then the Klonopin can be tapered and discontinued.
The take home message is that Xanax is a poor choice for panic disorder, and if a benzodiazepine must be prescribed, then Klonopin is the best choice. SSRIs are still the 1st line treatment for panic disorder. Benzodiazepines are almost never prescribed alone for panic disorder, given the effectiveness of SSRIs.
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Hi, I know this post is a year old but I have been diagnosed with PTSD, panic disorder and OCD. My APN (who is just a prescriber) has kept me on the regimen that my former board certified now retired Psychiatrist had me on: BusPar 30mgx2 daily and Xanax 0.5×3 daily PRN (now she upped it to x4 daily).
The issue I have is she has prescribed me three different SNRIs in the last year as my psychiatrist also had me on Klonopin 0.5mg x 1 daily. When I started seeing her she said that she’d never ever allow two benzos to be prescribed at the same time.
I’d love to not need the Xanax anymore but I haven’t even tried the Prozac she has latest prescribed for me because of the SSRI/SNRI and BusPar warnings. I am just too afraid of the serotonin syndrome?
I’m not sure this makes any sense but as I have a great therapist my anxiety attacks are stronger and the Xanax and BusPar don’t seem like enough anymore. Any ideas are appreciated and thanks for this post!
Yes, there is a risk of serotonin syndrome when combining serotonergic agents such as Prozac and Buspar. However, SSRIs and SNRIs are the best medication options for anxiety disorders, as benzodiazepines have a high addictive potential and numerous other side effects. If you are not confident in your APN, please get a referral to a psychiatrist with expertise in anxiety.
Oh come now, Dr. Carlo….
Clinical depression is the most over-diagnosed condition, as well as the most overprescribed for.
Not to mention many SSRI’s, SNRI’s & the like have worse side effect profiles than some benzodiazepines.
Black box warnings, here’s a few; suicide risk, heart problems, & with 1 or 2, even the potential for HOMICIDAL tendencies….sounds safer!
Sure benzodiazepines can worsen depression & even lead to suicide rarely, but is it not possible, Dr., that relieving somebody’s main symptoms (anxiety/panic) could improve their lives to such a degree that they wouldn’t need even MORE dangerous drugs(SSRI’s etc…).
Because let’s be honest with each other doctor, the benzodiazepines have been in use much longer than SSRIS & their side effects are infinitely more predictable & manageable, at this point in time.
I’m not even an anxiety patient, I’m a pain patient(never mind my ADD), so I’m well aware of the radical push away from potentially addictive drugs. Yet I have a hard time believing that benzodiazepines are any more hazardous or addictive than anti-depressant drugs.
Time will tell, Dr. Carlo, but barbiturates have been phased out entirely due to the “safer” option of benzodiazepines….but if doctors won’t even write for the safer benzodiazepines, what does the future hold for people who, unfortunately, happen to require controlled substances to live their lives?
No hope, Doctor, that’s what. Slippery slope….
P.s. To be fair I’m aware that the carelessness of some patients makes it difficult for doctors to provide adequate care for the majority, who are truly only seeking relief.
All I know is that if it weren’t so nearly impossible to get an adequate dosage of controlled meds, many more people….people like me, even, might actually be working, & contributing to society.
Longer than I intended but I’d like to leave you with a quote by the late, great, Sir Winston Churchill;
“It’s no use doing your best….you must succeed in doing what is necessary”
Doctors may be doing their best, but if they don’t succeed in relieving symptoms sufficiently to function, i for one will take matters into my own hands, because I must succeed….failure is not an option, and neither is misery.
Do doctors really want that for their patients?
You be the judge Dr. & Godspeed.
Thank you for that Tennessee…interesting perspective. You know, I’m not that keen on SSRIs and SNRIs either, given their side effects…it’s just the best we got for anxiety, unfortunately. In addition, the SSRIs and SNRIs seem to have similar withdrawal effects when it is discontinued, just like the benzodiazepines when they are discontinued. So it could be argued that SSRIs and SNRIs are also similar to addictive drugs, given the withdrawal side effects on discontinuation. What you mention about anxiety (or pain) reduction with benzodiazepines (or pain meds) to allow one to work and live with their disability is something doctors need to think more about, and they tend (myself included) to get on their judgmental high-horse and opt for the more ‘elegant’ treatment that are the SSRIs and SNRIs. But you do realize that there is a whole generation of doctors who have been subjected to the marketing blitz of the pharmaceutical companies that have made billions off the sale of these blockbuster antidepressants. No wonder the collective of medicine and psychiatry endorses these drugs so much. Thank you Tennessee for adding a more balanced perspective on this.
Dear Dr Carlo, Hi my name is Raymond Beddick I was in a serious car accident 16yrs ago & I had a broken neck c-5, c-6 & a lower broken back L4,L5. I’m currently on oxymorphone 20mg 2 × a day & percocet.10/325 2×a day. I had a triple by pass 7yrs ago & since then I’ve been in & out of the hospital since October. I was diagnosed with panic attacks I get very excited & I hyperventilate.I was told by a friend about Xanax & klonopin that may help me, and I was wondering if you could tell me what advice you could give me on these two drugs.
I’m sorry to hear about your chronic medical condition, and your developing panic attacks. In general, mixing pain killers (narcotics) with benzodiazepines (such as Xanax-alprazolam and Klonopin-clonazepam) is not a good idea. The reasons are that both are highly addictive, and the combination of narcotics and benzodiazepines can lead to death via accidental overdose. I would recommend that you try non-medication treatments for panic disorder first, such as psychotherapy, or self-help with books such as Anxiety Protocol. If these non-medication treatments do not turn out to be effective for you, then you can consider adding prescription medication treatment with an SSRI, or treatment with a natural anxiety supplement, such as KalmPro.