Drugs & Medications
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How Effective is Alprazolam (Xanax) for Anxiety?

Victoria LeBlanc, MS, LCPC
How Effective is Alprazolam (Xanax) for Anxiety?

Those who suffer from anxiety are often looking for ways to overcome their intense feelings. Medication is one route that is perceived to be “quick and easy” and why many people prefer medications to therapy. But medications also have their downsides, so finding the right anxiety medicine is crucial.

Alprazolam is one of the most prescribed anxiety drugs on the market today. You may know it by its trade name, Xanax. Alprazolam appears to be very effective for anxiety, but it's also something you need to strongly think about before you decide to utilize this type of medication.

Using Alprazolam For Anxiety

Alprazolam is one of the most prescribed medications in the world. One might say that it's prescribed too often, because most people are given Alprazolam by doctors, not psychologists. No medication should be a person's first choice when they're trying to manage their anxiety, rather medication needs to be a last resort, after you've tried other non-mediciated options. Furthermore, while many people just want to take a pill to address their anxiety, the best results are actually found when using medication in conjunction with therapy. 

Why to Avoid Medicine

The main reason to avoid Xanax and other anxiety medications unless you need them is because they don't cure your anxiety. They merely dull it. Eventually, if you stop taking the medicine, your anxiety will always come back.

That's clearly a problem. These medications already have trouble with side effects, tolerance, and addiction (more on that later), but perhaps their greatest problem is that they dull anxiety without helping a person truly fix the problem. Eventually you'll quit the medication, your anxiety will come back, and you'll find yourself suffering. That's why you need to make sure that you never depend on medication alone.

What is Alprazolam?

Alprazolam is a drug in the benzodiazepine class. Like other benzodiazepines, Alprazolam isn't just an anxiolytic (a drug to reduce anxiety). It's also a:

All of these other properties have both benefits and weaknesses for reducing anxiety. Alprazolam is one of the most prescribed medicines because it works quickly. It may take as little as 10 minutes and usually no longer than an hour for the Alprazolam to start working.

Alprazolam is used for all types of anxiety, but it's one of the few medicines prescribed for panic disorder. Most other benzodiazepines (including Alprazolam) are used primarily for generalized anxiety disorder and social anxiety disorder.

Alprazolam binds to GABA receptors to produce these anxiolytic qualities. Alprazolam is also generally not prone to allergic reactions, which is another reason it is prescribed so frequently.

Alprazolam As An Anxiety Treatment

There is no denying that Alprazolam works. It's been prescribed for severe anxiety and panic attacks for decades, and appears to show some fairly strong success rates. Xanax, and the generic versions, all seem to work well for most anxiety disorders and continue to provide relief for many months.

The problem isn't generally that Alprazolam doesn't work. The problem is that it is often prescribed without any other treatment, and with issues like panic attacks, you need to be able to manage them otherwise, when you stop taking the medication, the panic attacks will not only come back - they may come back stronger.

Taking Alprazolam for anxiety can also cause both psychological and physical dependence.

Dependence - especially physical dependence - can also lead to withdrawal symptoms, and in some cases these can be very severe. In many ways, Alprazolam has the same withdrawal symptoms as alcoholism, including not only anxiety and panic attacks, but also memory loss, muscle ache, headache, sweating, sleep problems, nausea, hallucinations, and even seizures. There is even a small risk of suicide.

If you wean off of the drug slowly over time you can decrease the likelihood of these withdrawal symptoms, but long term use of Alprazolam, even if it stops working, will increase the risk that withdrawal occurs. Perhaps even more unusual is that the withdrawal symptoms may also come and go over time after you stop taking the medicine.

The sudden stopping of Alprazolam can be life-threatening and is not recommended. Alprazolam is designed to depress the central nervous system, slowing things such as breathing, heart rate, body temperature, etc. When the drug is abruptly removed from the bloodstream these things can quickly elevate, leading to seizure, coma, or even death. 

Alprazolam Side Effects

The side effects of Alprazolam are similar to other benzodiazepines. The main concern is sedation. Alprazolam can cause extreme fatigue, not unlike alcohol use. It may also cause concentration problems, poor motor skills, memory loss, and lack of coordination. While many medications tell you not to operate machinery or drive until you know how the drug affects you, with Alprazolam you absolutely need to follow that advice.

Other side effects include, but are not limited to:

Upset stomach/nausea, and headaches may also occur. Combining Alprazolam with other drugs of abuse can also be fatal. Alprazolam should absolutely not be taken with alcohol.

Furthermore, if you are pregnant or breastfeeding you are not to take Alprazolam because of the harm it can cause to the baby.

Overall Thoughts on Alprazolam For Anxiety

Despite what some people may think, anxiety drugs are not inherently bad. For those that have not seen success with other treatments, or for those whose anxiety is so severe they need immediate relief simply to get through their day, anxiety medications may not be a terrible idea. They have side effects, but generally they are not too dangerous, and Alprazolam is an example of one of the few medicines that could have an impact on your life.

But, anxiety drugs should not be used as a first choice, nor should they ever be the only choice. You should first make sure to try to learn coping skills and use psychological interventions such as meditation, relaxation techniques, and therapy to learn how to manage your anxiety without medication. Furthermore, it is important to note that finding the right anxiety medication and the correct dosage for your needs can be a lengthy process. It may take months to figure out what the right medication and dosage is for your anxiety. Finally, if you do decide to take Alprazolam, or any anxiolytic, you need to make sure that you are also working on treatments that will keep your anxiety away if you stop taking the drug in the future. Medication alone is not the answer. It is important to know that it works best when used in conjunction with therapy which will address the root causes for your anxiety and teach you the necessary coping skills for managing it in the future.

Article Resources
  1. American Addiction Centers. (2018). How Long Do Xanax Withdrawals Last, Dangers, & Treatment? Learn If Detox is Needed. Retreived from https://americanaddictioncenters.org/withdrawal-timelines-treatments/xanax/
  2. Chouinard, G., et al. Alprazolam in the treatment of generalized anxiety and panic disorders: a double-blind placebo-controlled study. Psychopharmacology 77.3 (1982): 229-233.
  3. Klosko, Janet S., et al. A comparison of alprazolam and behavior therapy in treatment of panic disorder. Journal of consulting and clinical psychology 58.1 (1990): 77.
  4. Marks, Isaac M., et al. Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto. The British Journal of Psychiatry 162.6 (1993): 776-787. 
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