Anxiety and Xanax

The other day I stumbled on a Netflix documentary about Xanax (“Take Your Pills: Xanax”). It features psychiatrists as well as Xanax users. Here’s what I learned:

The use of Xanax has skyrocketed in the last twenty years: roughly one in eight adults take the pills for anxiety, panic disorder, and insomnia. Xanax is in the class of drugs called benzodiazepines, which also includes Librium, Valium, Klonopin, and Ativan.  They work by enhancing a neurotransmitter in the brain that reduces communication from one brain cell to another.

As the users in the program say, “It takes the edge off'"; “All the weight that’s on you is gone"; “It made me feel like a better version of myself"; and “I need to numb myself to be able to sleep.” But also this: “Knowing what I know now, I would never have taken that first prescription. Never.”

 Anxiety is complicated. It seems that both nature and nurture may be involved. For some, anxiety may be part of their baseline temperament, as seems to be the case for Scott Stossel, author of My Age of Anxiety and editor of The Atlantic magazine. “I was a nervous kid. I’d get panic attacks.” Other people mentioned the long-term effects of bullying, parental expectations, and sexual assault.

The psychiatrists viewed Xanax as a useful tool to use occasionally for acute anxiety. But if you take them every day, multiple times a day, abruptly discontinuing them can have serious consequences, including severe anxiety and insomnia. Some patients have no problems reducing their dosages and some are sensitive to even the smallest dose reductions. Stossel, whose anxiety is debilitating, tries not to take Xanax, but he does take Lexapro, an antidepressant.

The man who was sorry he had ever started on Xanax had been taking three milligrams a day for 15 years. When he decided to quit by tapering off, he lowered his dosage from three milligrams to two and a half. He was soon extremely ill: fatigue; heart palpitations; burning skin; muscle twitching; brain fog, etc. Not realizing his symptoms were those of withdrawal, he consulted 35 specialists including some at the Mayo Clinic. None concluded his symptoms resulted from Xanax withdrawal. They were wrong. More than a year later, he was still tapering off, using titration techniques to reduce his dosage by tiny fractions. This takes years. A memoir, called Blood Orange Night: My Journey to the Edge of Madness by Melissa Bond, chronicles a similar experience. Both people finally found the information they needed in the highly regarded The Ashton Manual.

As one of the psychiatrists noted, “I think benzos erode the resilience that we must rely upon at some point in our lives. If you’re mediating your anxiety through a Xanax, you’re not really confronting it. What’s going to get you on the other side of anxiety is to go through it and experience it and understand it and make some sort of peace with it.” For many, I’m guessing, this is easier said than done.

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