c. Rebound symptoms. Rebound is the temporary return of greater anxiety symptoms after withdrawal from medication than you experienced before the medication. This usually occurs two to three days after a taper and is often caused by too big of a reduction of the drug at one time. It is possible that a rebound reaction can trigger a relapse reaction. Between 10 to 35 percent of patients will experience the rebound of anxiety symptoms, especially panic attacks, when they discontinue the BZs too rapidly.

Suggestions For Tapering.

A slow tapering of the medication is best. One approach is to remain at each new lower dose for two weeks before the next reduction. Tapering a BZ over a two- to four-month period can lead to significantly less withdrawal symptoms.

3) Alcohol use. Alcohol will increase the drug's depressant effects on the brain and can result in excessive drowsiness or intoxication.

Alprazolam (Xanax)

Possible Benefits. The FDA has approved alprazolam in the treatment of panic disorder and several large-scale, placebo controlled studies support its effectiveness. It is also helpful for generalized anxiety disorder. Is rapid-acting so can offer some relief within an hour. Has few side effects. Can be taken daily or only as needed. Both panic disorder patients and generalized anxiety disorder patients can start feeling better within a week. To block panic attacks, two to four weeks of treatment may be needed.

Possible Disadvantages. See benzodiazepines-possible disadvantages, above. About 10 to 20% of panic disorder patients fail to respond adequately to Xanax. Do not take if planning to get pregnant, while pregnant or while breast-feeding. Be cautious in drinking alcohol, since it can lead to increased intoxication effects and drowsiness.

Possible Side Effects. See benzodiazepines-side effects, above. The principle side effect is sedation, but dizziness and postural hypotension, tachycardia, confusion, headache, insomnia and depression also occur.

Dosages Recommended by Investigators. Alprazolam is usually started using 0.25 mg (1/4 mg) or 0.5 mg (1/2 mg) two to three times a day. This lower starting dose helps reduce the side effect of sedation (sleepiness) that can come during the first week or so of treatment. If taken after meals, side effects such as drowsiness can diminish, and the therapeutic effects can last longer. Your physician can increase this dosage by adding 0.5 mg to one of the three daily doses up to a maximum of 2 mg three times per day. From that level, you take any additional increases at bedtime or apply them equally during the day. The dosage range is 1 to 10 mg per day. A common recommendation is to take a new dose every four hours during the day. If anxiety symptoms return earlier than four hours, clonazepam is sometimes added to the alprazolam.

Tapering. Generally physicians taper alprazolam at 0.25 mg every three days. Withdrawal and rebound symptoms can occur during taper. If you have been taking alprazolam for many months, it may be best that you gradually lower your dose over eight to twelve weeks. If you have difficulty with this regimen, then your doctor may suggest that you switch to a longer-acting benzodiazepine, like clonazepam (Klonopin), or a barbiturate called phenobarbital (Luminal). An alternative is to add a medication to alprazolam that would reduce some of the bothersome symptoms during the withdrawal period. These could be carbamazepine (Tegretol), propranolol, or clonidine (Catapres).