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Benzodiazepines for Treatment of Anxiety and Panic Attacks

Learn about the benefits, side-effects and disadvantages of benzodiazepines (Xanax, ) for treatment of anxiety and panic attacks.

D. Benzodiazepines (BZs)

Detailed info on benefits, side-effects and disadvantages of benzodiazepines (Xanax, Valium) for treatment of anxiety and panic attacks.Possible Benefits. You can take benzodiazepines as a single dose therapy or several times a day for months (or even years). Studies suggest that they are effective in reducing symptoms of anxiety in approximately 70-80% of patients. They are quick acting. Tolerance does not develop in the anti-panic or other therapeutic effects. Generics are available for many, which helps reduce cost. Overdose is not dangerous.

Possible Side Effects. Some patients experience the sedative effects of drowsiness or lethargy, decreased mental sharpness, slurring of speech and some decrease in coordination or unsteadiness of gait, less occupational efficiency or productivity and, occasionally, headache. These may continue during the first few weeks, but tend to clear up, especially if you increase the dose gradually. Sexual side effects can arise. Some people experience low moods, irritability or agitation. Rarely, a patient will experience disinheriting: they lose control of some of their impulses and do things they wouldn't ordinarily do, like increased arguing, driving the car recklessly or shoplifting. They also increase the effects of alcohol. A patient taking a BZ should drink very little alcohol and should refrain from drinking within hours of driving a car.

If taken over long periods, the BZs can produce a loss of muscle coordination and some cognitive impairment, especially in the elderly.

Possible Disadvantages

1) Abuse Potential. It is rare that a person with an anxiety disorder abuses the use of a benzodiazepine. However, patients with a history of substance abuse report a more euphoric effect from the BZs than do control subjects. They also can use the BZs to help with sleep, to control anxiety produced by other drugs or to reduce withdrawal symptoms from other drugs. Because of these concerns, it may not be in the best interest of patients who have both panic disorder and a current substance abuse problem to use the BZs for their anxiety.

2) Symptoms upon tapering. Studies indicate that between 35 and 45 percent of patients are able to withdraw from the BZs without difficulty. Of the others, three different problems can arise. These are symptoms of withdrawal, rebound, and relapse, which can sometimes occur simultaneously.

a. Dependence and withdrawal symptoms. Physical dependence means that when a person stops taking a drug or reduces the dose quickly, he or she will experience symptoms of withdrawal. BZ withdrawal symptoms usually begin soon after reduction of the drug begins. They can be any of the following: confusion, diarrhea, blurred vision, heightened sensory perception, muscle cramping, reduced sensation of smell, muscle twitches, numbness or tingling, decreased appetite, and weight loss. These symptoms can be bothersome but are usually mild to moderate, almost never dangerous, and resolve over a week or so.

At least 50% of patients experience some withdrawal symptoms when they stop taking a benzodiazepine, and almost all patients experience strong withdrawal symptoms if they stop the medication suddenly. Most experts now taper quite slowly, often taking months to completely discontinue the benzodiazopine.

A higher dosage of a BZ, as well as longer use, can increase the intensity and frequency of the withdrawal symptoms. Short acting drugs (Xanax, Serax, Ativan) are more likely to produce withdrawal reactions than BZs with longer half lives (Valium, Librium, Tranxene) if they are discontinued rapidly, although the difference is usually small if they are tapered in an appropriately slow manner. Panic patients seem to be more susceptible to withdrawal symptoms than those with other anxiety disorders.

b. Relapse symptoms. Relapse means your original anxiety symptoms return after reducing or stopping the medication. Often in relapse the symptoms are not as severe or as frequent as they were before treatment began. Withdrawal symptoms start as the medication is reduced and end one to two weeks after stopping a medication. So if the symptoms persist four to six weeks after complete withdrawal, it probably indicates relapse.

Last Updated: 30 June 2016
Reviewed by Harry Croft, MD

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