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Xanax for flying phobia?
June 22, 2010 10:13 AM   Subscribe

Tell me about using Xanax or other anti-anxiety meds to combat fear of flying.

My 65-year-old father has for the past 30 years had a fairly severe phobia of flying. He's managed to take a handful of flights in that time, but never without a lot of misery and bellyaching, as well as the ever-present worry that he'll freeze at the last minute and be unable to board the plane (has happened a couple of times). Non-chemical interventions (therapy, hypnosis) have pretty much failed. Thing is, my mom loves to travel, and as retirement approaches, I know they'd like to go farther than an RV will take them.

In my social circles, it seems like popping a Xanax has become as conventional and unexceptional a remedy for difficult air travel as aspirin for a headache. I'd like to encourage my dad to pursue this route, but since I've never touched the stuff myself, I have a few questions. In particular, if you have experience or knowledge about taking Xanax or other anti-anxiety medication on an as-needed basis (i.e. one or two times, not as part of an entire course of medication) to deal with a particular anxiety-causing situation, I'd love to know:

1. Does the medication work-- i.e., did you find your anxiety reduced to manageable levels and get through the experience OK?

2. Are there any unexpected features of the experience my dad should know about before taking this (weird side-effects, duration of action, dependency issues afterwards, whatever)? Additionally, my dad has angina and snores; I know sleep apnea warrants a "use with caution" for some anti-anxiety meds, since they can depress respiration, but is this really something to be worried about?

3. How should my dad approach this with his doctor (and what sort of doctor should he approach) so as to minimize his chances of getting shunted off into some complicated referral/treatment process? He doesn't have a lot of patience with the medical system, so I anticipate that each additional step required to get the meds will greatly decrease his chances of ever following this treatment path.

4. And lastly, I (ahem) just happen to have in my possession ~30 Xanax of unknown strength given to me by a boyfriend's aunt a few years ago before I took a long flight. I never did use them, but I'm guessing it'd be irresponsible for me to take one now just to see what it feels like, or to suggest that my dad take one for the same purpose.... right?

Anonymous because my father doesn't share our generation's easygoing, unembarrassed attitude toward mental health issues. Thanks!
posted by anonymous to Health & Fitness (24 answers total) 3 users marked this as a favorite
 
I have stupid insomnia sometimes where I get so spazzed out about something I'm worrying about that I can't sleep. Most of the time I just power through this but occasionally I need to sleep [important work stuff or social stuff the next day] and so I take... I guess it's lorazepam for this. I do this maybe once every month or two. It works. My cares go out the window and I get muzzy headed and can sleep. The big deal with this sort of thing is not to take it with alcohol because for some people they get stuporiffically drunk [or whatever you'd call it] by mixing it with alcohol. This is annoying at a party, it can be scary or problematic on a plane.

As far as doctors go, I think this sort of thing is exactly what it's for. Other people say "stage fright" or, as I did "anxiety-related irregular insomnia" Just make sure you're saying "this is negatively impacting my life, I've tried other things, I'm thinking it may be time to try this" or something. Usually they give you a prescription for a teeny amount so that you can't really get hooked on them anyhow. And I don't know if this happens to other people, but for me I get sort of an anxiety hangover the next day where sleeping is a little more difficult. Not a huge deal, but worth knowing. I never take it two days in a row, or more than once a week.

And I can't speak to the "should I try this" aspect. I'm a timid medicine taker, so I always err on the side of "no"
posted by jessamyn at 10:22 AM on June 22, 2010


Caveat: IANAD, IANAL, I have lots of experience with benzos both on an as needed basis and as part of a medication regime.

1) Yes, the medication worked well and my anxiety was greatly reduced. In addition, I've never found them habit forming, although I have never taken Xanax specifically.

2) Think about what he's like when he's really relaxed. That's how the Xanax/other benzo will hopefully make him feel. So he may be more talkative than usual, just generally calmer, that sort of thing. It can definitely be a little weird to be so relaxed in a situation that normally causes him severe anxiety, so prepare him for that. I don't know about the sleep apnea; that's definitely something to talk to the doctor about. In addition, benzos tend to make me a little sleepy, so that's another area of concern because I'm guessing he can't use his CPAP or whatever he does to treat his sleep apnea on the plane.

3) A GP should suffice. Granted, they probably won't want to prescribe Xanax specifically, they may want to start with Ativan (a "lesser" benzo which is still pretty relaxing and activates very quickly) to see if that works and then move on from there.

4) They're probably expired, but I have more to say about this if you MeMail me.
posted by saveyoursanity at 10:24 AM on June 22, 2010


1. Yes

2. No. There are zero dependency issues with occasional use. If I take two I get sleepy.

3. It's a very standard thing. "I would like a 10-tablet prescription of Xanax for flying anxiety" shouldn't even raise an eyebrow.

4. Everyone will tell you no because that's the prudent answer. I say yes because I tend not to believe in expiry dates for most medications. The properties of the drug do not change just because someone did or did not write it for you; if you're curious what its like, take one. I can't imagine that in an un-anxious state it will have any effect except to make you tired.

Having said that I'm not a doctor, you may have a contraindication, and you should never listen to irresponsible strangers on the internet.
posted by DarlingBri at 10:25 AM on June 22, 2010


1. For most people, benzodiazepines (the class of drug that xanax belongs to) are effective. They're much safer than earlier drug classes like barbiturates. They're especially effective in ameliorating acute anxiety, which is what your dad has with flying.
2. Most benzos have a minimal side effect profile, especially in short-term, relatively low-dose scenarios. However, sleep apnea can be a serious counter-indication, especially if it's severe. He should definitely consult with his GP before taking it.
3. He can only be honest and say what he wants it for and why. His primary care doctor can prescribe xanax.
4. You should use google (or...bing, I guess) to figure out what exactly those pills are. If they're not clearly marked, you could have another type of benzodiazepine, and you should really know what you're dealing with dosage-wise if you or anyone else will be taking them. Xanax comes in concentrations from .25 mg to 3mg, and the higher doses are sometimes used to treat PTSD, just to provide some perspective. But you should not give those to your father before he has a conversation with a doctor about his sleep apnea and its implications for taking sedatives like xanax.
posted by clockzero at 10:36 AM on June 22, 2010


Hells yes, google the pill description and see how much it is/make sure it is actually xanax. I don't condone taking drugs recreationally, which this is since it's not prescribed to him, so if you are worried, send him to his GP to get a valid prescription.

I would recommend .25 mg at home ( the smallest dose that can be prescribed, to see how he does on it.

Yes, there are issues with dependency, it's a benzodiazepine which are notoriously overused and abused, so just be aware. Also, I am not a doctor so I don't know what the actual processes that benzos work on so I don't know about any issues with other medications/other problems.

Send him to his GP and have him tell his GP exactly what you told us here. If he's a reasonable GP and knows your dad well, he'll have no problem. Benzos are the perfect solution for this.

Though, I would recommend, for flying, clonopin as it is quicker acting.
posted by TheBones at 10:41 AM on June 22, 2010


Wow, I swear I'm not on benzos right now, but my last post made little to no sense.

Yes, he should go to his GP for a script for benzos, though he will probably, as saveyoursanity mentioned, be prescribed ativan or another quicker acting benzo.

If you are to try whatever you have, I would suggest googling the pill to see exactly what it is. If it is xanax, have him take the smallest dose (.25 mg) one night when he doesn't have anything else going on so he can see what it is like.

As before, I am still not a doctor... I don't even play one on tv.

I don't know what other contra-indications there are with benzos so I would first recommend going to see your GP.
posted by TheBones at 10:49 AM on June 22, 2010


Well, think of it like this. Xanax (and by the way, a better choice for this is klonopin) for flying phobias (and other anxiety disorders) is a band-aid. It's semi-effective. It can, in part, mask the anxiety that your father feels. (And yes, it should be prescribed by a doctor--and this shouldn't be hard to obtain for his complaint.)

Your father has two kinds of anxiety: anticipatory anxiety and then in-plane anxiety. Since the first can start weeks before a flight, it's not really treatable in this manner. For the latter, taking a pill 30 minutes before a flight can mask some of his anxiety response.

For treating flying phobias, some professionals (and I have spoken to them all! Okay not all, but close!) will say that this sort of medication is a bad idea. Their rationale is that you're not treating the actual problem, and that this masking approach is delaying it. Others argue that helping people fly while associating it with reduced terror is helpful in the process of overcoming the phobia.

I've found both of those to be true? In that taking drugs to fly does not actually in any fundamental way help (in fact, once it made the plane trip into sort of a waking, fuzzy nightmare) but also that the drugs got me on a plane, which desensitized me to flying (helping me to start to rewrite the training I'd given myself to be afraid, in short).

I would be happy to talk to you about this more by email, if you like. I have flown with and without drugs, have suffered from a flying phobia for 20 years, and have had some success with treatment. I understand that it's extremely hard on loved ones actually; it's a very serious issue in my relationships.

The good news is that fear of flying is treatable. It's not a fun process for the phobic though! We'd like to live the rest of our lives without airplanes, so confronting that just basically sucks.
posted by RJ Reynolds at 11:02 AM on June 22, 2010


IANAD, IANAL, I am a Deadhead. I would look up what a typical dose is for xanax and what size pills you have and take a typical dose to test. I am only saying what I would do if I had no patience for the doctor. If I was good to go to the doc, I would have him prescribe something and test it before flying.

I have a BIL who is so afraid of flying he takes meds and sleeps (drools too) through the flight. Passes out. BIL is a doctor.
posted by JohnnyGunn at 11:18 AM on June 22, 2010


Also, although Xanax is the one you hear most about, it may not be the best one for him. I don't like flying and usually take a few Klonipin (Clonazepan) before my flight. It lasts longer than Xanax.
posted by Raichle at 11:39 AM on June 22, 2010


1 & 2 ) I flew for the first time in a decade in March with the help of klonopin. And vodka, but that's me. I have a prescription for .5 mg pills for generalized anxiety and I usually use it much like Jessamyn - like half a pill once or twice a month when I have trouble sleeping or am freaking out about something. I knew that to get on the plane I was going to need help, so I took a whole one about half an hour before the flight. I guess it helped. I got on the plane and I flew (and drank) and I even changed planes (and drank more) and eventually I got across the country, awake, wired, sober as a judge and kind of elated. During all this I was still scared but it was bearable; it wasn't a total, endless panic attack. On the way back to the east coast I took one and a half pills and two bloody marys and it was even better, although, again, I was still scared. Interestingly enough, if I take klonopin at home I get sleepy but while I was flying I never got even slightly drowsy; I wish I had.

3) AFAIK pretty much any doctor will prescribe you klonopin or xanax for phobias without batting an eye. I get my prescription from my gynecologist of all people. Just say, hey, I have this stupid phobia about flying, I hear there's newfangled drugs for that? and presto, he will probably walk out with a prescription.

4) I'd probably take one and see what happened or possibly give them to a friend to do the same but I am notoriously unsound and so are most of my friends, thank the gods.
posted by mygothlaundry at 11:45 AM on June 22, 2010


1) Yes, and it has absolutely transformed my flying experience. I have a prescription for Ativan, and take it shortly before take off, or whenever I start feeling the anxiety come on. Just having the medication has also helped me talk myself through the anxiety and bring it down on the occasions when I can't take it.

2) It makes me sleepy, which isn't exactly unexpected, and not really a problem. I've had no other effects.

3) I told my doctor I had flying anxiety and asked for medication to deal with it, and she gave me a prescription, no question. I get it refilled about once a year. I had previously talked to my therapist, who gave me some breathing exercises and encouraged me to ask my doctor for meds.

I really only use the Ativan for flying. It has changed flying from a dreaded experience to a neutral one. I've been through scary plane stuff (crash) and the anxiety was getting debilitating. This is so much better.

Do make sure he asks about benzo interactions with anything else that he's on, and I hope it's as effective for him as it has been for me.
posted by gingerbeer at 12:15 PM on June 22, 2010 [1 favorite]


My mom was in the exact same boat. Years of talk therapy and hypnosis and it was her doctor who finally said "will you please just let me give you some Xanax". The first trip she took a decent sized dose. She was super duper relaxed - talking to strangers relaxed and had to be helped onto the plane. She is totally amnesic about her pre-flight experience from that trip. Over time she's been able to steadily reduce her dose so that she takes an 1/8th or less of one of the pills she has and can stay lucid and get on a plane without anxiety. When I've taken a similar dose - I'm not a particularly anxious flyer - I just fall asleep very quickly.
posted by Wolfie at 12:25 PM on June 22, 2010


I took Xanax with alcohol and it made me giggly and relaxed. Thumbs up from me. My friend swears by Ambien and alcohol (you'll sleep all the way to your destination) - just make sure you use the restroom before taking the Ambien, as navigating the airplane aisle on Ambien can be difficult. Yes, you shouldn't take Rx drugs and alcohol together. YMMV.
posted by philad at 1:04 PM on June 22, 2010


I will not fly without my Xanax. Not because I'm afraid of flying, but because airplanes are full of screaming babies and pissy people, and that stresses me out. I make sure I use the restroom before I board, I find my seat and put my stuff away. I always make sure I get a window seat. I take a Xanax (or one and a half), curl up with a pillow and blanket, and wake up refreshed at my destination hours later. It's the only way to fly.
posted by xedrik at 1:27 PM on June 22, 2010


I don't know about Xanax but a close family member thinks the person who invented klonopin should win a Nobel prize. That said, I'm not sure of the duration of flights for which you're thinking it would be appropriate but I don't recommend driving after taking it. But yeah, lots of love for klonopin.
posted by kat518 at 1:33 PM on June 22, 2010


I took Xanax with alcohol and it made me giggly and relaxed. Thumbs up from me. My friend swears by Ambien and alcohol (you'll sleep all the way to your destination) - just make sure you use the restroom before taking the Ambien, as navigating the airplane aisle on Ambien can be difficult. Yes, you shouldn't take Rx drugs and alcohol together. YMMV.

Please, original poster, ignore this irresponsible advice. For some medicines, the "don't drink" warning is unnecessarily paranoid, but benzodiazepines and alcohol are some of the drugs you really don't want to take together. They've got a synergistic effect that can be very unpredictable, generally making you much drunker than you ought to be from a normal amount of alcohol. They're a common cause of blackouts and other unfortunate experiences, and, in some cases, death. If the prescribed dose of the drug doesn't alleviate your father's flying phobia, he should ask his doctor if he can increase the dosage - which is much safer than mixing it with alcohol on his own.

A little more on topic, I can say from personal experience that they work well for treating fear of flying (and insomnia, etc.) Your father and his doctor may want to try some at home to calibrate the dosage. Some people react much more strongly to these medications than other, and I suspect that taking too much the first time and having some of the experiences mentioned in this thread - needing to be helped onto the plane or finding himself unable to walk down the aisle to reach the bathroom - might not be great for someone who's already not happy to be on a plane.
posted by ubersturm at 3:02 PM on June 22, 2010


I know someone with a severe phobia of flying - he takes Valium in order to fly. It's worked out very well for him. I would suggest that your father go to his doctor, who will be able to recommend the appropriate medication for his needs.

Do NOT mix with alcohol. That is really, really bad advice - sure, it might turn out fine, but like ubersturm said, the combination of benzos and alcohol can easily lead to blackouts or other Bad Things. It's much better to stick with just the appropriate dosage of the medication.
posted by insectosaurus at 3:24 PM on June 22, 2010


I would suggest he try a dose before he leaves on any kind of trip. I took Xanax once and it gave me a wicked headache. Klonopin gives me no trouble, though. FWIW neither makes me sleepy so I wouldn't count on sleeping through the trip unless the doc prescribes you a big dose.
posted by IndigoRain at 4:46 PM on June 22, 2010


just have him go to his gp. he will barely get the sentence out before the doc is writing a script for 10 or 20. that was my experience. this is very common.
posted by misanthropicsarah at 7:04 PM on June 22, 2010


A common but not usually noted side effect: short term memory loss. It's not that you can't remember things, just that it all appears to be...letterboxed. Also, a very, very small number of outliers actually get more anxious when they take benzos.

But I'd still have your father explore it; it is *exactly* designed and proven over many years to be helpful for exactly his situation.

Not a doctor, doesn't play one, etc.
posted by digitalprimate at 7:22 PM on June 22, 2010


I have never had a fear of flying, but I almost always call up the ole family doctor and get a small valium script before hoppin' on the plane, because it makes the hassle of dealing with the airport and potentially annoying in flight phenomena considerably easier.
posted by solipsophistocracy at 7:52 PM on June 22, 2010


I have a severe phobia of flying. My experience is most similar to RJ Reynold's answer above. Having the Xanax did not stop me from worrying about the flight in the weeks leading up to it. Having it did not prevent my vacation from being totally ruined due to constant dread of the return flight. The Xanax's effect on the flight itself was OK. A walking, fuzzy nightmare is a good way to put it. I was not allowed to take enough to put myself to sleep as I was flying alone and it was feared that I would sleep and miss my connections. So instead, I just walked around stoned out of my mind and while my body felt calm, it felt like my terror just went deeper inside me...something that really made things worse in the end.

I had four to five trips that followed this pattern. I haven't flown in about six years, but to this day I still have weekly dreams that terrorize me in which I dream I'm on a plane about to take off and I can't find my Xanax.

My suggestion? You can start with the Xanax, but try therapy again. Try a different therapist that takes a different approach. You will eventually find someone that can help - trust me. My current therapist is amazing! Every week that I see her, the progress that I make startles me. My dreams are even changing - from sheer terror to "Hey, I am on a plane. No problem."

Good luck!
posted by bristolcat at 8:33 PM on June 22, 2010


1. Does the medication work-- i.e., did you find your anxiety reduced to manageable levels and get through the experience OK?

Oh Does it ever work. It's the best thing since sliced bread. I take it on my commute when I'm getting road rage or when I feel a fight brewing in my domestic zone. IT calms me down in about 10 minutes. When I get anxiety attacks i feel like my brain is scrambled. With Xanax I can move on, focus, and be productive.

2. Are there any unexpected features of the experience my dad should know about before taking this (weird side-effects, duration of action, dependency issues afterwards, whatever)? Additionally, my dad has angina and snores; I know sleep apnea warrants a "use with caution" for some anti-anxiety meds, since they can depress respiration, but is this really something to be worried about?

Have him ask his doctor about interactions with other drugs he's on and if it will cause sleep issues. Xanax isn't addictive when used as prescribed (I am not sure about amped up usage). However, you can very realistically overdose on it. I once took 1.5 mg and passed out on my couch with every light in the house on and music blasting and when my boyfriend came home he was poking me in the face and I wouldnt wake up (i woke up about 4 hours later). Small does go a long way. I can actually feel my pulse as being slower once it's taken effect. Keep it out of reach of children who might swallow a whole bottle's worth. They could very well die if that happened.

3. How should my dad approach this with his doctor (and what sort of doctor should he approach) so as to minimize his chances of getting shunted off into some complicated referral/treatment process? He doesn't have a lot of patience with the medical system, so I anticipate that each additional step required to get the meds will greatly decrease his chances of ever following this treatment path.

He should just ask his regualr doctor. This is pretty standard now. He'll probably get a small supply of .25 mg pills. The only hassle about Xanax is that if he plans to keep a supply on hand for life use (i.e. not just when he's going on vacation) you have to go back to the doctor for each refill. I think this has something to do with what "schedule" the drug is on in the US.

4. And lastly, I (ahem) just happen to have in my possession ~30 Xanax of unknown strength given to me by a boyfriend's aunt a few years ago before I took a long flight. I never did use them, but I'm guessing it'd be irresponsible for me to take one now just to see what it feels like, or to suggest that my dad take one for the same purpose.... right?

Firstly, be sure that they are Xanax. Secondly, what kind of person are you? I am a naturally wired type of person, pretty much constantly running on, driven even, by a small constant hum of anxiety. That I can live with, but when it escalates I have problems. So when I take one .25 Xanax (or occasionally 2 for .5 total) I don't really feel anything. Which is good because I take them so I don't feel the wave of wholesale rage i see coming from the shore. If you are a laid back person naturally, they may just make you feel sleepy or tired. It's not like you're going to feel high on them or see the pink elephant or anything. If you want to, take one. Consider whether you want to do that experiment in your baseline state or if you want to take one when you find yourself in a stressful anxiety inducing situation. If you get caught carrying Xanax without a prescription it is a crime, so don't keep that shit in your purse.
posted by WeekendJen at 1:26 PM on June 23, 2010


Xanax isn't addictive when used as prescribed (I am not sure about amped up usage).

This is sort of an ill-informed statement. A wide range of doses of alprazolam might be prescribed, and what cultivates a dependency in one person is different than in another person. Just because you "got it from a doctor" doesn't mean it's any less pernicious a drug. I'm not saying "oh noez Xanax is so dangerous," but the attitude that "it's not addictive if I take it as prescribed" is dangerous.

Quite frankly, how much you know about what drugs actually do to the brain and being allowed to prescribe drugs are orthogonal.
posted by solipsophistocracy at 7:04 PM on June 24, 2010


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