Should I ask for xanax?

May 10, 2011 1:15 PM

I'm considering asking a psychiatrist for a prescription for benzodiazepmes (Xanax, valium, etc.) to deal with acute anxiety episodes, but I am (surprise!) a little anxious about it.

I sometimes have general background anxiety in my day-to-day life, which can basically disappear for weeks/months at a time if everything is going well. Nothing incapacitating. But faced with stress (work, relationships, family) I can end up in a very unpleasant state. At worst, this means insomnia, sharp adrenaline peaks of anxiety, and almost constant rumination/worry. I might recover fairly quickly from this acute stage, but I'm left feeling fragile and ... injured, somehow. Plus, it just sucks.

I have done everything non-medical to deal with this -- and as I said above, I can go weeks/months with practically no anxiety. I exercise, eat right, CBT myself to death, yoga, meditate, you name it ... but faced with acute stress, I end up in the same place.

So this leads me to consider benzos. But I'm worried about 2 things: 1) physical addiction; 2) getting dependent on them to escape the symptoms of anxiety, and hence interfering with the mindfulness- and acceptance-based approach that has been so helpful and enriching to my life; 3) eventually not being able to distinguish between "normal" anxiety and these stronger anxiety attacks when it comes to using the medication.

posted by anonymous to Health & Fitness (17 answers total)

I have used Xanax a couple of times over the last 15 years. Twice I've been on a very small daily dose for a long period of time, and right now I have a prescription for "as-needed" times. I am very sensitive to psych meds, so YMMV, but I have not had a problem with needing a larger dose to get the same effect; I stayed on the same very small dose for several years without needing to increase. My former doctor once called Xanax "a junkie drug" but that hasn't been my experience. And I have never had any trouble tapering off when I needed to (to get pregnant, for instance); no big-deal withdrawal symptoms or anything, with a slow taper.

I do have some trouble with discernment about whether I should or shouldn't take any, now that I'm using it on an as-needed basis instead of as a regular dose. Just how anxious do I have to be? Am I anxious enough now? Now? Now? How non-anxious am I allowed to be? Can I take half a Xanax just to feel better even if it's not an especially bad day? And so on.

I am dealing with that partly right now by keeping track of doses on my calendar, so I can see at a glance how often I've been taking it. At my checkup a couple of weeks ago, I talked with my doctor about how often I was taking it and what dose I was taking, so as to have someone other than me keeping an eye on things.
posted by not that girl at 1:23 PM on May 10, 2011 [1 favorite]

Not to diminish your fears because I don't know your background with addiction, but everyone worries about those three things. I would say be CAREFUL. Be more careful than the doctor even says. You need to learn how to decide when you need to take it and when you can get by without it -- try all your other strategies first and if they don't work, reach for the medication. My doctor would say that just carrying one around should feel like a "blanket" like I have it if I need it -- that didn't work for me, I needed to take the damn thing. You'll learn for yourself how to manage the medication. That's a big part of recovery from anxiety and depression -- learning to recognize what's happening mentally and physically and reaching for the right tools to help you.
posted by sweetkid at 1:24 PM on May 10, 2011

My first psychiatrist put me on klonopin to help me sleep. She prescribed me 1 mg a night at bed as an open script. I took them for about 2 years every night and had no idea how bad the withdrawal would be when I came off of them.

However, if you are using them for a day or 2, you should have no issues with withdrawal.
posted by TheBones at 1:32 PM on May 10, 2011 [1 favorite]

My first psychiatrist put me on klonopin to help me sleep. She prescribed me 1 mg a night at bed as an open script. I took them for about 2 years every night and had no idea how bad the withdrawal would be when I came off of them.


I had a similar experience, which is why I say be more careful even than the doctor.
posted by sweetkid at 1:34 PM on May 10, 2011 [1 favorite]

I was the typical anxious patient who basically told my doctor "my tinnitus is driving me crazy, I need something to help shut my brain up at night and help me sleep. I am current;y using alcohol and I'd like to stop that" He was mellow about it. Once I got the prescription it was another few weeks before I even tried them because I am nervous like that. I found that, for me, it's not a "fun" drug and it makes me woozy so I don't use it during the day. I keep it around so that if I'm not sleeping, I have an option that is not drinking too much. My deal with myself is that unless there is something extreme happening (someone dies, family nightmare, something), I don't take it more than once a week. This has been pretty easy for me to keep up with, but it does mean that if I'm having a bad set of days I know I have options and just that knowledge has been super helpful for me.
posted by jessamyn at 1:37 PM on May 10, 2011 [1 favorite]

Have you thought about asking about non-benzos? I have a sort of social-anxiety thing. I can also "snap" if my brain gets overloaded with too much stimulus... So I have to run and cry it off. What works for me is Effexor XR (Venlafaxine).

That seems to be more for chronic stress? I'm not sure. But I would urge you to be careful w/benzos. I can understand wanting something for "as needed"... I'd prefer that than what I have now (which makes me mildly feel slower and not nearly as "ADD"/productive as I used to be)...

Will you be able to know to take it before it's too late and you've already hit that point?

If it seems like constant rumination, it seems that effexor may be more what you need. It helps "quiet" the brain. I try to keep a low dose as possible. I don't want to be medicated and feel more doped up than necessary. When stressors have gotten worse (as it has recently), I ask to up the dose and it can help, and then reduce as needed.

The only thing I'd caution w/effexor is some things that people have experienced called "brain zaps" (SSRI Discontinuation Syndrome)...

I wish I had an answer. I guess... The best things is to go in to the doc, tell them what your concern is, mention your thoughts on the matter (benzos vs non-benzos, withdrawal, short term vs long term, etc...) and see what they recommend. They may offer a non-benzo that may be just as good or better. They may think a benzo is the right choice.

Good luck with whatever you end up getting. I don't have any regrets being on meds. It would be nice if I didn't need them. But I do. Make sure that if you do use them, don't beat yourself up over it. It's a stigma that a lot of people feel when they end up needing medication. Peace...
posted by symbioid at 1:37 PM on May 10, 2011

But I'm worried about 2 things: 1) physical addiction; 2) getting dependent on them to escape the symptoms of anxiety, and hence interfering with the mindfulness- and acceptance-based approach that has been so helpful and enriching to my life; 3) eventually not being able to distinguish between "normal" anxiety and these stronger anxiety attacks when it comes to using the medication.

Two comments: (1) these are concerns to discuss with your psychiatrist, and (2) there are other meds for anxiety that are not benzodiazipines. Discuss this with your doctor.
posted by dfriedman at 1:40 PM on May 10, 2011 [1 favorite]

I have been taking Xanax for years and am a huge fan. I take them on an intermittant, as needed basis and I am in no way addicted. While xanax is great, I think you are severely over-anticipating it's superpowers. It is not going to alter your judgement; you are still going to know the difference between having a bad day and not being able to breathe and/or breathing through irrational terror.


Having abused recreational and perscription drugs in my teens and 20s, I have always been unclear about why exactly people get addicted to xanax; I have never experienced either a high or an altered state from it, merely the on-label cessation of anxiety. And believe me, were there a fun off-lable use that didn't involve shooting up, I am constituted in such a way that I very likely would have found it by now.
posted by DarlingBri at 2:02 PM on May 10, 2011 [4 favorites]

I used to have a very lightweight prescription of Ativan/lorazepam for anxiety - my doctor is very conservative with the meds and gave me the tiniest prescription possible. I took them every few days for a month or so, then found it easy to take them on an as-needed basis. I did not have any withdrawal/dependency stuff, I imagine because I was taking them irregularly at a low dose.
posted by Frowner at 2:04 PM on May 10, 2011

I have been an ER nurse for years. I would always 'cringe' when someone would come in the ER for an 'anxiety/panic attack'. I always thought those people were making it up.

UNTIL I STARTED GETTING THEM 2 MONTHS AGO.

I have tried everything non-medical that I can, just like you. I've had a lot on my plate since December and when it gets too full, well....I have these episodes....and I feel like I'm going to die. I'm on Pristiq already, I've been on it for a little over 3 years. I had an appt. with my NP 3 weeks ago and she put me on a tiny, tiny dose of Ativan, twice daily. She said to take it daily for a month, with the CBT, and when I see her again, we will take it to a prn dose. She said Ativan lasts longer than Xanax.

I can't tell any difference in how I feel (i.e. drowsy, drugged) when I take them, but the anxiety episodes have gone from every other day to about 1-2 X a week now.
posted by Jayes8ch at 2:56 PM on May 10, 2011 [1 favorite]

My dentist once asked my doctor to prescribe 7 days worth of Valium (for TMJ), but for some reason, they only came in a bottle of 50. (I was already on a long-term anti-anxiety drug). I eked that bottle out over the next 6 months or so, for TMJ attacks and other anxiety symptoms. As the number in the bottle dropped, I became more and more worried. How would I go if I had another major anxiety issue and had no Valium left - it helped me to sleep, I didn't drink so much alcohol. I became very focused on the bottle and number of pills and that is exactly the reason why I did not ask for a repeat prescription.

It seems possible to me that there is one non-medical method you might not yet have come across. One of the ways I dealt (continue to deal) with anxiety is Acceptance and Commitment Therapy (ACT). This YouTube is very similar to an MP3 my psychologist gave me that I still listen to on a semi-regular basis.

More information here: The Happiness Trap

It is different to CBT because you don't need to find a logical reason to not feel anxious, because yes, you do. And it's different to meditation because you're not trying to not focus on anything, you actually do focus on the anxiety and learn to accept it, to live with it.
posted by b33j at 3:30 PM on May 10, 2011

Back in the early '90s I was prescribed Xanax for panic attacks, by a doctor who doled it out by the hundred with the maximum number of refills. I took it every day for about 4 years and never felt the need to increase the amount I took. OTOH, when my anxiety resurfaced last fall, I went to a doctor who prescribed Zoloft, and also a few Xanax for "as needed". The Zoloft kicked my anxiety (along with some depression I didn't know I had) right out the door and I hardly ever have to take Xanax. YMMV.
posted by Daily Alice at 5:10 PM on May 10, 2011

IANAD, IANYD, etc....

Just chiming in to say that you shouldn't be paranoid about this - but do discuss your concerns with your doctor. Benzos can be *very good* at treating anxiety, short term or long term.

As for an out of control addiction - that depends on whether you have an addictive personality (and other stuff I guess), and is something your doctors (and you) should be aware of and keep track of.

Short term or occasional use of benzos is generally not problematic - I wouldn't be concerned about that.

Long term use, or abuse, is a very often understated problem, even among doctors. Benzo withdrawal can be nasty, even life threatening - but to get to the point of withdrawal symptoms that are anything to worry about, you have to use them for long periods of time or in rather large amounts (or, heaven forbid, both) - and then even then an understanding doctor can taper you off of them with minimal to no unpleasantness. Discuss all this with your doctor.

You do want to avoid prolonged, long-term chronic use of benzos, because the long-term withdrawal symptons in the majority of people can be extremely unpleasant - but they aren't heroin, you aren't going to get hooked instantly, they aren't going to screw you up.

Do keep in mind that what you read on the internet will be the worst horror stories and not the succcess stories - in some cases benzodiazepines are a good solution to anxiety issues and, with relatively little in the way of side effects, therapy can continue for long periods of time - as long as the doctor understands you cannot be abruptly withdrawn from them. I've had doctors tell me stories of patients they have who are on xanax for life - on a stable dose, they probably can never quit, but it works for them and their lifestyle is better because of it.

Again, for short term use, while there are clinically detected withdrawal symptoms, they are nothing to stress out over. What you want to be careful of is prolonged, ever increasing dosages on a regular basis, without clear direction from your doctor as to what the overall plan is.

All that said: Benzodiazepine withdrawal syndrom is no friggin joke - it can hit you like a trainload of bricks if not managed properly - and it can hit you at the oddest times - you can taper down from an extremely high dose to something you consider almost infinitisimal, but removing that last little bit can throw you into an unrelenting, brutal, non-stop panic attack that only resuming the drug will suppress - but again, that's only if your doctor doens't understand the withdrawal implications of benzos - a proper, tailored withdrawal schedule that adjusts to your feelings is generally successful and not unpleasant.

So don't worry about it - despite all the scary stuff. get help, and improve your quality of life.
posted by TravellingDen at 6:16 PM on May 10, 2011 [1 favorite]

I carry xanax all the time. Hardly ever use it, but having it along is a big help. I use it for panic attacks, or for predictably very stressful situations. I use a low dose, as I hate to feel drugged. Using it as needed, and rarely refilling, I am not concerned about addiction.

Did you see this thread?

Also, some meds exacerbate panic attacks/anxiety. In my case, prozac caused panic attacks. Work with a good doc to get the right meds.
posted by theora55 at 6:34 PM on May 10, 2011

I have panic attacks and I take klonopin.

I was also worried about addiction and withdrawal, so I made the conscious decision not to take them whenever I felt like it. I only take it when I really, really need it, as in I'm not going to be able to leave the house if I don't. So I take maybe one a week nowadays, and about 4/week at my worst. I've been doing this for 5 years now, and I am not addicted. I have never had withdrawal symptoms. Just knowing I have the option of taking something if it gets REALLY bad staves off some of the anxiety.
posted by desjardins at 7:12 PM on May 10, 2011

I was given Klonopin to help me sleep. After taking it continuously for six weeks, I found that I was feeling anxious all the time. This was a paradoxical reaction. At that point I was on 2 mg, which is the equivalent of 40 mg Valium. It was six months of sheer hell to get off of it. I wrote about it just this week here.
posted by jocelmeow at 1:40 PM on May 11, 2011

If you go to a doc and say, "I want benzodiazepenes for anxiety problems," you're going to start the relationship off on the wrong foot. It's going to set off alarm bells, right or wrong.

Go to the doc and say, "I have anxiety problems, and would like some help with managing those problems medically." Let the doc use his or her judgment.

You don't have to worry about your questions yet-- if the doctor feels like benzodiazepenes are the appropriate response, share your concerns at that time. Most doctors prescribing these drugs are already going to be concerned about the risk of addiction/physical withdrawal and are going to give you good instructions regarding how frequently you should use them.
posted by nathan v at 3:46 AM on May 13, 2011