Psychologically, what are the effects of benzodiazepines on anxiety.
September 5, 2012 6:24 PM   Subscribe

Psychologically, what are the effects of benzodiazepines on anxiety.

I have been struggling with very severe anxiety for a while now. I'm on the waitlist to see a therapist, but my doctor has suggested I take benzodiazepines to tide me over. However, he has been rather vague and noncommital about which one I should take (he just suggests xanax or klonopin) and exactly how much they can/will reduce my anxiety.

So my question is, do benzos (and I know different benzos have different effects on different people) totally get rid of anxiety or just reduce it. Also, is the affect tied to dosage amount?

To be clear, I don't actually care about the biological mechanism behind benzodiazepines. I'm just interested in the psychological affects on anxiety as experienced by users, because I want to know what expectations to have if I start taking them.

So, metaphor time. Say anxiety is a pride of lions. In your experience, would benzos:
1) Reduce the pride from 8 members to 2
2) Change them into bobcats or some other small wild cat
3) Change them into house cats
4) Change them into mice
5) Make them disappear

Anecdotes and information based on actually studies are both welcome. Throwaway email:
posted by anonymous to Health & Fitness (28 answers total) 12 users marked this as a favorite
I take Ativan for anxiety, when needed. I suggest you try that before Xanax or Klonopin. Benzos, all Benzos, are habit-forming and you don't want to use a tank where a gun will do. Most shrinks I've dealt with were sort of confounded at other doctors' jumping right to Xanax.

"Change them into house cats" is probably the closest. The thoughts causing the anxiety don't go away, but the anxiety itself drops a few notches, allowing you to either have an easier time ignoring the anxiety, or dealing with what's causing it (depending on what you have time and energy for.) I find myself taking it mostly either right after waking up (because I'm too anxious to get out of bed), or right before going to bed (because I'm too anxious to fall asleep.)
posted by A god with hooves, a god with horns at 6:30 PM on September 5, 2012 [2 favorites]

As an anxious person I was, of course, anxious about taking benzos. I had a bottle of them in my house as I'd lie awake worrying about nothing but feeling that I wasn't anxious ENOUGH to take medicine for it. And I was worried about addiction and whatever. The feeling for me, to sort of use your metaphor is that anxiety is a pride of lions, taking one lorazepam at my dosage level [.5 mg I think] would reduce them from 8 to 2 and taking two lorazepam would make me forget about them entirely and fall asleep, basically. But I take lorazepam specifically because anxiety keeps me awake and I like sleeping, so I'm sort of cued to sleep from it.

So for another example, I am in a plane, the ride is bumpy, I am convinced that I am going to die. I don't want to die with these people. I don't want to die without telling people I love them. I don't want to die wearing these pants, on and on and on, terrible. If I take a lorazepam, it's still bumpy but my thought process is more like "Huh, this is bumpy, I hope it wraps up soon because it is annoying..." and not jumping to the "I will die! Let's think about death!" part of it. it keeps me thinking more normal thoughts, but not completely ignoring what is around me, just not getting into an anxiety spiral about it.

For me it quiets useless racing thoughts and I don't really notice it otherwise. I don't feel drugged (though I am careful about alcohol). I don't feel happy or like really anything that is not-me. Just feel like me without the panic.
posted by jessamyn at 6:32 PM on September 5, 2012 [9 favorites]

When my anxiety level was very, very high, 1mg klonopin would take me to level 3-4. When my anxiety level got a little lower, it would put me to sleep. Now I take 1mg ativan and it takes me to 4. (Those are pretty small doses. I'm pretty small.) In short, these things work very well, but they're also very, very addictive (the most addictive being xanax instant release, the least being ativan, with klonopin somewhere in the middle).
posted by munyeca at 6:32 PM on September 5, 2012

For me (I've only taken Ativan, and I've only taken it nine times) it's more like I realize the pride of lions is more than thirty kilometers away, and actually, I'm kind of thirsty, and this movie is really interesting, and I'm breathing like normal which is great.

It moves the anxiety from the top of my brain to like, I don't know, a random item on the second or third shelf of my brain. I'm no longer drowning in it, it's no longer the only thing I can think about. It gives me time to use CBT tools, gives me a chance to make executive decisions like "I should loosen my collar and put in earplugs" rather than fleeing blindly, and so on.

It also puts a very, very, very big block in the way of the physical symptoms. I get random panic attacks in various situations - like, I had to watch The Avengers four times before I got through it without a panic attack - and Ativan makes them just not happen, if I take it ahead of time. I'm scared or uncomfortable, but the overwhelming physical stuff isn't there, and so I can deal. And in situations where the panic attacks are WAY in excess to my discomfort, I actually can enjoy myself.

(I think I'd still be able to get an adrenaline rush, and get physical signs of anxiety, if something REALLY MASSIVELY SCARY happened - I don't feel numb or anything, more like "not as easily set off.")

They also short-circuit panic attacks in progress. The first time I took it was a test - I waited until I had panic symptoms, and took it to see what would happen. Ativan starts working pretty fast, but it still took a while for me to notice the effect. But I was able to sleep an hour after I took it, which would have been impossible a half hour before I took it. Normally a panic episode, or severe anxiety, will offset my sleep cycle by as many as fourteen hours (that is, I suddenly can't sleep till noon, when normally I would have fallen asleep at 10pm) so this is a HUGE bonus.

One thing to keep in mind is that benzos are gradually less and less effective at any given dose. It's like, if you take it every day, after two weeks you can't tell you took it today at all. That's why I'm being so parsimonious with my pills (that and the fact it costs $1 each and I'm terrified of dependence.) Taking it "as needed" is a big help, from what I understand. But three doses, spread over two weeks, took me from "falling over sleepy" to "barely yawning." I no longer experience any actively sedating effects at all - by comparison, Benadryl and Dramamine and about sixty other drugs put me out like turning off a light, and I've been taking some of them my entire life.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:40 PM on September 5, 2012 [3 favorites]

In my experience (with Ativan), it makes it more like a safari: I can see the lions from far, but I can easily just turn my head away from them, not worry about them, read about something else, etc. The lions are not interesting to me. You may find the answers to this anon thread of mine helpful: I was super, shaking, paranoidly anxious about taking lorazepam, but reading that thread made a huge difference and now I regularly take it to fly.

I haven't experienced the diminishing returns thing that Fee Phi Faux Phumb has, but people experience things differently.
posted by c'mon sea legs at 6:43 PM on September 5, 2012 [2 favorites]

Your metaphors are kind of similar. So the answer is "yes." I've taken small doses of a variety of benzos (lorazepam, clonazepam, diazepam) once, or at most twice, per day over periods of months, and was able to stop taking them very easily (note: they were small doses. They work great at taking you from complete panic/racing thoughts/catastrophizing to a calmer, more rational state--one where you can handle life. The only side-effect I've ever experienced on a noticeable basis has been a bit of constipation, and it isn't even that bad.
posted by bennett being thrown at 6:44 PM on September 5, 2012

The rx level really depends on the person, but the goal would be in the housecat range. Xanax was wonderful for my anxiety, except that I had to keep increasing my dosage to maintain efficacy. This is why benzos are a bad long term solution. But you have a plan in place, you are working on a better long term solution. Your Dr might be vague BC you can't predict how someone will react ahead of time. If you are worried, take your first dose at a time when you will be able to relax or sleep, just in case. Good luck, I hope you are feeling better soon.
posted by PaulaSchultz at 6:46 PM on September 5, 2012

I've only ever taken xanax (and I would have to check the bottle to know the dosage, I think it is fairly low). Taking one basically returns me to normal, more or less. Normal is sitting there on the plane, reading your book, taking a nap, or chatting with your friend, right? But when you get all freaked out your heart is pounding and you can't read or chat happily because you are sweating and just plain, well, anxious. One xanax and I'm back to the land of chatting and napping, still a bit nervous but nothing impeding normal life.

I don't know how to map that onto your lion analogy -- if kittens are normal and anxiety is lions, the right dose of xanax changes them back into house cats, maybe?
posted by Forktine at 6:48 PM on September 5, 2012

I'll use a different metaphor: if overwhelming anxiety is a heavy metal concert and no anxiety is silence, Xanax turns the volume down to elevator music. I'm still aware of it, but I can tune it out and do other things (like sleep). .5 mg here, once in a great while. I find Xanax less groggy-making the next day than Klonopin.
posted by Sidhedevil at 6:55 PM on September 5, 2012 [1 favorite]

I've taken xanax for acute anxiety. It's like watching a pride of lions on tv, getting ever so bored, and switching to pop-up video.
posted by pickypicky at 6:58 PM on September 5, 2012 [1 favorite]

I don't think animal analogies are all that useful here. It's actually quite simple; benzos kick anxiety's ass. The effect does vary with dosage. So one dose might reduce your anxiety level from VERY HIGH to manageable while another dose might knock you out and put you to sleep. There's not a lot else to say; benzos are hugely effective for most people in treating anxiety. There are also downsides. Your doc should have talked to you about those.
posted by Justinian at 7:25 PM on September 5, 2012 [2 favorites]

My wife uses benzos (Ativan) once in a while for flying or severe social anxiety. Never more than 1 mg, or she falls asleep. Those lions are kitties.

I recently met someone whose doctor prescribed 1 mg per day without fail. Ativan destroyed her sleep cycle and memory. She was a wreck and took a month to wean herself off them. Those lions were winged, three-headed and hungry. So be careful.
posted by infinitewindow at 7:31 PM on September 5, 2012

I have Xanax for active panic attacks, and I probably take it no more than once a week on average, so my experience isn't the same as routine dosage. For me it blunts the anxiety -- it seems more distant and smaller. It also reduces the physical response (heart racing, sweating, etc.) which makes me psychologically calmer.

My doctor told me to take a practice dose one evening when I had nowhere to go and nothing to do but watch TV, so that I'd know how I reacted to it (particularly whether it made me too sleepy to drive, in case I ever took it while away from home) and what it felt like (not much, unless I'm panicking), so that I wouldn't feel anxious about the anxiety medicine. The "practice dose" was very helpful.
posted by Sockish American at 7:35 PM on September 5, 2012

My doctor told me to take a practice dose one evening when I had nowhere to go and nothing to do but watch TV, so that I'd know how I reacted to it (particularly whether it made me too sleepy to drive, in case I ever took it while away from home) and what it felt like (not much, unless I'm panicking), so that I wouldn't feel anxious about the anxiety medicine. The "practice dose" was very helpful.

This is a very good idea, both for the reasons above and that there is a slim chance you might have a paradoxical reaction. I took xanax the night before getting my wisdom teeth out (at the surgeon's suggestion - I was not particularly nervous about it) and had weird dreams and woke up inexplicably rage-filled. It wasn't a huge crisis or anything, but it definitely crossed off benzos as potential solutions for me should I ever need them.
posted by restless_nomad at 7:47 PM on September 5, 2012

Xanax slays my lions deader than dead. It breaks my heart that it's habit-forming.
posted by scratch at 7:49 PM on September 5, 2012

Today I had a patient come in to the ER with the chief complaint "shortness of breath, heart pounding, hands tingling and numb". His eyes were wide with fear and he looked on the verge of tears. I asked him what had happened and he said "I think it is a panic attack, because I feel very anxious." I asked for a description of what happened that made him come in to the ER, and he said "I kept feeling worse and worse, until I thought I was either going to pass out or have a seizure."

He had never taken benzos before, so I said "can I give you something to help with the anxiety?" He clutched his blanket and said "what will they do to me? I'm not sure." I said "they'll help you calm down" and he said "I don't know... I'm so scared!" I offered that his EKG looked normal as an initial reassurance, and he did not seem comforted by this at all.

I ordered a pill of Ativan and a few tests looking for other causes of the symptoms. 30 minutes later he looked calm when I passed by the bed, and seemed pleased when I relayed normal test results. By an hour later he was smiling and thanking me graciously as he walked out the door (with a short script for Ativan until he could get in to the therapist).

thought that encounter might be useful to you, although I'm not sure how to turn it into a lion metaphor. As a doctor, I have a love/hate relationship with benzos, but I think in a psychiatric emergency situation, they are amazing drugs.
posted by treehorn+bunny at 7:49 PM on September 5, 2012 [1 favorite]

i've taken xanax (usually for flying, but occasionally when i feel a panic attack coming on) and i take a relatively small dosage. i'd have to say that as to your metaphor, i see it as: oh, a pride of lions! they're pretty scary! good thing they're over there and not in my head all messing with it! you don't so much stop having nervous thoughts or worrying, it's just that they worry you less. the worriesome thoughts don't tend to stick, which can be the worst thing about panic attacks where you just cycle downward. because of everything i've read and know about benzos, i've made a conscious effort to delay taking the medication until i really think i will need it. the downside to that is it will take at least 20 min to (most probably) an hour (IMO) to really kick in. there was one awful week that i took a pill every day, and the next week i didn't take a single one. YMMV, but i have not found them addictive personally.
posted by ps_im_awesome at 8:24 PM on September 5, 2012

oh, and DO NOT mix with alcohol. a few years ago i took a small dose xanax in the middle of a work day and met up with a few friends about 4 hours later for drinks (3 beers). woke up in a different city with no recollection of how i got there. 0_o
posted by ps_im_awesome at 8:33 PM on September 5, 2012 [4 favorites]

.5 mg here, once in a great while. I find Xanax less groggy-making the next day than Klonopin.

Like I said above, I've only ever had xanax, never klonopin or the other varieties, so don't take this as any comparative statement.

But for me, taking one pill (.5mg, I just checked) takes the edge off of routine anxiety, not a full blown panic attack but when you are feeling more stressed than you should be for any situation that didn't involve a large man walking towards you asking for your wallet. Think Don Draper after work, sipping a stiff drink, relaxing back into normalcy after a crazy day, nodding and saying "aaaaah."

Two pills leaves me grinning loopily and I'm not sure I'd bother to get up if a large man really was walking towards me asking for my wallet. Great for flying, but more than I'd take otherwise, and definitely no driving or mixing with alcohol. If there isn't an airplane involved, I probably shouldn't be taking this much.

And three (I only did that once) knocked me out and then apparently I was talking in a disconnected kind of way for an hour or so when I woke up.

The point being, the advice above to try it out at home when you are happy and relaxed is great advice. It's good to know how long it takes for a dose to hit, how much you need, and how much is too much to safely function. Personally I take a pill very, very rarely, but just having access to it makes me about a thousand times more relaxed than before -- the first time I took a pill and sat through what would have been an awful experience all relaxed was revelatory; I wish I had been given a prescription decades before.
posted by Forktine at 9:41 PM on September 5, 2012 [1 favorite]

FWIW, Xanax turns lion prides into a manageable bobcat for me. I have easy access to them and am not addicted nor do I take them daily. I have gotten accidentally, exceedingly drunk because I forgot I had taken the fucking things, and never had a blackout or anything other than a "get drunk faster, go to bed at 7:30 PM" reaction.
posted by DarlingBri at 9:46 PM on September 5, 2012 [1 favorite]

I have taken benzos to handle anxiety.

The good: They really turn the anxiety from a lion into a mouse.
The bad: It only lasts for a few hours, and when the lion comes back it is fiercer and more resistent to the Magical Happy Pills. Also, you are, like, the sleepiest, most malleable mouse ever and that's not so useful if you have a career or family to deal with while awake.

It really wasn't a long term solution for me. I had to switch to a full-time SSRI for anxiety relief, and my general practitioner WAS able to prescribe me that while I researched psychiatrists in the area. So, ask your doctor about that. Something like Lexapro can help with the day-to-day anxiety without making you a sleepy worthless mess, and you can take a benzo as-needed on the really bad days to bolster it.
posted by joan_holloway at 9:51 PM on September 5, 2012 [2 favorites]

I have taken Xanax twice when I was anxious about going to a dentist appointment. I didn't really notice any difference. My friend told me that's the point - the Xanax makes you not notice things around you. She told me of a friend who was playing volleyball and just watching the ball come at him without putting up his hands or moving aside - he just didn't care. That was likely recreational use (not prescribed) so it may have been a larger dose.

For your analogy, I would say Option 6: it makes you not care if there is a pride of lions right next to you. Could be kittens, maybe they disappeared, or they could still be lions - doesn't matter.
posted by CathyG at 10:00 PM on September 5, 2012 [1 favorite]

I'm prescribed Klonopin/Clonazepam, which is the slowest uptake/longest half life of the family, as I understand. (And therefore supposedly the least habit forming?)

I take .25 mg daily (which my psychiatrist tells me is probably placebo level dosage, but if it's placebo it's still effective) and .25-.5mg as needed.

My experience, whether it's pharmacological or psychosomatic, is that the daily dosage keeps the 'background chatter' way down---to use your metaphor, I'm not constantly asking myself "Are those lions? Shit, they're lions. Fuck. Are they really lions? Oh they're totally lions," allowing me to focus on real shit.

Depending on the circumstances of the 'as needed,' it gives me the 'space' to either recognize that what I think is a lion is actually a housecat, or possibly a painting, or that I totally have the tools to handle these lions.

When I first started taking it, .25mg put me into weird detached zombie mode. Not sleepy---just zoned. I don't experience that anymore. If I end up taking an as needed dose, it tends to lead to an early bedtime, but not like, falling asleep in my cube.

My anxiety is all pretty cognitive (ruminateruminateruminatefreakoutruminate), with physical effects being mostly chest tightness and nausea. I'm not someone who ever really had full-on panic attacks, so I can't speak to effectiveness in that regard.
posted by PMdixon at 7:34 AM on September 6, 2012 [1 favorite]

My experience with Xanax is that it makes fears that seem overwhelming more rational and manageable. So into like house cats or mice, I guess. For example, I always take Xanax at the dentist (I've had some really terrible dental experiences and got into a panic feedback loop about it). So I'll take a Xanax and recognize that it's unpleasant and that some things are cause for concern but not unmanageable concern. Like if someone says that an area around a tooth is a little tender, I don't automatically start thinking I'm going to have to have the tooth extracted and I'll look terrible and weird and probably be fired and then I'll have to pay for an implant but that will take the money we saved up for the downpayment on the car and then the current car will break and we'll have to use my daughter's preschool tuition to pay for it, and we'll have to take her out of preschool and we will be socially humiliated and she will never catch up to the other kids socially or intellectually and she'll drop out of high school her junior year and marry a guy named Silas who is great looking but really stupid and a jerk and she'll spend the next forty years working as a cashier in a bowling alley and chain-smoking Merit ultra-lights.
posted by A Terrible Llama at 8:19 AM on September 6, 2012

Mod note: From the OP:
Thanks to everybody who responded. FYI, the lion metaphor was just my cutesy way of asking "How much exactly does benzos reduce your anxiety?" If it doesn't work for you that's cool. No need to frame your answers that way if you don't want. Although, I did get a kick out of the people who ran with.
posted by jessamyn (staff) at 9:20 AM on September 6, 2012

I personally love the lion metaphor.

I'm on Zoloft and "as needed" Xanax. The Zoloft has turned the anxiety from a pride of lions, occasionally a lion sitting on my chest and growling in my face, to bobcats in the distance.

I take the Xanax when the bobcats come closer, and it turns them in to fluffy kittens. It's not like my problems go away, but they're things I can deal with, and I'm the one in control, not the panic.

I'm careful with the Xanax because it's SUCH a useful tool, and I don't want to lose it. And Xanax withdrawal sounds like hell.
posted by endless_forms at 9:41 AM on September 6, 2012 [1 favorite]

I take klonopin. It takes me from



housecat with a lion cut

in about 5 minutes
posted by desjardins at 1:32 PM on September 6, 2012

I take Klonopin daily, at night. It keeps me from going bonkers when the lights go out. Mine are more PTSD issues. Personally I find they work better when I'm taking them regularly. It keeps the lions from even getting close to me.

I realize my usage is different than most people have posted about. But for me, it works.
posted by kathrynm at 6:55 PM on September 6, 2012 [1 favorite]

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