How Xanax can cause lasting damage

What you probably already know: Every year, millions of people in the U.S. use benzodiazepines, a class of depressant drugs colloquially known as "benzos” with brand names including Xanax, Ativan, Valium, and Klonopin. Doctors often prescribe benzodiazepines to people who need relief from stress and anxiety, or for trouble sleeping, making them some of the most-prescribed psychiatric drugs nationwide. They’re also some of the most misused depressants, with benzodiazepine-related overdose deaths and ER visits on the rise. Benzos and other tranquilizers were the third most commonly used illicit or prescription drug in the U.S. in 2017. Now, fresh concerns about benzodiazepines — and the potentially debilitating effects associated with quitting them — are mounting.

Why? While antidepressants can take at least a week to begin working, benzodiazepines take just minutes to kick in, making them useful for those in need of a quick, short-term fix for anxiety. The problems start to arise with the drugs’ long-term use. Side effects include mental and physical dependence. People can develop a tolerance within weeks of starting treatment; some studies suggest tolerance to the depressant effects of benzodiazepines begins within 24 hours. Some drugs like clonazepam (brand name Klonopin) and diazepam (Valium) stay in the body longer than alprazolam (Xanax), so doses can add up and can have a compounding effect.

What it means: Some benzos like lorazepam (brand name Ativan) and chlordiazepoxide (Librium) can be extremely addictive and those who take them can experience severe — even fatal — withdrawal symptoms. But even the short-acting alprazolam carries serious risks: More than a third of people who took it in a clinical trial experienced withdrawal symptoms and more panic attacks than they had before starting treatment. Still, the FDA approved Xanax in 1981 as a treatment for panic disorders and anxiety. The Wall Street Journal reported one woman’s struggle with Xanax and the symptoms she experienced when trying to quit after five years, which, at one point, led her to pen a farewell letter to her daughter. Lasting damage, even after withdrawal symptoms are gone, is something medical researchers are just starting to understand. Long-term use can lead to the “uncoupling” of GABA-A receptors in the brain and, for some people, permanent deficits related to memory and movement. A recent study suggests that parts of the brain shrink.

What happens now? Weaning off of benzodiazepines can take years for some people and patients may not be adequately warned about the full magnitude of the risks associated with taking them when they’re prescribed. The FDA updated its warning requirements for all benzodiazepines in 2020 to “address the serious risks of abuse, addiction, physical dependence, and withdrawal reactions” and further cautioned against combining substances. Still, groups like the Benzodiazepine Information Coalition are working to build more awareness about the crippling addiction and permanent harm these drugs can cause.