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[Xanax] is the most popular psychiatric drug in America. Should it be?
wandering
Russia state-affiliated mediaRegistered User regular
Russia state-affiliated mediaRegistered User regular
Xanax is the most popular psychiatric medication in the U.S. Which makes me uneasy, because of how powerful, addictive, and dangerous Xanax can be.
1. Any positive effects of the drug are short lived, because the body quickly builds up a tolerance to the drug. According to the official Xanax label, Xanax does not have positive effects when used for 8 or more weeks: “8-week…studies of XANAX XR…did not show a benefit…The longer-term efficacy of XANAX XR in panic disorder has not been systematically evaluated. “ And according to one study, clonazepam, a drug similiar to Xanax, “resulted in less severe symptoms and fewer panic episodes at one week…but not at four weeks.”
2. Going off the drug often has a ‘rebound’ effect, where anxiety is significantly worse than it was before the drug was taken. According to the official Xanax label, “Rebound refers to a return of symptoms of panic disorder to a level substantially greater in frequency, or more severe in intensity than seen at baseline….Experience in randomized placebo- controlled discontinuation studies of patients with panic disorder who received XANAX Tablets showed a high rate of rebound and withdrawal symptoms compared to placebo treated patients.
3. Xanax impairs driving ability even with small doses - “This study was conducted to determine the effects of alprazolam (1 mg) on driving ability…Relative to placebo, alprazolam caused serious driving impairment…alprazolam users must be warned not to drive an automobile or operate potentially dangerous machinery.”
4. Xanax impairs memory - “‘Benzodiazepines impair the formation of new memories,’ says Dr. Jason Eric Schiffman, Director of UCLA’s Dual Diagnosis Program, ‘so they interfere with psychotherapy, which actually heals the cause of anxiety rather than just attenuating symptoms.’”
….Meanwhile, cognitive behavior therapy, unlike Xanax, has been proven to have long term positive effects. According to one study that looked at patients that were suffering from panic disorder, “Most patients maintain clinically meaningful changes two years following [cognitive behavior therapy] treatment across multiple outcome measures”. According to another study, “CBT offers long-term benefits for people with depression”.
Anyway, I'm genuinely interested in hearing opposing points of view on this, because while there are other psychiatric medications that I believe might be useful, I can't see how Xanax is useful for any kind of long term problem, and feel like it is probably heavily overprescribed.
(Note: originally this OP contained some personal stuff that I decided to remove.)
1. Any positive effects of the drug are short lived, because the body quickly builds up a tolerance to the drug. According to the official Xanax label, Xanax does not have positive effects when used for 8 or more weeks: “8-week…studies of XANAX XR…did not show a benefit…The longer-term efficacy of XANAX XR in panic disorder has not been systematically evaluated. “ And according to one study, clonazepam, a drug similiar to Xanax, “resulted in less severe symptoms and fewer panic episodes at one week…but not at four weeks.”
2. Going off the drug often has a ‘rebound’ effect, where anxiety is significantly worse than it was before the drug was taken. According to the official Xanax label, “Rebound refers to a return of symptoms of panic disorder to a level substantially greater in frequency, or more severe in intensity than seen at baseline….Experience in randomized placebo- controlled discontinuation studies of patients with panic disorder who received XANAX Tablets showed a high rate of rebound and withdrawal symptoms compared to placebo treated patients.
3. Xanax impairs driving ability even with small doses - “This study was conducted to determine the effects of alprazolam (1 mg) on driving ability…Relative to placebo, alprazolam caused serious driving impairment…alprazolam users must be warned not to drive an automobile or operate potentially dangerous machinery.”
4. Xanax impairs memory - “‘Benzodiazepines impair the formation of new memories,’ says Dr. Jason Eric Schiffman, Director of UCLA’s Dual Diagnosis Program, ‘so they interfere with psychotherapy, which actually heals the cause of anxiety rather than just attenuating symptoms.’”
….Meanwhile, cognitive behavior therapy, unlike Xanax, has been proven to have long term positive effects. According to one study that looked at patients that were suffering from panic disorder, “Most patients maintain clinically meaningful changes two years following [cognitive behavior therapy] treatment across multiple outcome measures”. According to another study, “CBT offers long-term benefits for people with depression”.
Anyway, I'm genuinely interested in hearing opposing points of view on this, because while there are other psychiatric medications that I believe might be useful, I can't see how Xanax is useful for any kind of long term problem, and feel like it is probably heavily overprescribed.
(Note: originally this OP contained some personal stuff that I decided to remove.)
wandering on
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I'm not knowledgeable enough about alprazolam specifically to comment much on that without further reading, but I just wanted to respond to this as it seems to be a broad and potentially dangerous sentiment. Those "quick-fix solutions" are, in many cases, genuinely helpful, and although CBT and other forms of therapy certainly are effective there's a considerable amount of evidence that for many mental disorders the most effective treatment is a combination of both therapy and medication.
Yes, drugs will have side-effects, but that's always the case and both doctor and patient have to weigh up whether they're worth experiencing.
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
Why are you so invested in this person's treatment? Is there something more to this, like they have existing addiction problems? Xanax is usually prescribed for short-term anxiety, and it is effective for that. It can lead to addiction, but assuming that they will get addicted before they have taken one pill is odd.
Since you already messaged them, I assume you are looking for support rather than advice, since you can't take it back now!
That experience (which is not any sort of place-holder for a comprehensive scientific study whatsoever) suggests that the medication is good for treating panic attacks and other temporary surges of high levels of anxiety in a "take when necessary" manner, with a doctor monitoring frequency of use (no open refills, etc).
I would not personally recommend it as a regular prescription dose, and I have had multiple doctors tell me the same. But I am not a doctor.
I'd suggest someone in the OP's situation advocate for a second opinion and exploration of alternatives at most (and only with caution and grace), but I would never recommend sending someone a message like the one shown above. Someone who has been prescribed this sort of medication does not need alarmist text about that medication, and they absolutely don't need bits that read like shaming for taking prescriptions for anxiety disorders. It's hard enough to get such treatment due to existing stigmas in our culture, and this just adds to the weight (and sense of isolation and hopelessness).
Therapists are taught to check for medical causes in the beginning and recommend psychiatric appointments, as there can be additional underlying medical causes that exacerbate the problem, and therapy alone in such situations can prove fruitless or at least be excessively sluggish. Additionally medication can often help in the process by making it easier for the person to get through something that's very difficult (revisiting traumas tends to be relatively traumatic itself).
Is it a medicine you personally have had a problem with? I'm trying to figure out why you seem to have such a strong reaction to this. It's just a drug. Like, if they were taking Percocet after a wisdom tooth extraction would you send them a long email about the perils of opioids?
A friend in college was addicted to xanax (non-prescribed) for a long time, had all kinds of memory issues, etc. He quit cold turkey one summer, which is known to cause problems including seizures but, again, unprescribed. Shortly thereafter, he collapsed while visiting family in an assisted living facility and died a week later of cerebral hemorrhaging. I can't say whether his death was due to xanax abuse, of course, but it stuck with me.
On that note, there's a significant problem with the xanax black market - imported counterfeit pills, often much more potent than the real thing, are being sold all across the country at insane profit margins - what was once limited to diverting scripts of 30 or 90 pills is now open to being fueled by deliveries of thousands at a time. We have no way of tracking the associated auto accidents and hospitalizations, and since xanax is considered a Schedule IV controlled substance and not a Schedule II along with strong opiods, it's much less risky for traffickers than other drugs.
And the makers of Xanax appear to be very careful to point out it's not for long term use.
So who is your problem with? The manufacturer who recommends only short term use? The doctor who prescribes it? The patient who takes it? Unless you're one of those people, it's not any of your business.
-Indiana Solo, runner of blades
At the risk of sounding a bit pedantic, there are several manufactures of alprazolam and brand-name Xanax isn't really the issue here. I also think it's fair to be concerned about the practice of longterm benzodiazepine prescription - even if no one officially recommends it, it is occurring. Furthermore, concerns about the drug have led to in supplantation by other drugs in the treatment of panic disorders.
Link: Australian and New Zealand Journal of Psychiatry
Thanks for the batsignal!
Burnage covered the point I most wanted to make.
As for the OP:
I mostly agree, though wandering comes off a little more alarmist than I would. (I admit to having a very pro-pharma bias.)
Benzodiazepines have never been adequately shown to be particularly effective over the long term for generalized anxiety disorders. SSRIs have been repeatedly shown to be better at long-term treatment of anxiety.
Benzos do excel at short-term treatment. I wouldn't dismiss them because of that. Short-term treatment is important for panic attacks. It can help somebody who is entering treatment for the first time and whose anxiety is impairing them from, say, going to see the therapist, or from having difficult conversations with their family members that they need to have.
But much like opioids, the problem happens when occasional use, or short-term prescriptions, linger into longer periods of use. Either because the physician doesn't give a fuck, and is just willing to renew prescriptions month after month after month... or because the patient is begging for them or doctor-shopping or buying them through illegitimate channels.
Regarding the first line in the OP,
I'd want to know:
How many of these Xanax prescriptions are intended for daily use?
What are the quantities being prescribed, and how many prescriptions are going to repeat patients?
How many of those prescriptions are being written by general practitioners rather than specialists? (The data on ADHD medication suggests that general practitioners are more likely to overprescribe than specialists, and are less likely than specialists to give referrals to therapists. I see no reason why it would be any different for Xanax.)
I didn't know the answers to these questions off the top of my head, but a quick Googling did turn up this:
https://www.ncbi.nlm.nih.gov/pubmed/25517224
the "no true scotch man" fallacy.
In some ways, this is analogous to the "opioid epidemic."
(I don't like calling it an epidemic, but it is a bona fide huge social problem.)
An addictive drug, safe for short-term use, is being prescribed by physicians more than necessary, for longer periods of time than necessary, leading to iatrogenic dependence.
If opioid abuse is any indication, hamhanded attempts to crack down on the supply of benzos is likely to drive people to get them, or similar substances, through illegitimate channels. I'm not sure how much of a danger that really is; I suspect that booze has effects similar enough to benzos to serve as an adequate substitute for a lot of addicts.
the "no true scotch man" fallacy.
the "no true scotch man" fallacy.
Yup, this.
My wife has panic disorder, and takes Zoloft on a regular basis, with Xanax on hand when things get especially hairy. As a take-when-needed remedy, it's invaluable, and the idea that she could completely replace medication with just behavioral therapy is... no.
My opinion on Xanax is like my opinion on a lot of drugs - really useful in certain situations, probably not great in others, maybe overprescribed, certainly not without use.
I agree you shouldn't, like, drive or work a backhoe while on it, but that applies to Nyquil, too.
I was on lorazepam, and the equivalent amount of Valium for my dosage was 30-40 mg/day.
I am still suffering a bit from the protracted withdrawal symptoms. I've been totally clean for years now. It was a nightmare.
The drugs are really good at what they do. The problem comes when you get a doctor that doesn't understand what long-term use does to somebody, and has never been around to see someone withdraw. I'm sure they're wonderful as a quick fix to acute panic symptoms.
They should never, ever be prescribed as a routine, everyday medication for years on end.
I wrote a journal of my withdrawal experience, if you want a firsthand account of what it's like. Of particular note are the weeks I was bedridden, unable to turn my head anywhere except one certain direction or the room would immediately lurch and spin and I would puke.
Nowadays I'm on Zoloft and that's a bazillion times better.
Xanax (the generic, anyway) does what it's supposed to do when taken as prescribed (to me, at least). My psychiatrist prescribed it 'as needed' to help me when I was having a panic attack. Other, non-benzo drugs generally prescribed for that purpose don't work on me. Benzo's, as a class, have negative side-effects when I take them. Xanax has the the same side-effects for me as other benzos (nausea, paranoia, general feelings of lethargy and malaise) so I've never had to worry about addiction but damn if it doesn't help me with staving off incipient panic attacks. I had to go through, I think, 5 drugs for that purpose before my psychiatrist and I discovered that Xanax did the job.
All of that said: I think neurotropics are prescribed too easily and their effects are not sufficiently well-understood by, especially, general practitioners. When I was going through my seratonin syndrome period I went to my GP three times, each time being told, "Oh, well, your dose probably isn't high enough." I then had to go through two further psychiatrists to find one who recognized the problem and got me off the drugs.
Other posters have said all this so really I'm just giving my +1, I guess, but very much a plus one.
Xanax is excellent at what Xanax is meant to do. The problem isn't Xanax itself or even the use of Xanax for its intended purpose - it's the tendency (which I belive is particularly American, but that's anectdotal) of people to seek drug advice from people who are not well-suited to give it (I don't believe I've ever run across a GP who was really suited to give neurotropic drug advice) and of over-worked doctors willing to use the sledgehammer approach just to get the person out of the office.
Regarding CBT (and other forms of therapy): as others have said, it takes time. If you don't suffer from an anxiety disorder you probably don't understand this but that time is not acceptable. Panic attacks are debilitating. All the problems with Xanax listed in the OP are not as bad as the impact of a panic attack. I've been injured by panic attacks. I've had damage to my car due to panic attacks. I've come perilously close to injuring other people due to panic attacks. If a drug doesn't actually kill you it's going to take a lot to convince me it's worse than suffering the attack.
A little bit of knowledge can be so dangerous. Lets back this up first. CBT is one of MANY treatment methods for therapy that can help a great deal not just with anxiety, but with a wide swath of issues. CBT tends to be the most heavily researched, but that is because researchers tend to use it for a variety of reasons I am too lazy to type out. Short version is it lends itself well to research. Therapy is should always be suggested for someone with anxiety so severe they feel the need for medicine to manage it. Prescription medication works extremely well with it, and is often used in conjunction for severe cases. If Xanax specifically is being thrown about by a reputable doctor then the case is almost certainly severe.
Therapy is slow. Therapy often makes shit way worse before it gets better. It involves going to the deepest darkest parts of your brain and rooting around to see what all might be there. This is very difficult under idealized circumstances. If a person is suffering from severe anxiety they will have a huge barrier in their way to really getting at to root cause because the anxiety getting there is too great. Medicine to help manage that is fantastic! If the problem manifests itself in the form of severe, and random panic attacks I would certainly hope that something like Xanax would be used in the short term to help the person cope while they learn coping techniques that don't involve medicine.
This is not an either or situation. In fact, most studies show you get much better results over all by a mixed approach as appropriate. Medicine and therapy combined are amazing tools. One without the other can be appropriate, but they should never be seen as competing. That is a dangerous, and often shame filled idea that keeps people with severe anxiety from seeking all the appropriate treatment options available to them. This is just one persons opinion though. Informed by a decade of experience in the mental health field in various settings and loves delving deep into research.