Xanax, also known as Alprazolam, is one of the most commonly prescribed prescription drugs in the United States. As a benzodiazepine, it is heavily restricted for use and requires a prescription in the United States. In addition, it is now recommended for a maximum of 5 weeks of use at a time – with the implementation of a Risk Evaluation and Management Strategy (REMS). At the same time, in 2018, nearly 21 million people had Xanax prescriptions – many of whom have had those prescriptions for years.
While it’s unlikely that you would get a new prescription for Xanax extending more than a few months at most – many people still rely on older prescriptions to manage anxiety, stress, and panic attacks. Benzodiazepines have been a first-line treatment for panic disorders for decades. Changing that means evaluating each person with a prescription and transferring them to new treatment. In addition, Xanax is heavily abused as a street drug. Like other benzodiazepines, it’s used for euphoric, relaxing, and enhancing effects.
But, like every drug, Xanax can have extreme side effects and long-term impacts, on physical and mental health.
Xanax is a benzodiazepine class drug, meaning it is a tranquilizer. When you take the drug, it interacts with the GABA receptor in the brain, resulting in slowed responses in the brain and muscle relaxation. The overall result is relaxation and calm. In addition, Xanax isn’t entirely a benzodiazepine. The drug contains both benzodiazepine and Triazole – both of which function in similar ways.
This also means the side effect profile can be quite diverse. Most symptoms map to those you’d expect with nearly any medication. Dry mouth, dizziness or lightheadedness, and lethargy. However, those can be quite a bit stronger with Xanax than with something like a hay fever medication. On the other hand, if symptoms are very strong, it’s always a good idea to discuss them with your doctor to see if they fall under the range of “normal”.
For many people, these symptoms are very strong for the first few weeks you take the drug. Normally, they should die down over the first few weeks. However, for some people, symptoms remain consistent over the full duration of taking the drug. That’s especially true if you have a short-term prescription.
In some cases, Xanax can have more serious side effects. For example, in rare cases, people experience anterograde amnesia (difficulty forming memories), moderate seizures, difficulty with urinating or urinary incontinence, rashes, slowed breathing, feelings of weakness, or constipation. You might also experience ataxia, in which your speed and gait will change, you will slur when talking, and muscles will twitch. This is a sign you need immediate medical attention and should stop taking the drug.
The stronger your symptoms, the more likely you should talk to your doctor. And, for example, if you experience anything off the second list, you should call your doctor. You may be recommended to quit, to pause taking the drug, or to come in for a medical checkup depending on the symptoms.
Over time, Xanax can cause changes to the brain, can result in chemical dependence, and can result in addiction. Each of these long-term impacts is well studied and has contributed to the current recommendation of a maximum prescription of 5 weeks. Unfortunately, many people take the drug for far longer, which can lead to those long-term side effects.
Increases in Aggressive Behavior – Some users are susceptible to experiencing increases in aggressive behavior while using Xanax. One review of 43 papers found that this likely relates to both high dose and initial personality traits of existing anxiety and hostility. This means that people who are prescribed Xanax are already likely to be vulnerable, especially those with existing tendencies to respond with hostility or aggression when pushed or stressed. This can result in deteriorating interpersonal relationships, in increased likelihood to commit crime, and in increased impulsivity. That can backfire on other aspects of your life and in considerable ways.
Physical Dependence and Tolerance – Nearly everyone who takes Xanax for longer than a few weeks becomes physically tolerant and chemically dependent on the drug. This happens because it impacts the GABA production in the brain and central nervous system – which can cause significant changes in how the body manages and absorbs GABA itself. Quickly developing tolerance means you need more of the drug to produce the same effects as the first few doses. That’s fine if you’re using a REMS and a prescription and stick to it. If you’re using the drug immediately, it can quickly spiral. However, chemical dependence does mean that it is difficult to simply quit Xanax. Even people who have had a prescription for a few weeks can find it difficult to put Xanax down – especially as withdrawal symptoms can be severe. Those side effects can include sweating, nausea, vomiting, seizures, and significant muscle and stomach pain.
Reliance and Addiction – Mental reliance, or the process of coming to rely on Xanax to stop anxiety or a panic attack, is the first step of addiction. It’s also extremely common for Xanax users. This process is especially difficult with anxiety because you work up anxiety because you don’t have Xanax to stop the anxiety. That can result in panic attacks. So, many people become anxious that they will have a panic attack or anxiety attack without the Xanax, and then are forced to take the Xanax to prevent that.
This vicious cycle can eventually result in seeking behavior, where you run out of Xanax and go to extreme lengths to get new. That might mean doctor shopping, illegally buying the drug, or lying to your doctor. Often, addiction manifests in compulsively taking and seeking out the drug, even when you know it’s harmful, when it’s getting in the way of work or social life, and when you take risks to do so. This can eventually cause significant repercussions in your life, including mental, physical, and emotional damage. For example, long-term Xanax abuse causes liver and gastrointestinal damage that can last for the rest of your life.
Xanax is an essential drug for many people. In fact, in the short-term, Xanax can stop panic attacks, help to get PTSD under control, and can give people the chance they need to move into therapy. In the long-term, side effects can cause significant harm. It’s important to treat the drug with caution and respect, to take it as prescribed, and to ask for help if your usage of it is getting out of control.