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"Why Docs Don't Like Xanax"

A psychiatrist at the ShrinkRap site writes about the problems doctors have with the anti-anxiety medication Xanax (generic name: alprazolam).  Some of his concerns are; the short half life of Xanax, its quick absorption into the brain and its effect on GABA production in the brain.  Why are these problems?

As the doctor explains, the half life of Xanax is 6-20 hours.  That means that half of the drug is no longer working on your system in as few as 6 hours.  It is quickly absorbed into the brain, which means you get an immediate reaction to it, you feel it.  It also works like the brain's neurotransmitter, GABA, so the brain stops making so much GABA.  This is a problematic combination.  Why?

If the brain quickly absorbs something you feel it immediately.  This is the "rush" that drug addicts typically enjoy which is why this drug is so popular with that population.  "Bars" (the street name for Xanax because of the barlike shape of the 2mg pills) sell for about $3 to $10 per pill depending on the dose. 

Quick absorption by the brain also means that it leaves the brain just as quickly.  The "crash" when Xanax leaves the system may leave you feeling at least as anxious as before (in as little as 6 hours) and possibly worse if you experience "rebound anxiety".  The doctor at ShrinkRap does not mention rebound anxiety, but the Medscape site does a wonderful job of explaining it,

"Rebound is the expression of new time-limited symptoms that were not present before treatment and depend on the pharmacokinetics of the drug"

"Essentially, rebound goes beyond tolerance into the early phase of a withdrawal syndrome that develops between doses"

and warns that,

"the duration of action of alprazolam is too brief to prevent rebound anxiety with dose administration four times daily".

In other words, your anxiety is now more frequent and/or worse than before even if you take Xanax four times per day. 

(See the entire Medscape article, "Alprazolam-Induced Panic Disorder")

Why?  The ShrinkRap explains that GABA is the brain's braking system.  It blocks the transmission of an impulse from one cell to another in the central nervous system, which prevents over-firing of the nerve cells.  If you artificially stimulate GABA production in the brain by adding Xanax, the brain interprets this as an excess and slows natural GABA production.  It takes 1-2 weeks for this effect to take place after you start taking Xanax.  Likewise, it takes 1-2 weeks for your brain to start making GABA when you stop taking Xanax.  But the Xanax wears off to half its dose in only 6-20 hours.  You don't have to be a rocket scientist to see the problem.  If you only take a few doses of Xanax for a few days, you're OK.  If you take if for more than 2 weeks your brain is now making less GABA.  6-20 hours after you take the last dose of Xanax your brain is still not making its normal amounts of GABA and you aren't providing the artificially stimulated levels with Xanax.  The results?  You are now in withdrawal.

The final problem is when a patient has been taking Xanax for a long period of time.  When you pull Xanax out and GABA levels are insufficient to slow the system you now have a patient with increased heart rate, increased blood pressure, etc.  Not only is this extremely uncomfortable but it can be dangerous.  In his list of rules by which he prescribes Xanax the doctor states as #6:,

"If they are on it, warn them that stopping it suddenly, even for a day or two, can result in confusion, hallucinations, seizures, and even death."

This is an important point I don't think most people realize.  Suddenly stopping a benzodiazepine (the class of drugs to which Xanax belongs) can result in seizures or blood pressure increases so severe that they cause status epilepticus (seizures which do not stop), stroke or death.  I lost one client to such seizures and another client spent several weeks in the ICU because they could not get him out of "stroke range".  He lived, but lost 60% of his kidney function.  He was in his late 20's at the time. 

This is a very serious medication with very serious consequences.  If you are on Xanax and want to get off, please see your doctor.  Do not attempt it yourself.  For the original article on ShrinkRap please visit, "Why Docs Don't Like Xanax" on their site.


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Shaheen Lakhan

Thanks for submitting this post to our blog carnival. We just published the 15th edition of Drugs and Pharmacology and your article was featured!

Link: http://brainblogger.com/2009/04/30/drugs-and-pharmacology-fifteenth-edition

Thank you.



Thank you Shaheen!

Marriage Intimacy

Hello very very interesting information and excellent blog


some info on a blog about the dark side of benzos


as you've suggest here they are all potentially highly problematic. There is no safe benzo. I'm afraid this article may suggest that an alternative benzo might be safer if not read carefully.

beyond once in a blue moon for crisis people are playing with potential addiction or dependence if one doesn't like the word addiction though I think that is splitting hairs.

it's good to see critical thinking about these meds anywhere.


Hi Ginny,

Thank you for your comments. I will have to review the article, but I certainly dont want to suggest that one benzo is an improvement over another. In my humble opinion, this is a useful medication if used properly, but that proper use is very short term and in very small doses. This is not how I see them used. They seem to be handed out like candy with devastating and deadly results.

Thank you for your feedback.



Thank you for this post... So those of us who do take it, I myself per needed...so some days I do, some I don't, do you have a suggestion to maybe a holistic type... I do meditate and tried mental "mind over matter" and sometimes works, sometimes not...


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it's good to see critical thinking about these meds anywhere.


I used to take Xanax&it almost killed me. I still question if wat I had was strokes or seizures? ?? I weaned myself off&switched doctors. They got me on a regimen of meds now that I'm not happy with...but I'm no longer in fear of running out or losing my kids


My docs have no concern or answers...if I culd describe wat happened to me to someone experienced, I'd appreciate it a million times over

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