I came across the graphic below in Good Magazine online. Each pill represents one million psychiatric drug prescriptions. Of the 10 drugs shown, three are benzodiazepines prescribed for anxiety (Xanax, Ativan and Valium), and by far the most prescribed drug of the group is Xanax with 44 million prescriptions in 2009.
What surprises me about this is that of all the benzos, Xanax is the one most often criticized by the psychiatric community for its addictive potential and severe withdrawal effects.
The half life for Xanax is extremely short (6-20 hours) compared to all of the other drugs in its class, and it’s rapidly absorbed by the brain. On the face of it, this seems like a great combination–you get a quick hit of anxiety relief and the drug leaves your system within a 24-hour period. But in practice what often happens is that because the drug acts so quickly and dissipates quickly, the patient begins taking more of it to maintain the effect. Two pills a day turns into four, which turns into six and on and on.
That’s bad news, but it gets worse. As more of the drug is absorbed by the brain, the brain reacts by decreasing its production of GABA–the naturally occurring chemical that slows down brain activity when your cerebral gaskets start overheating. With so much of the sedative (Xanax) available, the brain’s efficiency process kicks in and turns down the GABA tap.
So what happens when someone who has been using Xanax daily stops taking it? The brain doesn’t immediately respond by restoring GABA production to its original level–that process takes time, and during that time withdrawal sets in. Xanax withdrawal is notoriously painful, and it’s not uncommon for a user to be hospitalized as the symptoms worsen. Even cutting down the dose of the drug can result in withdrawal. Cold turkey is a guaranteed ticket to hell.
With all of that in mind, how is it that so many doctors are still prescribing Xanax? The answer I’ve heard from a few people in the psych community is simply that “it’s cheap and it works.” But the same people admit that they’ve frequently seen patients become addicted to it and have a hard time getting them unhooked. With 44 million prescriptions in the U.S. last year, that’s a lot of probable addiction to a drug infamous for how difficult it is to kick. In a country where the war on addictive drugs never sleeps, and where a dime bag of pot can earn you a trip to jail, doesn’t this seem like a monumental contradiction?