Withdrawal, Rebound Anxiety, and Tapering

Do you feel that?

That doubt and dread and worry?

That’s anxiety - and lucky for you, there’s a pill for that.

It’s called Xanax. And it works. Really well. And really fast.

Prescribed for panic attacks and anxiety, one dose of Xanax usually kicks in within 15 or 30 minutes. Just like that, a sense of calm sets in, and your concerns fall away. It’s not a high, more like the opposite. You feel relaxed, your brain stops racing. It does the trick.

Which is why Xanax is also super dangerous. Because of how well it works, and the way it works, Xanax is highly addictive. It brings such relief that one pill every once in a while turns into a little nibble every night. It tricks people into thinking that their concerns and worries can disappear with just one dose. Which is why Xanax is among the most counterfeited and abused drugs in the world right now.

Writing this episode, I started thinking that Xanax was a perfectly fine drug that is sometimes a problem. But as I dug in, I realized that Xanax, like all benzodiazepines, is a trickster. It promises to be an easy, even fun way to push our anxiety aside. But as much as it brings relief, it also brings consequences - which can turn deadly.

In this episode of Drug Story, we look at the idea of anxiety as a disease - a common human problem that can become, for some, a treatable condition. And we consider what “treatment” means, for good and for bad.

Sources for this episode

[1] Quitting Xanax: One Writer's Story (2024) Vogue Magazine: Martha McPhee details her seventeen-year dependence on Xanax, originally prescribed for panic attacks.

[2] Fear and fitness: An evolutionary analysis of anxiety disorders (1994) Ethology and Sociobiology: Anxiety evolved as a defense mechanism with subtypes adapted to specific threats; anxiety disorders arise from dysregulated defenses.

[3] A history of anxiety: from Hippocrates to DSM (2022) Dialogues in Clinical Neuroscience: Traces the understanding and classification of anxiety from ancient Greek and Roman philosophy to the DSM, noting Greco-Roman recognition of anxiety as a medical condition and early cognitive-behavioral approaches.

[4] Should You Be Upset? Cicero on the Desirability of Emotion (2022) Antigone Journal: Examines Cicero’s views on whether suppressing or embracing emotions is desirable.

[5] Cicero and the state-trait theory of anxiety: Another case of delayed recognition (1983) American Psychologist: H.J. Eysenck argues Cicero anticipated the modern distinction between anxious temperament and temporary anxious states.

[6] The Effects of Stoic Training and Adaptive Working Memory Training on Emotional Vulnerability in High Worriers (2021) Cognitive Therapy and Research: Results from a study show that practicing Stoicism significantly reduces rumination and boosts self-efficacy.

[7] Seneca (2024) Stanford Encyclopedia of Philosophy: Lucius Annaeus Seneca was a Roman philosopher who shaped stoicism and contributed to the concept of mindfulness and use of the present to manage emotions. 

[8] The developmental origins of anxiety (2004) Nature: Early developmental mechanisms establish a predisposition to anxiety through the interplay of genetic and environmental factors. While anxiety is a biological adaptive response to danger it becomes pathological when interfering with normal life. 

[9] DSM-III and the transformation of American psychiatry: a history (1993) The American Journal of Psychiatry: American psychiatry transitioned from a biopsychosocial model to a research-based medical model following the publication of the Diagnostic and Statistical Model.

[10] The Feminine Mystique (1963) National Humanities Center: In her 1963 seminal writings, Betty Friedan wrote about a pervasive dissatisfaction and feeling of emptiness among American housewives.

[11] Barbiturates: A Blessing and a Menace (1947) Journal of the American Pharmaceutical Association: A 1947 journal article aptly describes the nature of barbiturates as both a blessing and menace describing their medical importance as sedatives and their ability to be misused. 

[12] Listening to the Past: History, Psychiatry, and Anxiety (2005) The Canadian Journal of Psychiatry: 19th–early 20th century treatments for anxiety included the use of bromides, alcohol, opiates, and later barbiturates for relief.

[13] How Was Anxiety Treated in the 1900s? (2023) Connect by ManagedMinds: Historically, anxiety has been treated by asylums, rest cures, early psychotherapy, and modern psychiatric medications like SSRIs.

[14] The history of benzodiazepines (2013) The Consultant Pharmacist: Leo Sternbach discovered one of the first benzodiazepines, Valium, in 1955.

[15] The Launch of Xanax (1989) Drug Information Journal: Upjohn Company ran a successful marketing strategy using targeted psychiatrist outreach and consistent messaging to establish Xanax’s market position.

[16] Listening to Xanax (2012) New York Magazine: This article explores “functional anxiety” in high-achieving urban professionals and Xanax’s role.

[17] The Great American Xanax Legacy (2018) VICE: Xanax has become a force in modern culture including hip-hop music where the brand drug is commonly name dropped and featured in songs. 

[18] The APA Task Force report on benzodiazepine dependence, toxicity, and abuse (1991) The American Journal of Psychiatry: Benzodiazepines are rarely abused alone but are often used alongside alcohol or opioids in substance abuse.

[19] F.D.A. Requires Stronger Warning Label for Xanax and Similar Drugs (2020) The New York Times: In 2020, the Food & Drug Administration added a warning label to all benzodiazepines cautioning against misuse and abuse of the drug.

[20] Balancing the Risks and Benefits of Benzodiazepines (2021) JAMA: Reviews benefits, risks, and strategies for rational prescribing following FDA labeling changes.

[21] FDA Drug Safety Communication  (2020) The U.S. Food & Drug Administration: FDA warning to highlight risks of abuse, addiction, dependence, and withdrawal for all benzodiazepines.

[22] A Review of Alprazolam Use, Misuse, and Withdrawal (2018) Journal of Addiction Medicine: There is high misuse liability of alprazolam and more severe withdrawal compared to other benzodiazepines.

[23] Alprazolam: Good for Some, Not Good for All! (2023) Journal of Clinical Psychopharmacology: Alprazolam poses high risk for addiction and difficult withdrawal given its pharmacological properties. 

[24] Benzodiazepine use, abuse, and dependence (2005) The Journal of Clinical Psychology: While there are few addiction cases from prescribed use of benzodiazepines, pharmacologic dependence can occur with long-term therapy.

[25] Benzodiazepine Tapering American Society of Addiction Medicine: Clinical guidelines recommend gradual tapering when discontinuing benzodiazepines.