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May. 29 2010 - 1:10 am | 835 views | 1 recommendation | 4 comments

Despite its Infamous Reputation, Xanax is Still the Most Prescribed Psychiatric Drug

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?


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  1. collapse expand

    It is just more of the same. Back in the day, they were prescribing speed to housewives. Today it is xanax.

    I read an article the other day that said the most prescribed drug in the country (not just limited to psychiatric drugs) is vicodin. Brilliant. http://www.forbes.com/2010/05/11/narcotic-painkiller-vicodin-business-healthcare-popular-drugs.html

    When you read stats like this, it is easy to see why the medical professions have seen such an erosion in public confidence. Many people feel that Doctors and psychiatrists are little more than drug dealers, and statistically it would seem to be a legitimate way of looking at it.

    Both overall, and apparently in the psychiatric community as well, the most prescribed drugs are the ones that people can sell on the black market because they are common street drugs. The medical community needs to take some responsibility and stop prescribing drugs with addictive issues so frequently.

  2. collapse expand

    I’m one of the 44 million filling a monthly script for xanax. Drop a 1mg along with my aciphex before I go to bed. It helps get me to sleep and keeps my mind from racing. My doctor prescribed it about ten years ago after I asked him for it. About a week ago I awakened, or rather, tossed out of bed only to discover both pills on the kitchen counter. I tried to drink my coffee and go on with my day but I was utterly exhausted and out of focus. I dropped a half xanax in the early PM and recovered. I don’t suffer from depression as many people do who take xanax but i do have a “racing mind” that keeps me from falling asleep. I have never experienced a physician carelessly prescribing a painkiller or psychotropic but I’m sure it happens all the time. There are many stories about oxycontin, known as “hillbilly heroin” and widely abused.
    Recently I read that LSD is being given another look by psychiatrists. I hate to think I’m “strungout” on one 1 mg pill of xanax a day – but yeah, I am but it helps me and, as you mentioned, is clear of my system when i wake in the morning. Tom Medlicott

  3. collapse expand

    There is no safe downer. The body has a natural desire to be awake, and Xanax is like a punch in the gut. The body reacts violently to the insult. This is why so many Xanax stories are just one sentence: “I took Xanax and I woke up in jail.”

    It’s also why downers – and there aren’t all that many – essentially kill brain cells. There’s no natural mechanism (besides sleep) for putting the body down. So any drug that does this has to break something to do it.

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