BLOG No. THIRTEEN

Welcome back to my blog on anxiety and depression, where today we will be discussing, “Just why can’t I have my Xanax?” If I had a dime for every time I had a patient tell me that, “Xanax is the only medicine that works for me,” I would still be writing this blog, but from a beach house in Malibu. But at the moment, I am on a plane heading to vacation…and yes, I am drinking a Chardonnay. And my cat is not with me because in actuality, our cats passed a couple years ago. But it was fun making up the cat story each blog, wasn’t it? Okay, let’s skip the cat stories for just a second, and get back to the Xanax story.

Xanax, as you might be aware, is a member of the benzodiazepine family, or as the street lingo goes, “benzo’s”. Like the American Airline chocolate chip cookies, they can be very addicting. But why are they so addictive, you might ask…I mean the benzo’s?

Well, first we need to know how they work. There are multiple benzo’s on the market, the list including Ativan, Valium, Klonopin, and of course, Xanax to name a few. Valium was the first benzo created, thus its generic name “diazepam” fits the name of the family, benzo-diazepine. And all of the benzo’s stimulate a receptor called GABA. Hmmmm, where have we heard that word before…hummmm. Oh yes, good memory. GABA is always in a balance war with glutamate and is the ultimate brain relaxer. So when glutamate has overtaken GABA (the glutamic theory) stimulation of GABA gives a temporary re-balance of the two chemicals, making a patient feel more calmness…temporarily.

So, what is so bad about that?

The problem lies in the fact that when there is GABA stimulation by Xanax, or another benzo, over time something happens that in pharmacotherapy terms we call tachyphylaxis. (Yes, it sounds like a poorly dressed cabbie at the airport, but that’s not what it is). Tachyphylaxis means that the dosage you used last month, may not work this month. Asthma rescue inhalers have the same issue. The more you use them, the more you need. The 1970’s and 1980’s saw an incredible overuse of benzo’s. (Remember, the glutamic theory was not out there yet). Dosages went up and up, and people got addicted—and they died. And they still do! (You-tube “The Eagles, Life in the Fast Lane.)

But more than tachyphylaxis, benzo’s are addictive in a different way.

When they are suddenly stopped, the brain can have negative effects—withdrawal, seizures, and even death. I joked about chocolate cookies being addictive, but I meant that after one cookie, you might want more. It doesn’t mean you will die if you don’t get a second one.

And more importantly, benzo’s depress the respiratory drive.

This means you don’t want to breathe as deep. I know that I am only a simple family doctor, but the last I heard, breathing was kind of important. Many a celebrity, as well of those not so famous, purchased their demise by taking too many—or mixing—benzo’s. And combining them with other meds, such as opiods (pain meds) can become lethal, if not carefully regulated by a clinician.

So in conclusion, occasional use of benzo’s can be supported, but because of the issues listed above, clinicians are more hesitant to use them these days. But, unfortunately, they are offering nothing more than SSRI’s in their place. And when D2 dopamine is driving anxiety like a Formula One racecar, patients who can’t get their benzo’s, can turn to self-medication, often getting their medications from the street.

Well, my imaginary cat has spilled another good glass of Chardonnay, (Just CAT-astrophic!). So, until next time, when we discuss the difference between anxiety/depression and attention deficit disorder, this is Dr. G saying, keep the faith.