Is Xanax (Alprazolam) Right for You? (2024)

America is one seriously anxious nation.

We Americans worry a lot—about our health, our safety, our personal finances, and our social media profiles. And the list goes on. According to the Anxiety and Depression Association of America (ADAA), a whopping 40 million adult Americans over age 18 suffer from anxiety disorders. That’s about 18% of the population.

American kids are also anxious. About a quarter of all teens ages 13-18 struggle with anxiety disorders. Untreated, anxiety can negatively impact a kid’s performance at school, relationships with peers, and can put a child at risk for depression, low self-esteem, and drug and alcohol problems later.

Of course, as any expert will tell you, a little anxiety can be motivating. It’s what gets you to work on time, drives you to study for a big exam, and helps you avoid reckless behavior—like wandering alone through a park at night.

“Some anxiety is actually good for us,” says Michael D. McGee, MD, chief medical officer at The Haven at Pismo, an addiction treatment center in Grover Beach, California. He is also the author of the Amazon bestseller The Joy of Recovery: The New 12-Step Guide to Recovery from Addiction, and a member of the Psycom Editorial Advisory Board.

But as you’ve probably learned from experience, things that are good for you can also spell trouble—especially if you have too much of a good thing.

So, here’s a brief rundown of stuff that amps us up, according to an American Psychiatric Association study:

• In 2019, anxious Americans worried about health, safety, finances, relationships, and politics, but the biggest concern was money.

• Almost three-quarters of women, nearly three-quarters of young adults ages 18–34, and about 4 in 5 Hispanic adults said they were somewhat or extremely anxious about their ability to pay bills.

• Women were more anxious than men and they had a greater increase in anxiety than men over a one-year period: 57% of women ages 18-49 reported being anxious, compared with 38% of same-age men.

The American Psychological Association (APA) named a slightly different set of anxiety-provokers—particular to people ages 15 to 21 (also known as Generation Z)—in its recent report on stress in America. Topping the list:

• Immigration and sexual assault are huge worries. Mass shootings are a big stressor for that group, too.

• Gen Z’ers are more stressed about the separation and deportation of immigrant and migrant families, compared with other Americans (57% of Gen Z members vs. 45% of all adults).

• More than 9 in 10 Americans in the Gen Z generation said they experienced at least one physical or emotional symptom due to stress—such as feeling sad or depressed (58%) or lacking interest, motivation or energy (55%).

• Only half of all Gen Z men and women feel like they do enough to manage their stress. (To combat the problem, the American Psychological Association urges self-care: exercise, taking time to unwind, making smart food choices, and spending time with family and friends.)

With all this worry about our worries, it is somewhat surprising that a significant number of nervous Nellies ignore expert advice and turn instead to one of the nation’s best-selling anxiety-blasters: Xanax. A study in the Journal of Addiction Medicine¹ suggests that US doctors write an estimated 48 million prescriptions for Xanax each year, making Xanax one of the most-prescribed benzodiazepines in the nation.

Xanax is the brand name for the generic drug alprazolam. It belongs to a family of drugs called benzodiazepines—a type of tranquilizer that makes the brain less sensitive to stimulation, which has a calming effect.

Benzodiazepines such as Xanax are commonly used to treat anxiety, insomnia, and panic. They also are used to reduce jitters before surgery.²

Drugs that are similar to Xanax include Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam). All work by slowing the nervous system to induce mental and physical relaxation. They also work fast, with some kicking in in as little as 15 minutes. The calming effect they produce can last 6 to 12 hours, says Dr. McGee, a winner of a Living Now Evergreen Medal for Health and Wellness and of a 2018 Readers’ Favorite medal.

Xanax is used for short-term relief for anxiety and panic. Only a qualified medical professional can determine whether you have an anxiety disorder, a diagnosis that is typically based on an evaluation of your symptoms and tests to rule out other medical causes for your anxiety—if necessary.

According to the US Department of Health and Human Services, there are several types of anxiety disorders. Among them:

• Generalized anxiety disorder, marked by chronic, unrealistic worry, fear, and apprehension.

• Obsessive-compulsive disorder, which comes with recurrent, unwanted thoughts and/or repetitive behaviors (obsessions and compulsions).

• Panic disorder, characterized by episodes of intense fear and physical symptoms that may include chest pain, heart palpitations, shortness of breath, restlessness, and trouble concentrating.

• Post-traumatic stress disorder, often linked to events in which profound harm occurred or was threatened—from an assault, natural and man-made disasters, an accident, or war.

• Social phobia disorder, which triggers overpowering anxiety and atypical self-consciousness in day-to-day social situations.

Xanax is FDA-approved for short relief of generalized anxiety disorder and panic disorder only.

Signs of an anxiety disorder may include:

• Nervousness, restlessness, or tension

• A sense of impending doom or danger

• An increased heart rate

• Rapid breathing

• Sweating, trembling or shaking

• Weakness or fatigue

• Trouble concentrating

• Concern over a present worry almost to the exclusion of anything else

Symptoms of a panic disorder may include:

• A sense of impending doom or danger

• Rapid or pounding heart rate

• Shortness of breath

• Tightness in the throat or chest

• Fear of loss of control, death, or heart attack

• Sweating, trembling or shaking

Xanax has many of the same side effects as alcohol, including mental and physical impairment, sleepiness, slower reaction times, balance and coordination problems, dizziness, and light-headedness. Other common reactions include memory problems, slurred speech, trouble concentrating, confusion, upset stomach, changes in appetite, headache, and blurred vision.

You should not take Xanax if you have shown sensitivity to other benzos such as Valium and Ativan, have narrow-angle glaucoma, or are pregnant or breastfeeding. Alert your health care provider if you have liver problems, as there is a risk that Xanax may build up in your system and lead to overdose or heavy sedation. Xanax has not been shown to be effective for adolescents and teens under age 18, so using it in this population is considered “off label.”

Xanax also may be habit-forming. The risk of addiction is about 2%, Dr. McGee says, but that risk is higher, he adds, among people who are already addicted to alcohol or opioids.

He also worries that Xanax and drugs like it may prevent some from learning how to manage anxiety. People have a tough time learning to cope without meds once you put them on them, so the real problem is dependence, Dr. McGee continues.

Over many years Xanax can increase risk of falls, motor vehicle accidents, dementia, and urinary incontinence, he adds. Moreover, there are serious risks with taking benzodiazepines along with opioids, so it is important to discuss with your doctor before starting treatment.

The typical Xanax dosage is 0.75 to 1.5 mg a day, divided into three 0.25–0.5 mg doses as needed for anxiety. It is best if used only as needed. But keep in mind that the dosage that works for you may not be the same as the one that works for someone else. Dosing can vary depending on the severity of your disorder and your height, weight, age, and metabolism. Your health care provider will likely prescribe the lowest possible dose that is effective for your disorder.

Although safe and effective when prescribed by a medical professional and taken as directed, there is a growing concern over the abuse of Xanax and drugs like it.

Headlines in recent years suggest that teen use of Xanax is rising. An article in the Journal of Addiction Medicine¹ calling Xanax one of the most widely prescribed drugs for anxiety and panic disorders noted too that “many primary care physicians continue to prescribe it for longer periods than recommended.”

One big concern is dependence. “This cannot be overstated,” Dr. McGee says. “People who start on Xanax often have a really hard time getting off it. The same is true for other benzos.”

Although medical intervention can help to keep anxiety at bay, lifestyle changes can also keep anxiety in check. Try these suggestions:

• Get moving. Physical exercise is a powerful and well-documented stress reducer. Aim for 30 minutes of moderate activity three to five times a week. Even smaller amounts of moderate exercise may make a difference.

• Make changes. Cut back on or give up cigarettes and caffeinated beverages. Nicotine and caffeine increase anxiety, studies suggest.

• Practice stress management. Look for stress-busting guides online or low-monthly-fee apps such as Calm and Headspace that you can download onto your smartphone. Learn yoga. Practice visualization and/or meditation to ease stress, anxiety, or panic.

• Seek help. Treatment works. Consider cognitive behavioral therapy, mindful acceptance, and prescription drugs including SSRIs, SNRIs, buspirone, and beta blockers.

• Use an anxiety app.

• Practice mindfulness and meditation.

• Take a walk in nature.

• Talk it out with a friend.

• Eat right. Some studies suggest that the Mediterranean diet can reduce anxiety.⁴

Benzos are best used short-term in crisis situations—and at times for isolated phobias like fear of flying or for sudden or severe trauma, such as death of a loved one. Xanax is also useful for anxious, agitated depression until the depression subsides. Dr. McGee notes, however, that it’s best to avoid Xanax and similar drugs for long-term use except as a last resort when all else fails.

He adds, “Keep use to under a few weeks if at all possible—ideally only a few days, or only once or twice a week use so that you don’t develop a dependence.”

This article was originally published October 11, 2019 and most recently updated August 15, 2022.

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