Xanax
Alprazolam, commonly known by one of its brand names Xanax, is a psychotropic medication frequently prescribed to manage panic and anxiety disorders. It belongs to a class of psychoactive drugs called benzodiazepines, known for their sedative and calming effects.
Alprazolam has also been used off-label for the treatment of depression and psychosis, although this is likely due to their anxiety-reducing effects. It reduces nervousness, promotes relaxation, and can help with sleep.
Due to their calming and sedative effects, but in some cases also stimulant effects, alprazolam became a target for abuse quickly after its release onto the market in the 1970s.
Alprazolam quickly diffuses through the blood-brain barrier and primarily works by interacting with GABA-A receptors. These receptors are special proteins in the brain that help regulate nerve activity. They are activated by a chemical called gamma-aminobutyric acid (GABA), which is the main neurotransmitter responsible for calming down nerve signals in the central nervous system.
Alprazolam binds at a site that is distinct from the GABA binding site, increasing the affinity of GABA to the receptor and potentiating the response of the receptor to GABA. The potentiation of the effects of GABA, which works as a depressor on the central nervous system, causes sedative effects.
Because of their quick diffusion and influence on the inhibitory neurotransmitter GABA, alprazolam has rapid sedative effects, causing relaxation. This makes it an attractive medication for those struggling with sleep and anxiety.
Alprazolam has been found to uniquely affect the dopaminergic function in the brain, similar to stimulants. Administration of alprazolam potentially elicits an increase in dopamine and serotonin levels, causing feelings of euphoria.
Alprazolam is widely used by medical professionals for a variety of indications. Because of its calming effects, alprazolam is often used for generalized anxiety disorder and panic disorder.
Alprazolam is sometimes used off-label for the treatment of depression, although its antidepressant effects have not been systematically proven. Especially since the advent of newer antidepressants, such as SSRIs, the use of alprazolam in the treatment of depression has declined.
Because of the risk of dependence and misuse when used for a longer period, alprazolam should be prescribed for short-term use. As first-line pharmacological treatment for anxiety disorders like SSRIs or SNRIs usually take a few weeks to reach therapeutic effects, alprazolam can help alleviate acute symptoms of anxiety and distress early in treatment.
Alprazolam has depressant effects on the central nervous system, through which it reduces anxiety, relaxes the mind and muscles, and decreases alertness and concentration. Its anxiolytic and antipanic effects make alprazolam an attractive medication to alleviate anxiety symptoms.
Common side effects are drowsiness, dizziness, fatigue, slurred speech, pore concentration, memory impairment, hypersensitivity and irritability. Additionally, alprazolam is also said to have euphoric effects, which adds to their potential of abuse.
Although alprazolam is a substance commonly described for long-term use in the clinical setting, it is not recommended to use longer than four weeks. This is because there are several risks related to long-term use of alprazolam. Due to the development of tolerance, which causes users to need increasing doses for the same symptom relief, there is a severe potential for dependence. The main way to avoid developing tolerance and dependence is to not use alprazolam for longer than four weeks.
When alprazolam is taken in high doses, it can cause unpleasant and potentially harmful effects. Overdosing on alprazolam may lead to slurred speech, dizziness, aggressive behavior and impaired motor coordination. Impaired motor coordination can increase the risk of falls, injuries, and traffic accidents.
In more severe cases, overdosing on alprazolam can result in depressed breathing and loss of consciousness. While this can occur from alprazolam alone, it is more commonly associated with combining it with other sedatives like alcohol or opioids. Mixing alprazolam with opioids significantly increases the risk of non-fatal and fatal overdoses, primarily due to respiratory depression.
Benzodiazepines carry increased risks for certain health conditions and patient groups. Individuals with pulmonary diseases, diseases that affect the lungs and other parts of the respiratory system, may face heightened risks due to respiratory suppression, while those with opioid use disorders have an elevated risk of (both intentional and unintentional) overdose.
Older adults are especially vulnerable, as physiological changes associated with the aging process can lead to impaired excretion of the substance, higher levels in the blood, and accumulation of the substance in the body. Besides, benzodiazepine use in general and alprazolam use in particular, is associated with increased risk of falls, hip fractures, delirium, and motor vehicle accidents, for older adults.
During pregnancy, alprazolam reaches the foetus by permeating the placenta. Long-term effects of alprazolam during pregnancy are not fully understood, but exposure to the substance during pregnancy has been associated with spontaneous abortion, low birth weight, preterm birth, and low Apgar score, which is used to determine the health of a newborn.
Alprazolam is depressant of the central nervous system and can therefore have several interactions with other drugs and medications that work on that system.
Combining benzodiazepines with substances that are also central nervous system depressants, like alcohol and opioids, can be extremely dangerous. When taken together, they can amplify each other's effects, leading to a greater risk of respiratory depression, low blood pressure, or even death.
One-off, occasional or short-term use of alprazolam is unlikely to result in the development of dependence. However, when the substance is being used for a longer period, users can develop a physical and psychological addiction. Part of the emergence of dependence is the development of tolerance, as users need higher doses for the same symptom relief.
There are two main groups of people who develop alprazolam dependence. The first group consists of people who sought medical help during increased anxiety, but continued using the medication beyond the recommended time-frame or at doses outside the recommended range. The second group consists of people actively seeking out the sedative effects of alprazolam, often accompanied by dependence on other substances and / or alcohol.
Alprazolam is a short-acting and high-potency benzodiazepine, which makes it more addictive than other long-acting benzodiazepines. People who suffer from a substance use disorder are at higher risk of developing alprazolam dependence.
The harms of alprazolam addiction are in many ways similar to those of other substance addictions. It is characterised by a strong desire or sense of compulsion to take the substance, difficulty in controlling its use, tolerance to the use of the substance, neglect of alternative pleasures and interests and persistent use of the substance, despite harm to oneself and others.
Physical dependence on alprazolam is usually defined by withdrawal symptoms, similar to those of alcohol withdrawal. These include both physical (pain, dizziness, muscle stiffness, tachycardia, seizure) and psychological (anxiety, irritability, insomnia and restlessness) symptoms.
Alprazolam withdrawal syndrome has been described as more severe than other benzodiazepine withdrawal symptoms, characterized by a unique rebound anxiety. It can lead to an anxiety more severe than the pretreatment anxiety, cause delirium, psychosis and severe sleep disturbances.
Because of the severe withdrawal symptoms like seizures and the effects of rebound anxiety, abruptly stopping alprazolam is dangerous. Someone with a physical and / or psychological dependence on alprazolam should seek supervision from a doctor to stop their use. An effective and safe way to stop alprazolam dependence usually consists of a slow taper, although this can still lead to withdrawal symptoms.
The long-term effects of alprazolam on health and wellbeing are not well-studied. What is known however, is that the longer alprazolam is used, the higher the risks of tolerance, dependence and severe rebound anxiety are. Chronic use of alprazolam has also been associated with impairment of memory performance and is likely to have a negative influence on other psycho-cognitive functions.
More research will have to be done to better understand the full scope of its long-term effects, including its impact on mental health, cognitive decline, and overall quality of life.
Short-term, occasional medical or recreational use of alprazolam has a relatively low risk of harm. However, there are dangerous sides to the use of alprazolam, especially when they are mixed with other substances or when they are taken in higher doses or for longer periods than subscribed.
A first sign of the possible development of benzodiazepine dependence is when you start developing a tolerance for the substance’s effects. In order to avoid developing dependence, it is advised to not take alprazolam for longer than four weeks. Because of the severe withdrawal symptoms like seizures and the effects of rebound anxiety, abruptly stopping alprazolam is dangerous. Someone with a physical and / or psychological dependence on alprazolam should seek supervision from a doctor to stop their use.
It is not advised to combine alprazolam with other substances. When you are mixing them, it is important to be aware of the potential risks. Combining alprazolam with substances that are also central nervous system depressants, like opioids, can lead to a greater risk of severe sedation, respiratory depression, coma, or even death.
When someone is overdosing on alprazolam it is important to help them, as overdosing can lead to depressed breathing and loss of consciousness. When you notice slower breathing or unconsciousness, there are a few things you should do:
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Place the person on their side so that their airway is not blocked if they vomit.
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Do not leave the person alone, as their condition might get worse.
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Monitor the person and if they a) become unresponsive; b) vomit while unconscious; or c) have slow breathing, make sure to call emergency services.
Let the medical team know what the person has taken, if you know.
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