Panic attacks come suddenly and without warning, at any time, and in the absence of any precipitating cause. The symptoms vary but are always frightening, including fear of dying, pounding heart, heartbeat racing out of control, chest pains perceived to be a heart attack, shortness of breath or the feeling of being smothered, and fear of losing control or going crazy. The intensity of these symptoms generally peak in about ten minutes and pass within about thirty minutes. Some individuals have only one or two attacks in a lifetime, while others have daily or weekly attacks—a condition termed panic disorder. Sufferers often have extreme anxiety about when the next attack will strike. Panic disorders are by no means rare, affecting 1.5–2 percent of the population in the United States every year.
Two groups of drugs are highly effective in reducing the frequency and intensity of attacks: different classes of antidepressants and several short-acting benzodiazepines, including Xanax (alprazolam). Both classes have shortcomings: They must be taken for extended periods (six to nine months) because quitting too soon often leads to a recurrence of attacks, and the preferred drug group, antidepressants, may have to be taken for six to twelve weeks before their full benefits kick in.
Xanax, which has both antianxiety and antidepressant effects, works after the first dose and causes few major side effects, but normal doses taken over only several months may lead to tolerance and physical dependence. These problems occur with other benzodiazepines but are much more pronounced with Xanax. When Xanax is abruptly discontinued or the dose is sharply reduced, hallucinations, delirium, and seizures may result.
More common during withdrawal is extreme anxiety and the return of symptoms reminiscent of the original panic disorder—symptoms that can continue for six months to several years. To prevent these problems, the dosage of Xanax must be gradually reduced over a period of many months, which often proves to be extremely difficult. All benzodiazepines are subject to recreational use, but Xanax leads the list for emergency-department visits.
SEE ALSO Tofranil and Elavil (1957), Librium (1960), Monoamine Oxidase Inhibitors (1961), Valium (1963), Prozac (1987).
Sufferers of panic attacks commonly say that Xanax has saved their life by rapidly alleviating their extreme anxiety with few noteworthy side effects. To retain its beneficial effects, Xanax must be taken continuously. If abruptly stopped, withdrawal effects occur, inducing a recurrence of extreme anxiety in addition to possible seizures.