It is important to distinguish between therapeutic and non-therapeutic use when analyzing the significance of benzodiazepine dependence.

This is the second installment of an introductory series on medications commonly prescribed for panic disorder. The series is for informational purposes only. If you have any questions about your prescriptions, you should ask your doctor or psychiatrist. Click here for the first installment on SSRIs.

Benzodiazepines affect the activity of a neurotransmitter called "gamma-aminobutyric acid" (GABA). GABA works by limiting the nerve cell activity in areas of the brain associated with anxiety. It is believed that people with anxiety disorders have overactive cell activity in these areas, so benzodiazepines help GABA return brain activity to normal. Benzodiazepines act quickly and have few side effects, making them the "preferred medications for most anxiety disorders" (see NIMH's Medications).

There are numerous benzodiazepines used in the treatment of panic disorder. They differ from one another in that they each have a different "half-life." The half-life is the length of time it takes for all the drug to leave your body. (See the Benzodiazepine Equivalence Charts.)

The benzodiazepines with longer half-lives, such as Klonopin, tend to give a more continuous calm than those with shorter half-lives, such as Xanax. For some the continuous relief from anxiety is a priority. Others take benzodiazepines such as Xanax on an "as-needed" basis, when they think they'll be entering a situation that may cause panic.

How you use a benzodiazepine is up to you and your prescribing doctor or psychiatrist. Never stop taking a benzodiazepine abruptly and/or without telling your doctor. It is recommended that if you choose to stop the medication, you taper off slowly.

Long-term benzodiazepine use may cause physical dependence. Tapering off the medication can lessen or even eliminate withdrawal symptoms. Studies show that actual addiction has been a problem only for people who have previously abused drugs or alcohol (See Piper, "Addiction to benzodiazepines -- how common?"). Studies also show that people with anxiety disorders stay at the same dosage of benzodiazepines over time or, as is usually the case, gradually decrease the dose (See Romach, et al, "Clinical aspects of chronic use of alprazolam and lorazepam").

The Benzodiazepines

Be sure to return next week for information on tricyclic antidepressants.

Cathleen