Panic Disorder Treatment Benzodiazepines for Anxiety By Sheryl Ankrom, MS, LCPC Sheryl Ankrom, MS, LCPC LinkedIn Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. Learn about our editorial process Updated on May 30, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Dean812 / Flickr / CC BY 2.0 Table of Contents View All Table of Contents How They Work Dosages for Anxiety Types Precautions Side Effects Risk of Overdose Tolerance, Dependence, and Withdrawal Alternatives to Benzodiazepines Frequently Asked Questions Benzodiazepines, sometimes referred to as benzos, are a class of medications commonly used for their tranquilizing and anti-anxiety effects. They can be effective in the treatment of anxiety, but they also have some side effects and risks that you should know about. These medications were once the most common treatment for anxiety, but there are also newer and often more effective treatments available that do not carry many of the same risks associated with benzodiazepines. If you have anxiety, learning more about the use of benzodiazepines to treat this condition can help you decide if this is the right treatment choice for your needs. How Benzodiazepines Work for Anxiety Benzodiazepines affect the gamma-aminobutyric acid (GABA) receptors of the brain. This action results in slowing of the central nervous system (CNS), inducing a state of relaxation. Benzodiazepines are fairly quick-acting, relieving symptoms in a short amount of time. They may also be used to treat insomnia, which can be both a symptom of anxiety or a contributing factor. Anxiety may interfere with sleep, but a lack of sleep may also lead to or worsen symptoms of anxiety. Dosages for Anxiety Depending on your condition and symptoms, benzodiazepines may be taken once per day, multiple times per day, or on an as-needed basis. Your doctor may begin with a low initial dose that may be increased if you are still experiencing symptoms. The therapeutic dosage varies greatly from individual to individual. It may also depend on the severity of symptoms and a person's unique body chemistry. Typical Dosages Ativan (lorazepam): 0.5 to 1 mg three to four times a day.Klonopin (clonazepam): 0.5 to 1 mg three times per day, with a maximum dose of 20 mg a day.Librium (chlordiazepoxide): 5 to 25 mg three to four times a day, with a maximum dose of 100 mg per day.Serax (oxazepam): 10 to 30 mg three to four times a day, with a maximum dose of 120 mg per day.Valium (diazepam): 5 to 25 mg three to four times daily, with a maximum dose of 40 mg per day.Xanax (alprazolam): 0.25 to 1 mg three times per day. The maximum dose per day is 4 mg. In addition to prescribing benzodiazepines, your doctor may also recommend psychotherapy to help treat your anxiety. Research has found that combining medications and therapy may be the most effective treatment option. A type of therapy known as cognitive behavioral therapy (CBT) is one of the methods most frequently used to treat anxiety. Types of Benzodiazepines for Anxiety Common uses for benzodiazepines include the treatment of anxiety, panic attacks, and insomnia. Examples of benzodiazepines used for the treatment of anxiety-related to panic disorder or other anxiety disorders include: Xanax (alprazolam): Prescribed for short-term relief of anxiety symptoms Klonopin (clonazepam): Prescribed to treat panic disorder and panic attacks Valium (diazepam): May be prescribed during the initial phase of treatment for panic disorder Ativan (lorazepam): May be prescribed to treat anxiety symptoms that occur with other psychiatric conditions Librium (chlordiazepoxide): May be used to treat anxiety disorders as well as alcohol withdrawal Benzodiazepines may also be prescribed for other conditions including seizures, muscle spasms, and withdrawal from alcohol or other drugs. They may also be used to treat sleep disorders and to induce a relaxed state prior to surgery. Precautions When Taking Benzodiazepines Benzodiazepines should be taken only as directed by your doctor. You should not increase your dosage without consulting your doctor. If you've been prescribed a benzodiazepine, do not stop the medication without your doctor’s advice. Doing so may cause unwanted withdrawal symptoms or worsen your condition and symptoms. In the United States, benzodiazepines are classified as Schedule IV controlled substances. Safe Usage Benzodiazepines can cause drowsiness, which can affect your ability to drive safely. You should avoid driving or operating other heavy equipment if you feel drowsy or sleepy. You should also avoid taking benzodiazepines with alcohol or other sedatives. Drug Interactions Certain drugs, including some types of the SSRIs, may affect how a benzodiazepine is metabolized and excreted from your body. This may cause a rise of benzodiazepine medication in your blood. It is important to follow your doctor’s dosing instructions when taking benzodiazepines with SSRIs or other medications to avoid an increased risk of overdose or unwanted side effects. Mixing benzodiazepines with alcohol or other classes of sedative (depressant) medications may produce an increased depression of the CNS. These interactions can be potentially serious and can result in an increased risk of overdose. There have been reports of fatalities involving these interactions. This list is not all-inclusive. There are other drug interactions that should be avoided and medical issues your doctor may need to consider before starting benzodiazepine therapy. Be sure to tell your doctor about all medications, including over-the-counter drugs and supplements you are taking. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medications with benzodiazepines. Pregnancy and Breastfeeding Benzodiazepines have been linked to congenital birth defects when administered during the first trimester of pregnancy. They are also excreted in human breast milk. If you are taking benzodiazepines and become pregnant, talk to your doctor right away. Age Benzodiazepines should generally not be used to treat anxiety in children and teens. These medications may cause symptoms of irritability rather than inducing feelings of calmness. Older adults may also be more sensitive to the effects of benzodiazepines. Because of this, they may be more likely to experience symptoms of confusion and poor muscle coordination, which may lead to falls, bone fractures, or other accidents. Health Conditions Before beginning benzodiazepine therapy, tell your doctor if you have any of the following conditions: A history of alcohol or other drug abuse or dependence Glaucoma Kidney or liver disease History of seizures History of bipolar disorder or depression Suicidal thoughts If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Side Effects of Benzodiazepines The most common side effects of benzodiazepine use are drowsiness and impaired coordination. Such side effects tend to be mild and may not be noticeable or troublesome when benzodiazepines are taken at low doses for short-term periods. Other side effects include: ConfusionFatigueMemory impairmentSlowed mental processing The side effects associated with benzodiazepines abate once the effects of the drugs wear off. When used as a treatment for insomnia, you may notice lingering feelings of daytime drowsiness the following day. If these or other side effects arise and continue to be bothersome, talk to your healthcare provider. It is also important to note that this class of medications carries an FDA black box warning noting the serious risks of abuse, addiction, physical dependence, and withdrawal. Even when taken at prescribed doses, benzodiazepines can lead to physical dependence, and abruptly stopping their use can lead to serious withdrawal reactions, including seizures. Risk of Overdose When used as directed, benzodiazepines are generally safe and effective. However, overdose events have been reported with benzodiazepines alone or in combination with alcohol or other drugs. These events can be potentially life-threatening. Symptoms and signs of overdose include: Extreme sedationConfusionImpaired coordinationDiminished reflexesDifficulty breathingComa If benzodiazepine overdose is suspected, immediate medical attention is required. Tolerance, Dependence, and Withdrawal Benzodiazepines have the potential for physical dependence when used for long periods of time, especially at high doses. They can also be psychologically addictive in some individuals. Studies have shown that people who take benzodiazepines over a long period of time may develop tolerance that reduces the therapeutic benefits. If tolerance occurs, larger doses of benzodiazepines may be needed to bring about desired results. Long-term use of benzodiazepines may result in physical dependence and withdrawal symptoms if the medication is stopped or decreased suddenly. Withdrawal symptoms may include: Anxiety Diarrhea/stomach upset Insomnia Muscle cramps Headache Decreased concentration Rapid breathing Tremors Seizures Do not discontinue or decrease your benzodiazepine medication without consulting your doctor. It may be necessary to decrease your dosage slowly to avoid withdrawal complications. Alternatives to Benzodiazepines Benzodiazepines are effective and fast-acting, which often makes them a good choice for short-term, acute episodes of anxiety. However, benzodiazepines are not the only option for treating symptoms of anxiety. Other medications that may be prescribed to treat anxiety include antidepressants, beta-blockers, and a medication called BuSpar (buspirone). Supplements and over-the-counter (OTC) anxiety remedies may also be helpful in some situations. Herbal remedies including chamomile, lavender, l-theanine, and valerian are sometimes utilized to help with anxiety. Antihistamines such as Benadryl are sometimes used off-label to help with symptoms of anxiety. Cannabidiol (CBD) may also offer some benefits in the f relieve symptoms of anxiety. Lifestyle modifications can also be helpful in relieving anxiety levels. Getting enough sleep, minimizing caffeine intake, and getting regular exercise can play a role in keeping anxiety levels in check. Medications can be helpful for anxiety, but they are often most effective when they are used in conjunction with psychotherapy and lifestyle modifications. A Word From Verywell Anxiety is a treatable condition and benzodiazepines are just one way to relieve symptoms. If you have symptoms of an anxiety disorder, work with your doctor to find the treatment that works best for you. The 7 Best Online Anxiety Support Groups Frequently Asked Questions How do benzodiazepines work for anxiety? Benzodiazepines work by increasing the activity of a neurotransmitter called GABA. This chemical messenger helps induce feelings of drowsiness and calmness. What is an alternative to benzodiazepines for anxiety? Other medications that can be prescribed include selective-serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers (a type of blood pressure medication), Vistaril (hydroxyzine), and BuSpar (buspirone). Psychotherapy and lifestyle changes, such as increasing physical activity, making dietary changes, and getting more sleep, can also be helpful. When are benzodiazepines prescribed for anxiety? Benzodiazepines are often prescribed to treat acute episodes of anxiety, including panic attacks or severe situational anxiety. A person with panic disorder might take benzodiazepines to help stop panic attacks, or a person with a phobia might take this type of medication to cope with exposure to the source of their fear. Which benzodiazepines are prescribed most often for anxiety? Some of the most commonly prescribed benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam). 10 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. John Hopkins Medicine. Benzodiazepines. John Hopkins Psychiatry Guide. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow Balon R, Starcevic V. Role of benzodiazepines in anxiety disorders. Adv Exp Med Biol. 2020;1191:367-388. doi:10.1007/978-981-32-9705-0_20 U.S. Department of Justice Drug Enforcement Administration. Drugs of abuse, a DEA resource guide. FDA. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class. Vinkers CH, Olivier B. Mechanisms underlying tolerance after long-term benzodiazepine use: A future for subtype-selective GABA(A) receptor modulators? Adv Pharmacol Sci. 2012;2012:416864. doi:10.1155/2012/41686 Kandola A, Stubbs B. Exercise and anxiety. Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23 Tibrewal P, Looi JCL, Allison S, Bastiampillai T. Benzodiazepines for the long-term treatment of anxiety disorders? The Lancet. 2021;398(10295):119-120. doi:10.1016/S0140-6736(21)00934-X Garakani A, Murrough JW, Freire RC, et al. Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Front Psychiatry. 2020;11:595584. doi:10.3389/fpsyt.2020.595584 Kroll DS, Nieva HR, Barsky AJ, Linder JA. Benzodiazepines are prescribed more frequently to patients already at risk for benzodiazepine-related adverse events in primary care. J Gen Intern Med. 2016;31(9):1027-1034. doi:10.1007/s11606-016-3740-0 Additional Reading National Institute of Mental Health. Mental health medications. By Sheryl Ankrom, MS, LCPC Sheryl Ankrom is a clinical professional counselor and nationally certified clinical mental health counselor specializing in anxiety disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.