Panic Disorder Treatment Benzodiazepines for the Treatment of Anxiety By 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 Sheryl Ankrom, MS, LCPC Medically reviewed by Medically reviewed by Steven Gans, MD on January 30, 2020 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Review Board Steven Gans, MD Updated on March 05, 2021 Print Dean812 / Flickr / CC BY 2.0 Table of Contents View All Table of Contents How They Work Examples Precautions Side Effects Tolerance, Dependence, and Withdrawal Benzodiazepines 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. 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 and may depend on the severity of one’s symptoms and his or her unique body chemistry. 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. Examples of Benzodiazepines 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 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 for 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 1-800-273-8255 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 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: Confusion Fatigue Memory impairment Slowed 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. Potential for 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 sedation Confusion Impaired coordination Diminished reflexes Difficulty breathing Coma 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 Again, 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. 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 Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. 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. 2017. FDA. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class. Updated October 2, 2020. 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 Additional Reading National Institute of Mental Health. Mental health medications. Updated October 2016.