How Xanax (Alprazolam) Is Used to Treat Social Anxiety Disorder

Worried, anxious, middle-aged woman sitting on her couch at home

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Xanax (alprazolam) is a medication, taken in the form of an oral tablet, that can be used in the treatment of social anxiety disorder (SAD). Xanax belongs to the benzodiazepine class of medication, and it's commonly prescribed for anxiety and panic disorder.

SAD is characterized by an intense, chronic fear of social situations. People with this condition often worry that they'll feel self-conscious, embarrassed, scrutinized, or rejected while in public, which may cause them to avoid social situations. While in public, they may have symptoms like:

  • Avoiding eye contact
  • Blushing
  • Heart pounding or racing
  • Nausea
  • Rigid body posture
  • Shaking
  • Speaking too softly
  • Sweating
  • Trembling voice
  • Trouble breathing

Benzodiazepines like Xanax are often prescribed as support alongside a primary treatment, like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Psychotherapy, like cognitive behavioral therapy (CBT), is also frequently used together with medication.

Xanax will not permanently cure your anxiety; rather, it helps to reduce your symptoms in the moment, often so that you can better participate in other forms of treatment, such as psychotherapy. Because Xanax starts working quickly, it will give you some immediate relief if you are suffering from severe bouts of anxiety.

What Is Xanax Used For?

Xanax is approved to treat generalized anxiety disorder (GAD) and panic disorder (with or without agoraphobia), and to reduce symptoms of anxiety short-term. It works by depressing the function of your central nervous system (CNS) and quickly bringing on a sedative effect. It can be used short-term as a way to offer people immediate relief from their symptoms or as part of a long-term management plan for GAD or panic disorder.

Xanax is often prescribed for panic attacks, which can occur as part of SAD. It might also be used in the case of specific phobias for situations that infrequently occur; for example, a doctor might prescribe Xanax to someone with a fear of flying ahead of an upcoming trip. Xanax is helpful for panic-inducing situations as it can be used as needed before an event.

In the case of SAD, Xanax is more commonly prescribed for cognitive symptoms like worrying about performance or the judgment of others. Xanax can be taken about an hour before a performance event.

How It Works

Xanax provides fast relief of anxiety symptoms often seen in SAD and other anxiety disorders. It works specifically by binding to GABA receptors in your brain. This slows down your brain activity, and has the effect of reducing anxiety, fear, and feelings of terror. It might also leave you feeling sleepy, relaxed, and calm.

Xanax has a half-life of around 11 hours. "Half-life" refers to how long it takes the body to eliminate half of the ingested dose. The clinical effectiveness of one immediate-release Xanax tablet is often much shorter; most people notice the effects wearing off within four to six hours.

Precautions and Contraindications

You should not take Xanax if you have a hypersensitivity to benzodiazepines or are pregnant or breastfeeding. Xanax has also not been shown to be effective for people under age 18, and elderly people may be more susceptible to adverse side effects. Xanax may also be less effective for people who smoke.

People with liver or kidney problems also should not take Xanax. The medication is processed by these organs, and if they are not working correctly, Xanax may build up in your body leading to the possibility of overdose or heavy sedation.

You should also avoid Xanax if you're currently taking the antifungal medications ketoconazole or itraconazole.

Dosage

When used to treat the short-term symptoms of SAD, Xanax is generally prescribed at a dose of 0.25 to 0.5 milligrams (mg), taken three times daily, to start. Your doctor may increase your dose incrementally every three to four days until you reach a maximum of 4 mg daily (given in divided doses). These doses are according to the manufacturer.

Xanax is generally prescribed for a limited time. A doctor who prescribes this medication for longer than eight weeks should check on the status of your anxiety to see if other treatment options might be more suitable.

If your doctor determines that you no longer need to take Xanax, they will slowly wean you off of the medication. Your specific schedule may vary, but generally, they will reduce your dosage by 0.5 mg every three days until you're no longer taking it.

Xanax can be prescribed as:

  • 0.25 mg tablets
  • 0.5 mg tablets
  • 1 mg tablets
  • 2 mg tablets

How to Take and Store

You should take Xanax exactly as your doctor prescribes. Overdoses are possible with this medication, so be sure you don't take too much or double-up on your doses. If you do forget to take a dose, take it as soon as you remember, as long as it's not too close to your next scheduled time.

Xanax should be kept at room temperature and, since it is a controlled substance, you should store it securely, out of the reach of others, in a tightly closed container.

Do not take Xanax with grapefruit juice, as it could increase the medication's effects, or with any other substance that can depress your CNS, like alcohol.

Side Effects

There are several factors to keep in mind when taking Xanax. Good communication with your doctor can help you determine what's normal and when to be concerned.

Common

The most common side effects of taking Xanax are sedation and drowsiness. In general, benzodiazepines like Xanax have fewer side effects than other longer-term medications for anxiety. Avoid driving, operating machinery, and participating in hazardous activities until you know how you react to Xanax.

Severe

Xanax can cause mania, as well as lead to abuse and physical and psychological dependence. Talk to your doctor if you have a history of substance abuse, as Xanax may not be a good choice to treat your SAD.

Warnings and Interactions

Using Xanax together with opioids can carry serious, life-threatening side effects. This combination can result in extreme sedation with the risk of slowed breathing, coma, and death.

You shouldn't take opioids and Xanax together unless your doctor believes there is no alternative treatment available to you. If that is the case, they should keep your dosage as low as possible and watch you closely for signs of respiratory depression and sedation.

A number of medications can potentially interact with Xanax. It is important that your doctor is aware of all the medications you are currently taking. Drugs that may cause issues include:

  • Antibiotics like erythromycin, clarithromycin, and isoniazid
  • Anticonvulsants like carbamazepine
  • Certain antidepressants, including Luvox (fluvoxamine), Norpramin (desipramine), Paxil (paroxetine), Prozac (fluoxetine), Serzone (nefazodone), Tofranil (imipramine), and Zoloft (sertraline)
  • Antihistamines like cimetidine
  • Antifungals like itraconazole and ketoconazole
  • Blood pressure medications like diltiazem, nicardipine, and nifedipine
  • Heart medications like amiodarone
  • Immunosuppressive drugs like cyclosporine
  • Migraine medications like ergotamine
  • Oral contraceptives
  • Pain relievers like propoxyphene

Grapefruit juice may also interact with Xanax. In addition, the effects of Xanax may be intensified if combined with alcohol.

There is a risk of emotional and physical dependence when taking Xanax. Withdrawal symptoms are possible if the medication is abruptly stopped and may include the risk of seizures. This is why it's so important to work with your doctor to wean off of this medication slowly.

Be sure to follow your doctor's directions for stopping Xanax or changing the dosage. Over time, there is a risk of your brain producing less GABA naturally, which may make Xanax less effective.

Obtaining a Xanax Prescription

If you've suffered for a long time with SAD, you may wonder how to get prescribed Xanax and if it could help. While it is something that you can ask your doctor about, ultimately they will make the decision about the best treatment options for your situation.

It is important not to use Xanax obtained from someone else. Not only is it illegal to take a medication without a prescription, but it can be dangerous. Besides the risk of dependence and withdrawal, combining Xanax with other substances that suppress your CNS, such as painkillers, antihistamines, and alcohol, can be dangerous.

Xanax should only be taken under the advice of a prescribing physician. Xanax can cause feelings of euphoria when taken in large doses or by people who don't have anxiety, making abuse of this substance more likely.

A Word From Verywell

As always, you should check with your doctor if you have questions about taking Xanax for SAD, and you should always follow their guidelines for this medication. If you feel like Xanax isn't helping your condition, your doctor may be able to recommend another medication or another form of therapy. It may take time to find the right treatment protocol that works for you.

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6 Sources
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