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- Why Use Medications for Xanax Withdrawal?
- What Medications Are Used?
- Is Medical Detox Always Necessary?
- How Can I Treat Anxiety Without Xanax?
Withdrawing from benzodiazepines like Xanax on your own can be quite difficult, physically distressing, and in some instances, dangerous. Due to certain medical complications associated with acute sedative withdrawal, attempts to detox from Xanax alone could present significant health risks.
Professional medical detox programs can keep you comfortable and safe throughout this potentially risky period. Staff at these programs can administer medications to manage benzodiazepine withdrawal and can also help treat symptoms of anxiety that may emerge once you stop using Xanax.1
Why Use Medications for Xanax Withdrawal?
The acute benzodiazepine withdrawal syndrome associated with medications like Xanax may include symptoms such as:1,2
- Autonomic hyperactivity, which can lead to sweating and elevated pulse.
- Hand tremors.
- Nausea or vomiting.
- Psychomotor agitation, such as pacing or fidgeting.
Xanax withdrawal may also cause anxiety and panic; however, because the drug may have initially been prescribed to manage conditions such as panic and anxiety disorder, it may be difficult to know whether symptoms are the result of withdrawal or whether they simply reemerged once Xanax was no longer available to keep them at bay.1
In cases of severe physiological dependence, the abrupt discontinuation of Xanax raises the risk of more severe, and potentially life-threatening, withdrawal symptoms. These risks may also be increased should a person have developed polysubstance dependence with substances such as alcohol or other sedating drugs. Medications help to lower the risk to the patient by preventing the most serious symptoms, such as seizures and agitation, from developing. They also help to keep the patient more comfortable and psychologically stable during acute withdrawal.1
What Medications Are Used?
Different medications are used to manage benzodiazepine withdrawal and can vary based on your individual situation and needs. For example, people who are detoxing from benzodiazepines are often put on a controlled taper of the same medication they are currently taking. However, such a tapering protocol may be easier to conduct and, ultimately, more effective with relatively long-acting benzodiazepines, whereas Xanax is short-acting.
In many cases, people who are detoxing from shorter-acting benzodiazepines will be first switched over to a longer-acting agent like clonazepam (Klonopin), diazepam (Valium), or chlordiazepoxide (Librium). More rarely, you may be switched from Xanax to phenobarbital, a long-acting barbiturate, for seizure prophylaxis or control of seizure activity that isn’t responding well to benzodiazepine management.1
In certain cases, to further help minimize the risk of seizures, you may be given an anticonvulsant, such as carbamazepine or valproate. Anticonvulsants are usually only recommended for use in conjunction with long-acting benzodiazepines or phenobarbital.1
Other adjunct treatments might include clonidine or propranolol may to help alleviate autonomic symptoms of withdrawal, e.g. excessive sweating or elevated pulse.1
Is Medical Detox Always Necessary?
Benzodiazepine-dependent individuals are often advised to detox under medical supervision. Very commonly, this involves inpatient treatment so that any emergencies, such as seizures, may be dealt with immediately. People who have been using Xanax in high doses or for long periods of time may be more susceptible to severe withdrawal symptoms and thus are safest under 24-7 medical supervision.1
Keep in mind that people who abuse benzodiazepines often use alcohol, other sedatives, or other substances simultaneously, which is referred to as polysubstance abuse. For those who are dependent on more than one drug, withdrawal can be somewhat complicated; inpatient medical care, and the intensive monitoring that it avails, may be necessary during acute withdrawal.1
Inpatient medical detox is a safe environment for those withdrawing from Xanax because it provides 24/7 supervision, monitoring, and care. Staff in the facility are available as needed to address any physical or psychological symptoms that arise and will also understand the safest ways to manage polysubstance withdrawal.1
For some, outpatient detox may be an option. However, an outpatient detox route should only be taken by someone with relatively mild sedative dependence (someone who has not used Xanax in high doses for significant periods of time), who can commit to regular doctor visits, and who has a strong family or social support network to provide regular monitoring and support. 1
If you are considering outpatient detox, your physician can help you to determine whether this is the appropriate level of care for your needs. Ideally, outpatient detox should only be used by those at relatively low risk of experiencing a difficult or complicated withdrawal. Outpatient detox may not be appropriate for you if you suffer from:1,3
- Polysubstance dependence or abuse of any other CNS depressant (e.g., alcohol, sedative-hypnotic medications).
- One or more medical or psychiatric conditions.
- A seizure disorder or have a history of seizures.
Furthermore, if you wish to undergo outpatient detox, you and your family and/or support network should be informed that there is an increased risk of seizures. You will be instructed not to drive or operate dangerous machinery while you are undergoing detox, and possibly for a certain period of time after the detox process is complete.1
How Can I Treat Anxiety Without Xanax?
Xanax is often prescribed to treat panic and anxiety disorders. When you stop taking Xanax, you may be concerned that your anxiety will return. However, there are several medications your doctor might consider as an alternative to benzodiazepines. Some people prefer a holistic or alternative approach or prefer to use a combination of medication and holistic methods of treatment; it’s advisable to talk to your doctor about the options that are best for your needs so that you can make an informed decision.
Some of the non-benzodiazepine medications that can be helpful in managing anxiety include:1,4
- Such antidepressants can include SSRIs such as fluoxetine (Prozac) and paroxetine (Paxil), as well as tricyclic agents such as imipramine and nortriptyline. These medications have a much lower potential for abuse and are less sedating than benzodiazepines.
- Buspirone (BuSpar). This medication, which has less potential for abuse than Xanax, may serve as a substitute when anxiety management is still needed but the risks of continuing benzodiazepines are too high.
Therapeutic alternatives for managing anxiety that may be used alone or in combination with medication include the following:4-7
- Cognitive-behavioral therapy (CBT), which helps you identify and rectify certain thoughts and behaviors. It is usually a short-term treatment that can help you change negative or unhealthy thought patterns common to anxiety, such as catastrophizing.
- Psychotherapy, which can help you identify and work through the underlying causes of anxiety and teach you healthier coping skills.
- Exercise, which can help you release stress while promoting the release of feel-good chemicals in your body known as endorphins.
- Yoga, which is an increasingly popular approach that combines physical postures, breathing exercises, meditation, and a philosophy that focuses on the integration of the body, mind, and soul.
- Relaxation techniques, such as deep breathing.
- Acupuncture, which utilizes thin needles to aid in releasing stress. Although more clinical research is needed to fully support the benefits, limited studies have shown that acupuncture may produce positive results for people suffering from anxiety.
- Nutritional supplements and herbal remedies, such as passionflower or kava. Always consult a qualified practitioner before using any supplement.
- Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol (TIP 45). Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Government of South Australia, SA Health. (2012). Benzodiazepine withdrawal management.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Harvard Health Publishing. (2014). Benzodiazepines (and the alternatives).
- Anxiety and Depression Association of America. (2018). Complementary & Alternative Treatments.
- Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition Journal, 9, 42.
- Pilkington, K., Kirkwood, G., Rampes, H., Cummings, M., & Richardson, J. (2007). Acupuncture for anxiety and anxiety disorders – a systematic literature review Acupuncture in Medicine. Acupuncture in Medicine, 25,1-2.