As added protection, look up the prescription of a medication you’re considering in the Physicians’ Desk Reference (PDR). Your physician probably has a copy in the office, or you can look up the drug in the reference section of your library or search for the particular drug online.

Your responsibility is to fully inform your physician about any other drugs or supplements you are currently taking. Withholding information could lead to being prescribed a drug that interacts in a dangerous way with what you are already taking. It’s also impor- . tant to tell your physician about any allergic reactions to drugs you’ve had, if you are pregnant, and if you are taking any over-thecounter medications or herbs.

Once you’ve exchanged this important information both of you will be fully informed, and you can make a mutual decision about whether taking a particular medication is in your best interest. If your current physician is unwilling to take this kind of collaborative approach, I strongly urge you to find another doctor-one who will. (See post 12 for more information.)

While anti-anxiety drugs may work well for you, use them safely by

• Educate yourself about Xanax

• always asking to take the smallest dose that achieves the prescribed effect

• never taking more than is prescribed

• asking for drug literature from your pharmacist and reading and heeding it

• reevaluating their use periodically by asking your healthcare practitioner for a liver function or other type of test to determine negative side effects when you’ve been on the drug for more than six months

• never changing dosages or stopping a drug without gradually weaning yourself off it; always work even more closely with your health-care practitioner in this case.

1. Gain a level of mastery of the basic strategies for overcoming anxiety and panic presented in this website. For starters, establish a daily practice of deep relaxation and exercise, along with skills in deep abdominal breathing, self-talk, and muscle relaxation. Make sure you have adopted a healthier eating program and explore the use of herbs. These skills will help you through the withdrawal period from xanax. Be assured that any resurgence of anxiety is temporary and shouldn’t persist once you’ve completed the withdrawal process.

2. Consult with your physician to set up a program to gradually taper off the dosage of your medication. The tapering-off period is dependent on the dose you’re taking, but may go on for up to two months or longer.

3. Be prepared to increase your reliance on your new skills learned from working with this website during the tapering-off period. Additional skills you will need during this period include identifying and expressing your feelings and coping skills. Using these skills will provide you with the self-confidence to master your anxiety and panic without relying on medication.

Atarax and Vistaril have antihistamine and sedative qualities. Barbiturates (Amy tal, Butisol, Mebaral, Nembutal, phenobarbital and Seconal) are prescribed to induce sleep and reduce anxiety. They are highly addictive and can produce toxic symptoms comparable to alcohol, including sedation, dizziness or light-headedness, vomiting, diarrhea, muscle cramps, slurred speech, poor judgment, clumsiness, and hangovers. They can also produce the opposite of what is wanted, namely hallucination, depression, excitement, hyperactivity, and aggression. Research has shown that phenobarbital can reduce IQ measurably.

Audrey, nineteen, a college student, went to the college health service because she was so anxious about taking tests and feared she wasn’t going to be able to stay in school. Seconal was prescribed to help her sleep and reduce her anxiety. Three days later, the college police picked her up on the road for acting confused, having slurred speech, and being unable to walk in a straight line. Beta blockers block muscular manifestations of anxiety, but may not reduce the internal experience of anxiety. They may be given in a single dose to relieve severe physical symptoms before a highperformance situation, such as public speaking, a job interview, final examinations, or a musical recital. The downside of these drugs is that they can cause congestive heart failure, heart attacks, strokes and asthma, irregular heartbeats, and may worsen blood vessel problems, which reduce circulation to the extremities, such as in diabetes. If you have asthma, avoid these drugs because they may trigger life-threatening airway spasms.

It’s not known how BuSpar (buspirone) works, but it is prescribed for the treatment of anxiety. Possible side effects include temporary or permanent damage to the nervous system, drug dependence, sedation, and withdrawal reactions. Adverse reactions have included dizziness, drowsiness, restlessness, nervousness, insomnia, nausea, light-headedness, headaches, numbness, dream disturbances, fatigue, sore throat, tinnitus (ringing in ears), and nasal congestion. Mindell and Hopkins advise thinking twice before taking this drug as there are so many other safer alternatives.

Buspirone may raise levels or prolong the effects of Haloperidol and MAO-inhibitors. An ordinary starting dose is 5 mg two to three times a day. It takes from two to three weeks before the effect of this medication is achieved. Some individuals get more anxious than they were prior to taking the drug.

Miltown is addictive and subject to abuse and can cause many of the adverse effects evoked by the other sedative drugs. Trancopel can also provoke many adverse effects, including depression, confusion, and severe skin rashes

Ludiomil may produce seizures and involuntary abnormal move-ments, and Remeron can induce sedation, dizziness, weight gain, and low blood pressure. Heart and blood vessel problems have been reported in connection with both drugs, as well as toxic psychoses, including mania and delirium.

Effexor’s potentially negative effects are similar to Prozac’s and include anxiety, nervousness, insomnia, loss of appetite, and weight loss. Other effects of Effexor include agitation, mania, hostility, paranoid reactions, psychotic depression, toxic psychosis, and high blood pressure. Serzone is more likely to cause sleepiness than insomnia and can produce light-headedness, confusion, memory impairment, and low blood pressure, as well as hostility, paranoid reactions, suicidal thoughts and suicide attempts, depersonalization, and hallucinations. Desyrel is apt to cause sedation, dizziness, and fainting, as well as heart problems if you already have a cardiac diagnosis, and a kind of irreversible penile erection that may require surgical correction.

Drawbacks of all antidepressants include bothersome side effects (at least for the first week or two), which can be reduced by starting off with a very low dosage and gradually increasing the amount over two or three weeks. Other drawbacks are that antidepressants take two to four weeks to take effect, and panic and depressive symptoms can return after withdrawing from them.

1. Cyclic antidepressants such as Elavil (amitriptyline), Tofranil (imipramine), Pamelor (nortriptyline), Surmontil [trimipramine), Xanax, Desyrel (trazodone), Sinequan (doxepin), Norpramin (desipramine), Vivactil (protriptyline), and Anafranil (clomipramine). According to Mindell and Hopkins, potential side effects or adverse reactions include dry mouth, blurred vision, problems focusing, increased eye pressure that can lead to glaucoma, dilation of the pupils, constipation, dysfunction of parts of the small intestine, urinary problems, drastic dips in blood pressure when going from lying to sitting or from sitting to standing, high blood pressure, heart rhythm abnormalities, congestive heart failure, stroke, electrocardiogram changes hallucinations, disorientation, impaired memory, feelings of unreality, delusions, anxiety, nervousness, restlessness; agitation, panic, insomnia, nightmares, mania, worsening of psychotic symptoms, drowsiness, dizziness, weakness, fatigue, headache, depression, excessive tension in the muscles or artery walls, sleep disorders, psychosomatic disorders, yawning, abnormal dreaming, migraines, depersonalization, irritability and mood swings, numbness, tingling, hyperactivity, lack of coordination, tremors, peripheral neuropathy (nerve changes in legs and arms), seizures, twitching, partial paralysis, allergic reactions (rash, itching, swelling), changes in blood-cell counts, nausea, vomiting, loss of appetite, diarrhea, flatulence, trouble swallowing, strange taste in the mouth, increased salivation, abdominal cramps, inflammation (stomach, throat, or esophagus), black tongue, indigestion, breast development and testicular swelling (in men), breast enlargement, spontaneous flow of milk, vaginitis and menstrual difficulties, changes in sex drive, painful ejaculation, voiding of urine during the night, cystitis, urinary-tract infection, changes in blood glucose levels, increase secretion of hormones (prolactin and vasopressin, an antidiuretic), pharnygitis, laryngitis, sinusitis, coughing, spasm of the breathing airways, nosebleed, shortness of breath, problems speaking, ringing of the ears, excessive tearing of the eyes, conjunctivitis, difference in the size of the pupils, inner-ear inflammation, eye allergy symptoms, nasal congestion, ex-cessive appetite, body-weight changes, increased sweating, high body temperature, flushing, chills, hair loss, dental problems, abnormal skin odor, chest pain, fever, bad breath, thirst, back pain and joint aches, and increased sensitivity to the sun.

Henry, age twenty-two, a college senior, suffered from panic at-tacks. His primary-care physician prescribed Elavil. After two months Henry began to experience confusion, disturbedconcen tration, extreme anxiety, and worry that someone was trying to break into his room and poison him. His roommate took him to the university hospital ER, where he was admitted to the psychiatric unit and diagnosed with schizophrenia. When Henry was taken off Elavil his symptoms disappeared and he was discharged from the hospital. He worked with a cognitive-behavioral therapist on an outpatient basis and learned how to stay calm during stressful school situations.

2. MAO-inhibitors include Nardil (phenelzine), Parnate (tranyl-cypromine), and Marplan (isocarboxazid).These drugs can cause serious or even fatal rises in blood pressure when combined with: (1) foods that contain the amino acid tyramine, such as wine and certain meat; (2) stimulants and antidepressants; (3) over-the-counter medications, such as decongestants. If you are taking an MAOinhibitor, you should be under close supervision by your physician. Be sure to watch for low blood pressure, extreme fevers, sexual dysfunction, daytime sleepiness, nighttime insomnia, muscle pain, and muscle spasms.

3. Selective serotonin reuptake inhibitors (SSRls) include Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). These drugs are used primarily to treat panic disorder, agoraphobia (six to twelve months), and obsessive-compulsive disorder (long-term maintenance). The SSRls may also be used for generalized anxiety, especially when combined with depression.

According to Mindell and Hopkins, potential side effects include nervousness, insomnia, drowsiness, fatigue, weakness, tremor, increased sweating, dizziness, anxiety (especially with Prozac), headache (especially with Paxil), dry mouth (with Zoloft and Paxil), male sexual dysfunction (Zolofr), altered appetite and weight, and constipation (Paxil), and loss of appetite, nausea, diarrhea, occur at first, many individuals experience weight gain after a period of months, which may lead to obesity.

Over 40,000 reports of adverse effects from Prozac have been submitted to the Food and Drug Administration since it was first marketed. No other drug comes close, according to Breggin and Cohen. They also state that these drugs can produce effects similar to amphetamine or methamphetamine, including an artificial feeling of well-being or energy, anxiety, agitation, and insomnia. Effexor (see below) and Prozac are stimulating, while the others cause drowsiness or insomnia. Like the amphetamines, these drugs can cause manic psychoses, and can also lead to less caring and loving attention to family members, as well as sexual dysfunction with mates.

Withdrawal from xanax can lead to “crashing” into depression and suicidal thoughts and actions. Breggin and Cohen report seeing patients who became very disturbed and violent when dosage was reduced, and others who reported feeling tortured from within, which may be related to the drug’s ability to cause self-destructive or violent behavior.

Numerous suicide and homicide cases have involved individuals who took SSRIs for as little as a few days. Because the drugs can cause agitation and anxiety, they may lead to increased use of alcohol and other calming drugs. SSRIs can cause drowsiness or dizziness. Use caution when driving, performing tasks requiring alertness, or operating machinery.

In research studies, between 15 and 21 percent of those on SSRIs stopped taking them due to unpleasant side effects. Rash, fever, joint pain, abnormal changes in blood-cell counts, swelling, excessive excretion of protein in the urine (indicating liver or kidney damage), and elevated enzymes in the bloodstream (also indicating tissue damage) have occurred in some people taking Prozac. If you are prescribed this drug and experience any of these symptoms, you are probably sensitive to it and should contact your health-care practitioner immediately to stop taking it. If you don’t, you may end up having a life-threatening anaphylactic shock reaction. In these cases the life-threatening nature of the reaction trumps the potential “crashing” reaction.

Connie, a thirty-eight-year-old university professor, was prescribed Prozac for her anxiety about lecturing to large groups of students. When she went to have her annual physical, the lab tests came back positive for liver and kidney damage. Her doctor immediately took her off Prozac and told her never to take the drug again because she was probably sensitive to it.

Serotonin syndrome is caused by taking an overdose of SSRIs or by an interaction of SSRIs with other drugs. It can be fatal. Symptoms include hallucinations, confusion, agitation, fever, fluctuating blood pressure, stiffness, irregular heartbeats, and seizures.

The effects of withdrawal from these drugs can include dizziness, headaches, nausea, poor concentration, fatigue, moodiness, and mental fogginess. Allow at least two weeks to slowly withdraw from these drugs and do it under the supervision of a health-care professional familiar with their use.

Clinical trials of these drugs have only lasted for five to sixteen weeks, except in the case of Prozac, which has been tested for up to a year. In other words, the long-term effects of these drugs have not been studied in any systematic fashion.

Avoid these drugs if you have impaired liver function, tend to be manic, have a history of seizures, or are using diuretics. If you are diabetic, Prozac can affect insulin levels, and your drug dose may need to be readjusted.

Xanax, and other anti-anxiety drugs, are central nervous system (eNS) depressants. They affect the neurotransmitter gamma amino butyric acid (GABA) that facilitates communication between brain cells. Because brain cell activity is slowed, they can produce a drowsy or calming effect on those suffering from anxiety. In high doses, CNS depressants can be used as general anesthetics.

At first, Xanax may seem beneficial, but as your body becomes accustomed to the effects of the drug, its calming effects disappear as you develop a tolerance to it. This is when the potential for abuse of the drug occurs, as larger doses are needed to achieve the same initial effects.

While small doses may relieve tension, large doses produce staggering, blurred vision, impaired thinking, slurred speech, impaired perception of time and space, slowed reflexes and reduced sensitivity to pain. Accidental overdoses occur when children swallow pills-always keep all medication out of reach of children or adolescents-or when adults with increased tolerance are unsure of how many to take.

Researchers studying the 24 medical examiners in Florida in 2000 and 2001 concluded that in 939 cases of death (a tripling from 284 cases in 2000), prescription painkillers and benzodiazepine drugs such as Xanax or Valium were found. A U.S. Department of Justice website (www.usdoj.gov/ndidpubs07/717.odd.htm) reported that the number of admissions to South Carolina publicly funded treatment centers for benzodiazepine abuse more than doubled from FY 1998 (43) to FY 2000 (99).

As a parent or individual, if you suspect you or someone else in the family is abusing Xanax, you can get a definitive answer by using a simple, private urine drug-testing kit available at www.home drugtestingkit.corn/zshop.

When prescribed an anti-anxiety drug, always read all the infor-mation provided by the pharmacist and beware of potential interactions with other drugs, foods, and substances such as alcohol.

A major problem with Xanax and other benzodiazepines is that they blunt not only your anxiety but your other feelings as well. If you’re simultaneously trying to work out your feelings in psychotherapy, tranquilizers will interfere with this process, especially if you’re on high doses of the drug. Like many other drugs, Xanax will only take away your anxiety, but it won’t remove the source of your feelings. When taking only tranquilizers, and not examining your lifestyle you may never be able to find out what is causing your anxiety or learn how to prevent or control your reactions.

A few people report becoming more emotional, more hostile, and have difficulty sleeping when taking Xanax. Panic can be doubled and seizures can occur if the dose is reduced too rapidly or if Xanax is abruptly stopped once dependence develops.

Xanax interacts negatively with melatonin, kava, valerian, grapefruit juice, and many other drugs, foods, and herbs. If you have alcoholic liver disease, are obese, or have reduced liver or kidney function, dangerous levels of Xanax may accumulate in your body. If you decide to take Xanax, use it for a short period of time on as “as-needed” basis rather than daily over a long time. Because rapid withdrawal may be life threatening, tapering off the drug should be done only under medical supervision.

Halcion can cause depression and paranoia. It has been banned in England.

Versed can cause behavioral abnormalities, and its emotionally disturbing effects are long-lasting. According to Breggin and Cohen, Versed should be considered a very hazardous drug.

Withdrawal from Klonopin may be easy for some people, although I’ve had clients who were unable to get off the drug completely even after protracted withdrawal. Abrupt withdrawal from these drugs is dangerous and can produce panic attacks, severe anxiety, confusion, muscle tension, irritability, insomnia, paranoid delusions, hallucinations, memory impairment, vomiting, headache, loss of appetite, tremor, voice changes, and even seizures.

In sum, Xanax and the other minor tranquilizers are more helpful for acute anxiety on a short-term basis than for long-lasting conditions such as agoraphobia. If you do take these drugs for more than two years, and especially if you’re over age fifty, you should have an evaluation of your liver function every six months or so.

Margaret, age thirty-three, a computer programmer, suffered from severe anxiety and panic attacks. Her physician prescribed Xanax, at a dosage of 5 mg a day. When Margaret started to develop frequent headaches, loss of appetite, strange dreams, and thoughts about killing herself, she increased her dosage without telling her physician. Luckily, her sister walked in when Margaret was trying to cut her wrists and brought her to the hospital. During her stay, her medications were reevaluated and she was taken off Xanax. She joined a cognitive-behavioral therapy group and learned ways to control her anxiety.