FOR THE LAYPERSON – Dr. Cox’s Guidelines for Discontinuing Xanax (Alprazolam)
Stephen Cox M.D., Assistant Clinical Professor of Psychiatry, U.K. College of Medicine.
This article is written in lay terminology and with analogies to make complicated medical science understandable. I have written it from my personal opinions generated from my training as a board certified psychiatrist with more than 30 years of experience in both prescribing Xanax (aprazolam) for legitimate anxiety disorders and detoxing drug abusers from it.
This is written for anxiety health educational information only. Do not treat yourself. See a qualified mental health provider for diagnosis and treatment.
We have all read stories of negative aspects of the abuse of Xanax. These stories are sometimes overestimated. I, personally, have experienced only occasional difficulty in tapering Xanax in legitimate patients with panic disorder. This may be a surprise to those who are not experienced in prescribing psychoactive medicants for anxiety disorders.
I today’s world, the majority of physicians prescribe either cognitive behavioral treatment (CBT) or antidepressants for panic disorder. It is very difficult to find CBT counselors who really know how to do CBT properly. A single antidepressant prescribed for panic disorder often fails to be effective or to be tolerated by persons with panic disorder. In such a case, physicians usually switch to another antidepressant and start all over a several month trial. Often, if the first antidepressant fails, the odds of the next antidepressant failing are higher. The odds of third, fourth and so on antidepressants failing increase with each failure. There are about 28 antidepressants. It may take years to try them all.
I believe from what I have seen and know, after failing to respond satisfactorily to 2 or 3 antidepressants, it is prudent and merciful to give up on this class of medicines and try one of the two other classes of medicines for panic disorder: the high potency benzodiazepines [Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam)] or the MAOI (monoamine oxidase inhibitor) Nardil (phenelzine). Of these, I prefer Xanax because it does not seem to me to cause depression at higher doses. I also like the two other forms of Xanax that are available: extended release Xanax which can last all day and the orally disintegrating Xanax tablet that in my experience acts faster than traditional Xanax.
The fact is that even if antidepressants repeatedly fail, Xanax works very well indeed in treating its main FDA approved indication, panic disorder.