From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
Subject: Re: Xanax
Organization: Syracuse University, Syracuse, NY
Date: Wed, 26 Aug 92 20:59:58 EDT

In article <1992Aug24.141401.11022@apgea.army.mil> sjnaccar@apgea.army.mil (Susan J. Naccarato <sjnaccar>) writes:
>
>Would someone please tell me the side effects that can occur while
>taking this drug.  Seems to me it's being prescribed quite frequently.
>Two young women I know are now on it.  The reasons just don't seem to
>warrant being put on a drug like this...[stuff deleted]...She went to 
>an internist, and he's the one who prescribed the Xanax.  Thyroids fine!  
>Just seems to me that Xanax is being handed out to these young women the 
>way some doctors used to throw the valium to them.  
>Exact words of one of these girls to me were "everyone I know is on Xanax".

Xanax (alprazolam, Upjohn) is a triazolobenzodiazepine, and is a cousin
of Valium.  The drug is FDA approved for the treatment of Panic
Disorder and is very widely prescribed for generalized anxiety.  Side
effects of Xanax are identical to other benzodiazepine tranquilizers
and hypnotics (sleeping pills), and include:  drowsiness, sedation,
psychomotor impairment (decreased capacity for sustained attention,
increased reaction time, decreased fine motor coordination, etc), and
impaired memory.  Please note that the tolerance to the psychomotor
impairment begins to develop very rapidly -- after only one or two
doses -- so less adverse effects of this sort MAY be observed in people
who take Xanax regularly as opposed to only when needed.  Rare side
effects of Xanax include paradoxical agitation and disinhibition
(including violent behavior).  Clinically, side effects of Xanax,
aside from drowsiness, are rare; there are many people who take
Xanax and similar drugs for very long periods of time without
seeming to suffer any harm from their benzodiazepine.

Xanax and similar tranquilizers are not addictive in the same
way in which opiates, alcohol, crack, or nicotine are addictive.
Abuse of Xanax and similar drugs is very rare among anxious patients.
People with anxiety disorders are not "getting high" on Xanax. 
They are getting their feet back on the ground.  
Drugs of this kind have been abused mostly by people who
would rather abuse Quaalude but can't get their hands on any, or
by people who have been doing a lot of amphetamines and need to
calm down, etc.  People with panic disorder and other anxiety
disorders -- which are often chronic conditions -- often come to
depend on their Xanax.  This is not the same as being addicted;
there is no escalation of dose, etc.  Doctors describe some diabetic
patients as "insulin dependent" but that doesn't mean they're addicted
to insulin.  Just that without insulin, their blood sugar goes sky high.
Some people feel and function a heck of a lot better on Xanax or similar
drugs; some people are totally disabled without them.

Xanax has been heavily marketed to primary care internists and
family doctors by Upjohn Pharmaceuticals.  The drug is about to
go off patent; its had a great run.  My belief as a psychiatrist
is that Xanax has been overly prescribed in some quarters -- and
under prescribed in others.  Generally when people might benefit
from Xanax there is some sort of behavioral/cognitive/psychological
treatment which could be of significant benefit to them, which they
are not going to get in their internist's office.  In some circumstances,
though, Xanax from the family doc is better than no treatment at all. 

Jack Gorman and Stuart Yudofsky have both written very good books
on psychotropic drugs for the general reader, available at any
Mall bookstore.












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mark kline                              mdkline@rodan.acs.syr.edu
suny health science center, syracuse    voice: (315) 422-1050
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