Updated on March 31, 2022.
Nearly 30 percent of adults will have an anxiety disorder at some point in their lives. Often, drugs called benzodiazepines are prescribed to control symptoms. Also called “benzos,” these drugs include lorazepam (Ativan), alprazolam (Xanax), and diazepam (Valium). Taken as prescribed, these drugs can offer temporary relief of anxiety symptoms, but they are often misused, and overdoses are rising. Illegal benzos are also an important factor in overdose deaths.
The percentage of outpatient-clinic visits that result in a prescription for benzodiazepines increased from 3.8 percent in 2003 to 7.4 percent in 2015. By one estimate, the drugs were prescribed at nearly 66 million office visits a year in 2014-2016. At the beginning of the coronavirus pandemic, prescriptions made to women rose, though overall they trended down in 2020-2021 compared with 2018-2019.
Since 2019, however, illicit benzos have become more available, according to a 2021 study by the Centers for Disease Control and Prevention (CDC), which found an uptick in emergency-department visits for benzodiazepine overdose between 2019 and 2020.
Deaths, too, have skyrocketed. Between spring 2019 and spring 2020, a study of 38 states and the District of Columbia found that deaths from benzo-involved overdoses rose by 21.8 percent from legal prescriptions and by a staggering 519.6 percent from illicit benzodiazepines. Many of these deaths involved opioids, which when taken with benzos make a particularly dangerous combination.
Here’s what you need to know about anxiety, benzodiazepines, and how to prevent an overdose.
Anxiety or anxiety disorder?
Anxiety is a catchall term for a variety of disorders, says Yevgeniy Gelfand, MD, a psychiatrist and internist with Trident Medical Center in Charleston, South Carolina. “It’s a spectrum disorder, including everything from panic attacks to excessive worrying to post-traumatic stress disorder to phobias,” he says. “It’s a separate cluster of diagnoses and can coexist with anything else. It’s basically a doctor word for ‘worrying.’”
The difference between normal worrying and an anxiety disorder is that with an anxiety disorder, anxiety is persistent and out of proportion to the perceived threat. Anxiety disorders also disrupt how you function in everyday life.
How benzodiazepines can help—or harm
Benzodiazepines are sedatives and tranquilizers that work quickly to relieve symptoms of anxiety. They are supposed to be prescribed for just a few weeks at the lowest possible dose for severe anxiety or insomnia. In reality, though, they are often prescribed more liberally and for longer periods than those guidelines suggest. This is a problem because benzodiazepines are addictive if you take them chronically. It’s easy to become hooked on their effects, and the body develops a tolerance to the drugs over time.
“These medications are very effective, but only when used appropriately, for a short time and as needed instead of, ‘Oh, I don’t want to deal with this, let me take some meds,’” Gelfand says. “The underlying problems won’t go away by putting on a Band-Aid, which is what benzodiazepines are. They’re for improving symptoms.”
Deadly combinations
Taking benzodiazepines presents the risk of dependence as well as withdrawal symptoms. For people who take high doses, abrupt withdrawal can be life-threatening.
As for overdose, taking too much of a benzodiazepine can result in slurred speech, trouble walking steadily, drowsiness, slowed breathing, and an altered level of consciousness. Still, taking benzodiazepines on their own in excess is rarely fatal.
When they can become deadly (aside from withdrawal situations) is if people take them with other “downers,” especially opioids or alcohol. The combination can lead people to become comatose, to stop breathing, and to die. The CDC found in its 2021 study that of all the benzo-related overdose deaths in the first half of 2020, 92.7 percent involved opioids.
A holistic approach to anxiety treatment
Anxiety treatment is best if it’s holistic and multi-layered, including lifestyle changes, mind-body approaches, psychotherapy, and non-addictive medications.
Mindfulness and deep breathing may be helpful.
“The mind can’t focus on many things at once. One thing we can do is bring your awareness to the body,” Gelfand says. “Feel the skin, feel the air brush it, feel the clothes on your skin. Feel yourself inhabit your body.”
Then, switch to focusing on your breath. “Use your belly to push your diaphragm down and cause air to rush into your lungs,” says Gelfand. “That stimulates the vagus nerve. That’s what produces relaxation. It brings out more calmness. We’re not thinking of whatever stressful thing, we’re changing our breathing, making it slower and more efficient. There’s some relief.”
Other interventions may include:
- Community integration, such as religious support
- Changes in personal behaviors or the home environment
- Changes to diet, alcohol, or caffeine use
- Journaling
- Exercise
- Creative practices, such as making art
- Addressing underlying physical health problems.
Figuring out what combination works can require trial and error, as everyone is different.
In some people with anxiety disorders, benzodiazepines have a place as short-term treatment aids. But the drugs can be dangerous, especially if they are taken with other medications that sedate you. They should not be used as a substitute for more lasting, evidence-backed solutions to anxiety disorders.
