Non-Addictive Anxiety Medications: Xanax Alternatives

October 17, 2022

Table of Contents

Xanax has a place in medicine, but it is also a benzodiazepine, a class of drugs that has significant addiction potential. Several alternative medications exist if an individual is concerned about this misuse potential or has otherwise struggled with addiction in the past and wants to avoid potentially addictive substances.

How Xanax Works

Alprazolam, known by the brand name Xanax, is an anti-anxiety drug that belongs to the class of benzodiazepines.[1] Benzodiazepines act on gamma-aminobutyric acid (GABA) neurotransmitters to produce a relaxing anti-anxiety effect. For this reason, Xanax is often taken to treat sudden onset symptoms or short-term anxiety. Other commonly prescribed drugs of this class include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), temazepam (Restoril), chlordiazepoxide (Librium), and midazolam (Versed).

Xanax’s Misuse Potential

When taken properly and treatment does not extend beyond a few weeks, the addiction potential for Xanax is relatively low. However, when taking benzodiazepines more often or for longer than intended, the risk for addiction as well as tolerance and physical dependance increases.[2]

Long-term side effects of Xanax use include the following:

  • Loss of coordination 
  • Disinhibition
  • New or worsening depression or anxiety
  • Suicide thoughts
  • Cognitive impairment
  • Increased risk of dementia
  • Psychosis
  • Drowsiness
  • Nausea or vomiting
  • Delirium

Additionally, withdrawal from Xanax comes with serious side effects. Physical dependance can begin within a few days of taking the drug, even when taking it as prescribed, depending on the individual and their proclivity to develop physical dependence. 

Xanax Withdrawal Symptoms 

The symptoms of Xanax withdrawal can be severe, especially when stopping the drug abruptly.[3] Quitting after prolonged use can be dangerous, with withdrawal lasting weeks to months.

Severe withdrawal symptoms can resemble acute alcohol withdrawal and may include the following:

  • Seizures
  • Sleep disturbances
  • Catatonia
  • Panic attacks
  • Psychosis
  • Tremors
  • Suicide
  • Death

Discontinuing the use of long term benzodiazepines like Xanax should happen under the supervision of a doctor. Although medical detox cannot prevent withdrawal symptoms, specialists can help reduce the severity of symptoms, alleviate discomfort, and develop a treatment plan.

Most importantly, working with a doctor to develop a plan to stop taking benzodiazepines helps protect a person from the most dangerous withdrawal symptoms, allowing them to be addressed before they become life-threatening.

Non-addictive Alternatives to Xanax

While benzodiazepines are still commonly prescribed for anxiety disorders, there are better options that are generally safer, with a lower risk of addiction. Many of these medications can be used on a long-term basis, although it is important to talk to your doctor about the potential benefits and downsides of each option, and ask about any long-term health effects a treatment option may have.

Here are some of the non-addictive alternatives to Xanax you could try:

SSRIs & SNRIs 

For many prescribers, the non-addictive drugs of choice to treat anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs have lower misuse potential and fewer long-term side effects associated with their use. SSRIs and SNRIs are considered the first line treatment for chronic anxiety disorders.

SSRIs block the absorption of the neurotransmitter serotonin.[4] Serotonin regulates mood, digestion, sleep, libido, and more. Drug alternatives in this class used to treat anxiety disorders include Prozac (fluoxetine), Zoloft (sertraline), Citalopram (Celexa), and Lexapro (escitalopram).

SSRIs take around four to eight weeks to take effect and may produce side effects like headache, nausea, trouble sleeping, and dizziness. However, in the majority of people, side effects are mild and disappear after the first few days, and the treatment benefits outweigh the issues.

SNRIs have the same method of action as SSRIs, but they also block the reabsorption of norepinephrine in addition to serotonin.[5] These drugs are typically used if first-line medications like Prozac or Lexapro fail to control or help alleviate anxiety. SNRIs include Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine). 

Buspirone

Buspirone is a unique non-benzodiazepine anxiolytic originally used as an antipsychotic but found to better treat generalized anxiety disorder (GAD).[6] It may be used in place of or alongside SSRIs to mitigate unfavorable side effects. 

Hydroxyzine 

Hydroxyzine is actually an antihistamine drug in the class of allergy medications, but also has some sedating and anxiolytic effects. It has little to no addiction potential but does help to take as needed for short term, severe anxiety, similarly to benzos, and thus might be a good alternative for someone who does not want to become dependent on benzodiazepines. 

Beta Blockers

Beta blockers are typically taken to treat hypertension (high blood pressure).[7] However, they are also sometimes used to treat anxiety, especially the physical symptoms of anxiety such as shaking or sweating. Two commonly prescribed beta blockers for this off-label use are atenolol and propranolol.

These drugs work by acting on two key messenger chemicals in the body, adrenaline and noradrenaline. When the body gets anxious, these chemical messengers are what cause certain unwanted side effects, such as sweating, shaking, and the elevation of heart rate. Beta blockers block the effects of these chemical messengers, reducing the physical symptoms of anxiety and partially helping with psychological symptoms as well.

While these drugs aren’t habit-forming, it usually isn’t recommended that a person take them on a long-term basis. They don’t generally cause harm even with months or years of use, but regular checkups can help make sure they aren’t impacting your health. Notably, a person should get their blood pressure checked more regularly when using beta blockers.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Alprazolam. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a684001.html. May 2021. Accessed September 2022.
  2. 1 in 4 Older Adults Prescribed a Benzodiazepine Goes on to Risky Long-Term Use, Study Finds. Institute for Healthcare Policy & Innovation. https://ihpi.umich.edu/news/1-4-older-adults-prescribed-benzodiazepine-goes-risky-long-term-use-study-finds. September 2018. Accessed September 2022.
  3. Benzodiazepine Withdrawal. Emergency Medicine News. https://journals.lww.com/em-news/fulltext/2001/12000/benzodiazepine_withdrawal__potentially_fatal,.13.aspx. December 2001. Accessed September 2022.
  4. Fluoxetine. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a689006.html. January 2022. Accessed September 2022.
  5. Venlafaxine. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a694020.html. January 2022. Accessed September 2022.
  6. Repurposing Buspirone for Drug Addiction Treatment. International Journal of Neuropsychopharmacology. https://academic.oup.com/ijnp/article/16/2/251/623187. October 2012. Accessed September 2022.
  7. Propranolol. NHS UK. https://www.nhs.uk/medicines/propranolol/. November 2021. Accessed September 2022.

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