Alprazolam (Xanax) acts on the brain and nerves (central nervous system) to produce a calming effect. Xanax is used to treat the following:
- Repeated episodes of anxiety
- Anxiety as associated with depression
- Chronic insomnia
Talk to your healthcare provider about your complete medical history, especially any instances of alcohol or substance abuse. Admit to the years you smoked, then quit cold turkey when you turned forty, for reasons you can no longer remember. Smoking decreases blood levels of this medication, so skip the part about the cigarettes you sneak now from time to time, savor on nights you have the house to yourself, when you stretch out on the chaise lounge and watch the starless sky. Provide a list of all prescribed, over-the-counter, and/or herbal medications you are taking, minus the bottle of pain pills you’ve rationed over the past year after a routine outpatient procedure you prefer not to dwell on here. Classify yourself as a moderate drinker—a glass of wine or two with dinner, a beer at lunch, a truth you may dispense with if necessary. These details have no bearing on your current condition, though, admittedly, they may play some part in the future.
Report any recent physical changes you may be experiencing: if your shoulder slowly seizes up, freezes so hard you can no longer hook your bra or dress yourself without help; if your upper arms, the one body part you once held in high regard, now swing like your grandmother’s Hadassah arms; if you wear a scarf—even in summer—to cover your neck after your brother teased you with his incessant gobbling; and if you’ve stopped thinking about sex, stopped fantasizing about the masseuse at your salon who moves like she is part cat, stopped trembling when she puts her hands on your shoulders and asks if you’d like to schedule a massage, stopped stammering when you answer her, say you found a guy from Thailand at a place down the street who has twice her strength for half the price.
Tell your doctor right away if any of these unlikely but serious side effects occur:
- behavior problems, including difficulty in concentrating and outbursts of anger
- unusual excitement, nervousness, or irritability
- mental and/or mood changes, thoughts of suicide, or memory problems
It should be noted this is the exact same list of symptoms you gave the gynecologist (the one young enough to be your daughter) who insisted the best approach was to eat right and exercise; the list you gave the next gynecologist (the one nearly old enough to be your mother) who wrote you a prescription for hormones—hormones!that’s the answer!; and the list you did not give the last doctor (the one you’ve known for twenty-five years) who greeted you in the waiting room, led you to his disheveled office, and cleared a stack of files so you could sit, hands folded in your lap, and ask for updates on his five grandkids and his lovely wife and their trip to Italy, until he finally wrote you the prescription for a controlled substance (plus six refills) without any questions, any suggestions, any advice, then gave you a big hug goodbye.
Adults over fifty may be more sensitive to the side effects of this drug, especially drowsiness. Of course, as you know, this is the very side effect you hope for. In fact, you expect the drug to address the following: the nights when you rise to change your sweat-soaked pajamas, then lie awake worrying about your dog’s age, your parents’ ages, and then your own age and whether you should be living in this house, sleeping beside the same woman for the last nine years (and whose snoring you secretly blame for your insomnia), and then you try to picture living alone in the mountains where the snow blankets all sound, a silence impossible not to sleep through, an imaginary world so cold you start to shiver, pull up the bedcovers and wait for their warmth to overwhelm you again.
Xanax may reduce the number of panic attacks you experience. Everyone responds differently to the medication, so try to be patient and follow your healthcare provider’s directions. Take the medication before any family occasion: birthdays, Thanksgiving, Passover, and especially for those Hallmark holidays (as your mother likes to call them) that contain little significance (every day is Mother’s Day!) yet hold so much expectation. The drug’s effects may take longer to appear than you can tolerate, longer than it takes the waiter to bring the drinks or for your mother to ask you why you keep cutting your hair so short. Such a crime, she says, you always had beautiful hair.
It is important to take Xanax exactly as your healthcare provider has prescribed. In the situations as stated above, excuse yourself from the table, and on the way to the bathroom, stop at the bar for a little jumpstart. Though alcohol should generally not be used while taking this medication, you did not drive yourself to the restaurant, nor will you be using heavy machinery or performing any activity that requires alertness, so use at your discretion.
Store medication at room temperature away from light and moisture. Do not store in the bathroom. It is suggested instead to bury the bottle inside the box of tissues on your nightstand for convenient and inconspicuous nighttime consumption. Wait until your girlfriend falls asleep and begins the first in a series of deafening snore patterns. If you do not have a glass of water handy, dissolve the bars under your tongue. The promise of a restful night far outweighs the pill’s bitterness.
While highly unlikely, if you do miss a dose, take it as soon as possible. If it is near the time of the next dose, double the dose to catch up. If you like the results, then consider this an alternative to your normal dosing schedule.
Your healthcare provider may want to see you from time to time, to help assess how well your symptoms are controlled with treatment. Lie when he asks if you are sleeping through the night. Interdose symptoms such as early-morning anxiety can occur. Describe the nights you awaken at three a.m., heart pounding, trembling, disoriented until your girlfriend’s snoring brings you back, reminds you of your greatest fear: absolutely nothing has changed.
The use of Xanax at high doses is often necessary to treat panic disorders. This is one instance in which you do not have to lie to your healthcare provider. Tell him about your inability to leave the house. Recount the times you’ve tried to drive to a yoga class (exercise!) without turning around halfway there; to stand in line at the grocery store (eating right!) before abandoning your cart full of leafy greens and canned salmon; or to make plans to meet a friend for lunch (social stimulation!), then cancel when a paralyzing knot forms in your stomach. Nod, though not too enthusiastically, when your healthcare provider decides to increase your dosage. Look serious when he reminds you there is a substantial risk of dependence in Xanax users and that its pharmacological properties—high potency, a short elimination half-life—increase the potential for misuse. The consumer’s ability to completely discontinue therapy with Xanax after long-term use has not been reliably determined. Reassure him you understand the risks. Promise to inform him immediately of any changes that may accompany this increase, then break this promise the first chance you get.
This medication may cause withdrawal reactions, especially if it has been used for a long time or in high doses. Do not stop taking it. In such cases, withdrawal symptoms may occur if you suddenly stop using this medication. Again, do not stop taking it. To prevent withdrawal reactions, your doctor may reduce your dose gradually. To prevent this from happening, do not report any withdrawal reactions. Most importantly, do not, under any circumstances, tell your doctor if your condition persists or worsens.
Drug Abuse and Dependence:
If you do not take this medication exactly as prescribed, the risk of addiction increases. Along with its benefits, this medication may cause drug-seeking behavior (addiction). If you detect apprehension in your doctor’s voice when you call in for a new prescription and doubt your ability to sit politely through another appointment without demanding he hurry up and write the damn script already so you can be on your way, then it may be time for you to consider new options. Begin with the medicine cabinets in your neighborhood. Try wangling an invitation to tea from the old Swedish woman across the street. Listen to her story about her recent hospital stay, and all the pills they sent home with her, amber bottles of who-knows-what-they’re-for. Then, after a few cups of tea, pick up your purse and ask if you may use the bathroom to powder your nose.
The neighborhood busybody’s Yorkshire terrier (off leash, by the way) was attacked and killed by a mangy German Shepherd, and she tells you she’s having a hard time sleeping because of this. Say you understand, and suggest she see her doctor. (Do not share your medication with others. It is both against the law and defeats the very purpose of this conversation.) Later, when you drop by to check on her, say yes, you’d love to see the dog’s photo album. This is your window of opportunity. Once she starts blubbering, wander the house “in search of tissues.”
When the neighborhood is tapped out, move on to the streets, which is a more promising territory anyway. Memorize the slang names before you go on the hunt. Zanies. Zanbars. Handlebars. Totem Poles. Planks. Leave your good jewelry at home. Wear all-black, a baseball cap, and sunglasses, chic yet intimidating.
Remember that your doctor has prescribed this medication because he believes the benefit to you is greater than the risk of side effects. You have no reason to doubt those expectations. Though some women manage menopause with diet and exercise, or take hormones to balance the mood swings, hot flashes, and loss of sleep, do not stop taking this medication. Many people using this medication do not experience serious side effects. This could be you.
Lori White earned her MFA in Creative Writing from Antioch University Los Angeles. Recent work has appeared in The Journal, Superstition Review, Pithead Chapel, and Sequestrum. Her story, “Gambling One Ridge Away” won first place in the 2013 Press 53 Open Award for Flash Fiction. She teaches English composition at Los Angeles Pierce College and Oxnard College.