Dr. Peter Breggin: Xanax Facts and Whitney Houston
Often when I think about how much I love my wife, Ginger, I wish I could sing to her. But I cannot sing. Instead, I imagine Whitney Houston singing to Ginger in her incredible soaring voice. Whitney became the voice expressing how much I love my wife. That is how much Whitney came to mean to so many of us who knew her only through her music. She became the music about love we carry in our hearts.
Whitney's passing has raised the specter that she was taking the benzodiazepine Xanax (alprazolam) at the time she died.
If it turns out that Whitney was under the influence of Xanax (alprazolam), then there's a good chance she would be alive today if that drug had never been put on the market.
Although Xanax is the most commonly prescribed benzodiazepine, and in my experience the most dangerous, the same harmful effects can be caused by all benzodiazepines, including Valium, Ativan, Klonopin, Serax, Halcion, Dalmane, and Halcion. When I address Xanax, I'm also talking about all of these drugs.
Reports that Xanax and other benzos are not usually lethal when taken alone are vastly misleading. Xanax is rarely taken alone. Why? Because as much or more than any other prescribed drug, Xanax causes medication spellbinding. It corrupts judgment, memory and self-control, so that individuals have no idea how badly they are being impaired. Eventually it erodes all mental faculties, often without the person fully grasping this loss of function. The impairment of judgment and self-control causes people to overdose on drugs or alcohol without intending to, leading to coma, cardiovascular collapse and death. The Xanax-induced memory impairment causes them to forget how many pills or how much alcohol they have already taken, again increasing the lethal risk.
Xanax has been called "alcohol in a pill" because its effects are so similar to alcohol. However, as will be documented, Xanax can be far more dangerous than alcohol. It should not be prescribed to patients with alcohol problems, because it becomes a powerful impetus for alcohol abuse.
At critical moments in their lives when individuals are suffering from serious emotional problems, their ability to deal with them is further compromised as a result of Xanax-induced medication spellbinding and cognitive deficits. In acute distress, they often have no idea what is happening to them. They have no idea how impaired they have become, they forget what they've already taken, or increase the dose, or increase or add other medications or alcohol.
This cannot be over-emphasized: Benzodiazepines, including the worst offender Xanax, can change people so that they become no longer rational, responsible or aware of the consequences of their behavior. Whether or not Xanax intoxication specifically causes death in these cases, Xanax-induced mental dysfunction contributes to the death.
Because the benzodiazepines so seriously impair judgment and other cognitive functions, it is often impossible to determine if a death was intentional or accidental, and as a result, we may never know in Whitney's case. News coverage saying that a loud sound like a falling body was heard from the room above her may indicate that she unexpectedly and unintentionally collapsed.
Even in the short run, Xanax often makes people worse than they were before starting the drug. As I first documented in Toxic Psychiatry (1991, pp. 252-254), the original studies for panic disorder showed that at 8-10 weeks of exposure the patients were more phobic, more anxious, and had a 350 percent increase in the panic attacks for which they were being treated. Upjohn, the manufacturer, promoted the first four weeks of the study without indicating that patients were worse than ever at eight weeks. When these studies for panic disorder were published in the AMA Archives of General Psychiatry, the editor-in-chief, himself on the Upjohn payroll, permitted the misleading research to be published without comment.
Eventually, after much delay, the FDA required some of the negative data to be included in the FDA-approved label for Xanax. Perhaps because the label had become rather ominous, Upjohn has stopped putting Xanax in the most commonly used reference for prescribers, The Physicians' Desk Reference. As a result, many or most prescribers will be using the drug on the basis of their recollection of much weaker labels from the past. To make it readily available, I've put the 2011 Xanax label up at www.ToxicPsychiatry.com. This version of the label is for the extended release or long-acting version, called Xanax XR, because this label contains the latest FDA-mandated upgrades. All page number citations in this blog are to this Xanax XR label.
Reports that Xanax only causes abuse and dependence (addiction) in addiction-prone patients are very false and extremely misleading. The 2011 label for Xanax XR states:
Some patients may find it very difficult to discontinue treatment with XANAX XR due to severe emotional and physical dependence. Discontinuation symptoms, including possible seizures, may occur following discontinuation from any dose... P. 10
While the severity and incidence of withdrawal phenomena appear to be related to dose and duration of treatment, withdrawal symptoms, including seizures, have been reported after only brief therapy with alprazolam at doses within the recommended range for the treatment of anxiety (eg, 0.75 to 4 mg/day). Pp. 18-19
Notice that "after only brief therapy" in the "recommended" dose range Xanax can cause withdrawal symptoms. Withdrawal symptoms are often the initiating factor in future abuse and addiction, including the abuse of alcohol.
After the short several-week trials used for FDA approval, many patients were simply unable to stop taking the drug. That is, they were already addicted! In various studies, the number unable to withdraw ranged from a low of 7 percent to a high of 29 percent (p. 6).
Why do so many patients have to stay on the drug after such short-term exposure? Withdrawal symptoms for Xanax and other benzos are far worse than a mere "craving" that an individual might hope to control. The person doesn't "crave" the drug; the person needs the drug to end the agony of withdrawal.
Withdrawal reactions typically include overwhelming anxiety and panic, as well as insomnia, far worse than the individual has ever before experienced. Irritability can grow into uncontrollable anger and even violence. Muscle spasms, painful feelings in the extremities, painfully-heightened awareness of diminished mental faculties, confusion, depression, suicidality, paranoia, hallucinations, and myriad other unforeseen symptoms can demoralize and terrify the individual.
Withdrawal from Xanax can become far worse than withdrawal from morphine, hydrocodone, oxycodone, and heroin, and require weeks in rehab or months in outpatient practice (See my medical text, Brain-Disabling Treatments in Psychiatry, Second Edition, Chapter 12). Benzodiazepine withdrawal should never be taken lightly and should be conducted with experienced clinical supervision, sometimes including hospitalization.
Xanax is so short-acting and potent that it is especially liable to cause interdose withdrawal in between doses (p. 7). A person taking Xanax at bedtime can wake up in withdrawal in the early morning and mistakenly attribute it to "anxiety." After the first pill in the morning, this same person can go into withdrawal a few hours later, again mistakenly believing that it's "anxiety."
As I describe in my book Medication Madness, Xanax is the benzo most likely to cause abnormal behavior, including violence and suicide. It is the drug I have most commonly found in association with SSRI antidepressants like Paxil and Zoloft in a number of legal cases involving SSRI-induced violence, suicide, and manic-like crime. These are really SSRI/Xanax induced tragedies. Xanax is the only benzo whose FDA-approved label warns about the risk of causing mania (p. 9).
Again according to the official label, "As with all benzodiazepines, paradoxical reactions such as stimulation, increased muscle spasticity, sleep disturbances, hallucinations, and other adverse behavioral effects such as agitation, rage, irritability, and aggressive or hostile behavior have been reported rarely" (p. 17).
There's one last issue that is painful to bring up. As I describe in Brain-Disabling Treatments in Psychiatry, Second Edition (2008), I have treated and evaluated many patients whose mental faculties have never fully returned after years or decades of exposure to Xanax. They suffer from what I have described as drug-induced Chronic Brain Impairment (CBI).
If you are currently taking this drug, seek help for a careful, slow withdrawal. It's not only dangerous to start Xanax, it's dangerous to stop it. If you have already stopped the drug and fear that you have lasting effects, remember that the spirit can triumph over almost any impediment, even harm to the brain. Also, recovery from drug-induced brain injury can take place gradually over many years, so keep up your hope. Stay drug free, live healthy, and make the most of your life -- while avoiding all psychoactive substances as much as possible.
Believe nothing about the safety of Xanax! If it turns out that the drug played a role in taking away our Whitney, it is one more demonstration of why this drug should never have been put on the market.
Join Dr. Breggin and other prestigious speakers, April 13-15, 2012 in Syracuse, New York. The annual conference of Dr. Breggin's 501c3 nonprofit international organization, The Center for the Study of Empathic Therapy, will present information and inspiration about the key issues in psychiatric reform today. Conference information is available at www.EmpathicTherapy.org. Peter R. Breggin, M.D. is a Harvard-trained psychiatrist and former full-time consultant with NIMH who is in private practice in Ithaca, New York. Dr. Breggin is the author of more than twenty books including the bestseller Talking Back to Prozac and the medical book Brain-Disabling Treatments in Psychiatry, Second Edition. His most recent book is Medication Madness, the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime. He is also the author of dozens of peer-reviewed scientific articles, many in the field of psychopharmacology.
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