This drug has boxed warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

  • Taking benzodiazepines with opioid drugs increases your risk for severe sleepiness, respiratory depression, coma, and even death. Xanax shouldn’t be taken with an opioid unless there are no other available treatment options.
  • Using benzodiazepines, even as prescribed, can lead to physical dependence and withdrawal if you stop taking the drug suddenly. Withdrawal can be life threatening.
  • Taking this drug can also lead to misuse and addiction. Misuse of Xanax increases your risk of overdose and death.
  • Only take this drug as your doctor prescribes. Talk with your healthcare provider if you have any concerns about safely taking this drug.

Xanax is a medication that is approved by the Food and Drug Administration (FDA) to treat anxiety and panic disorders.

Xanax, which is the brand name for the generic drug alprazolam, isn’t usually used to treat depression because there are several newer and safer medications available.

Occasionally, however, it may be prescribed by a doctor as an “off-label” treatment for depression. As far back as the 1990s, Xanax has been shown in clinical studies to help treat major depressive disorder when prescribed in double the dosage used for anxiety relief for a short period of time.

Despite this, the use of Xanax in depression is controversial. This is because Xanax is considered highly addictive when used at higher doses or for a long period of time (more than 12 weeks).

Xanax has even been shown to cause depression in some people due to its sedative properties and to make depression worse in people who are already depressed.

Xanax is in a class of drugs called benzodiazepines. Benzodiazepines are mild tranquilizers that work by slowing down the brain and central nervous system (CNS). By slowing down the CNS, Xanax helps to relax the body, which in turn reduces anxiety. It also helps people sleep.

Like most drugs, Xanax carries a risk of several side effects. Usually, these side effects occur at the beginning of therapy and go away over time.

Side effects of xanax

The most common side effects of Xanax include:

  • drowsiness
  • light-headedness
  • depression
  • lack of enthusiasm
  • headache
  • confusion
  • sleep problems (insomnia)
  • nervousness
  • sleepiness
  • dry mouth
  • constipation
  • diarrhea
  • nausea and vomiting
  • palpitations
  • blurred vision
  • muscle twitching
  • weight changes

Since Xanax has CNS depressant effects and can impair your motor skills, you should not operate heavy machinery or drive a motor vehicle while taking Xanax.

Xanax side effects in people with depression

Episodes of hypomania and mania (increase in activity and talking) have been reported in people with depression taking Xanax.

If you have preexisting depression, alprazolam can make your depression symptoms worse. Call your doctor right away If your depression gets worse or you have suicidal thoughts while taking Xanax.

Risk of dependence

Long-term use of Xanax carries a high risk of physical and emotional dependence. Dependence means that you need more and more of the substance to achieve the same effect (tolerance).

You also experience mental and physical side effects (withdrawal) if you abruptly stop taking the drug.

For this reason, Xanax classified as a federal controlled substance (C-IV).

The risk of dependence is highest in people treated with doses greater than 4 milligrams/day and for those taking Xanax for more than 12 weeks.

Suddenly stopping Xanax can lead to dangerous withdrawal symptoms. These include:

  • muscle cramps
  • vomiting
  • aggression
  • mood swings
  • depression
  • headaches
  • sweating
  • tremors
  • seizures

Don’t stop taking Xanax abruptly or decrease the dose without consulting your doctor first. When you or your doctor decides it’s time to stop taking Xanax, you’ll need to gradually reduce (taper) your dose over time to avoid withdrawal symptoms.

Xanax can be beneficial for people with anxiety or panic disorders.

Generalized anxiety disorder is characterized by excessive or unwarranted anxiety and worry for a period of at least six months. Panic disorder is described by recurrent unexpected periods of intense fear, also known as a panic attack.

During a panic attack, a person will usually have a pounding or racing heart, sweating, trembling, shortness of breath, a choking feeling, dizziness, fear, and other symptoms.

In clinical trials, Xanax was shown to be better than a placebo in improving anxiety symptoms in people with anxiety or anxiety with depression. For panic disorders, clinical studies found that Xanax significantly reduced the number of panic attacks experienced per week.

It isn’t known if Xanax is safe and effective when used to treat anxiety disorder for longer than 4 months or to treat panic disorder for longer than 10 weeks.

Some studies have found that Xanax to be just as effective as several other antidepressants, including amitriptyline, clomipramine, and imipramine, for the treatment of moderate depression, but not for severe depression.

However, these studies only addressed short-term effects (up to six weeks) and were considered “poor quality” in a review published in 2012. It was also not clear if the effects of Xanax was due to an actual antidepressant effect or rather a general positive effect on anxiety and sleep issues.

With the arrival of newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), the number of clinical trials evaluating Xanax in depression has significantly decreased. There have been no clinical trials directly comparing Xanax to SSRIs or other newer antidepressants for treating depression.

Benzodiazepines are central nervous system depressants. One of the most common side effects of Xanax is depression, including feelings of sadness, hopelessness, and loss of interest. If you’re already depressed or have a history of depression, Xanax can actually make your depression worse.

See a doctor right away if your depression worsens or you are having thoughts of suicide while taking Xanax.

Xanax has the potential to interact with many other medications:

  • Opioid pain medications: Xanax shouldn’t be taken in conjunction with opioid pain medications due to the risk of profound sedation, respiratory depression, coma, and death.
  • Other CNS depressants: Using Xanax with other medications that provide sedation, like antihistamines, anticonvulsants, and alcohol could result in additive CNS depressant effects. This can cause severe drowsiness, breathing problems (respiratory depression), coma and death.
  • Cytochrome P450 3A inhibitors: Xanax is removed by the body through a pathway known as cytochrome P450 3A (CYP3A). Drugs that block this pathway make it harder for your body to eliminate Xanax. This means that the effects of Xanax will last longer. Examples of cytochrome P450 3A inhibitors include:
    • azole antifungal drugs, such as itraconazole or ketoconazole
    • the antidepressants fluvoxamine and nefazodone
    • macrolide antibiotics such as erythromycin and clarithromycin
    • grapefruit juice
    • birth control pills
    • cimetidine (Tagamet), which is used to treat heartburn

Like Xanax, alcohol is a central nervous system depressant. Drinking alcohol while taking Xanax can lead to dangerous can result in severe drowsiness, respiratory depression, coma and death.

Xanax isn’t usually prescribed for treating depression. It may make depression worse in people who have a history of depression. If you have anxiety that is linked to depression, Xanax may be able to help with both conditions on a temporary basis.

However, due to the risk of physical and emotional dependence, abuse, and withdrawal, Xanax shouldn’t be used for a long period of time.

Before taking Xanax, tell your doctor if you have a history of depression, suicidal thoughts, alcoholism, a history of drug addiction, or if you’re taking any other medications. If you’re already taking Xanax, don’t hesitate to tell your doctor if you start to experience any of the symptoms of depression.