Anxiety is a natural part of being human. Most of us feel anxious to some degree at some point during our lives. But for some people, anxiety can be all-encompassing and overwhelming, notes the American Psychological Association. People struggling with an anxiety disorder often experience recurring and intrusive thoughts. Anxiety can even affect them physically and hinder their ability to cope with challenging situations and day-to-day responsibilities.
There’s been an increase in the number of people taking prescription medication for anxiety, reports the British Journal of General Practice, particularly among those under the age of 25. For these individuals, anti-anxiety medication (also referred to as anxiolytics) may feel like a sigh of relief. It can help them keep their heads above water in order to function and get through difficult moments that might otherwise feel unbearable. While drugs won’t cure anxiety, they can help some people manage and ease its symptoms.
There are various types of medications available for people with anxiety, ranging from antidepressants to benzodiazepines to beta blockers. Despite their uplifting effects on mood, some drugs can have a less desirable impact on your physical and mental health in the long term. Since each person is different, anti-anxiety medication affects each individual differently. Whether you decide to take the pharmacological or therapeutic route, it’s important to do a bit of research and find an approach that’s right for you. Here are some things that go on in your body when you swallow that anxiety-busting pill.
Your heart rate and breathing slow down
One of the ways in which benzodiazepines help relieve anxiety is by slowing down your breathing and heart rate (via Journal of the American Heart Association). They have a sedating effect on your central nervous system, which controls most of your bodily functions, including respiration and heart rate.
Benzodiazepines work by increasing the effects of gamma-aminobutyric acid (GABA) –- known as the brain’s "calming" neurotransmitter (via Frontiers in Pharmacology). GABA blocks impulses between nerve cells in the brain. This is why benzos generally have hypnotic and amnesia-inducing effects (via Journal of the American Heart Association). They can make you feel relaxed and drowsy, and are often used to treat insomnia, which is described as "hyperarousal" of the central nervous system.
Excessive use of benzodiazepines, however, can slow down vital functions like respiration to the point where your muscles and organs are not able to get enough oxygen. This can lead to all sorts of life-threatening complications such as heart failure, and it can even result in cardiac death.
Your heart rate may soar
In contrast to their usual depressant effects, benzodiazepines can also elevate your heart rate. According to a study published in Pharmacology, it’s not uncommon for benzodiazepine users to have their heart rate shoot up both during the night and in the early morning hours. This might explain why benzos can provide short-term relief for anxiety and insomnia, but they often have paradoxical effects of worsening both mood and sleep in the long-term (via Journal of Clinical Medicine).
A spike in anxiety and sleeplessness are common withdrawal symptoms in people who have been using benzodiazepines chronically, also known as a "rebound effect." When someone abruptly stops taking benzodiazepines after a long period of time, their central nervous system is no longer being suppressed. So it becomes over excited as it attempts to restore balance when the inhibition is suddenly taken away. This can lead to an increase in heart rate, especially if the drug was previously taken in high doses. Some people may notice a rise in impulsivity, irritability, and agitation, while a few may even experience paranoia, panic attacks, and hallucinations.
It changes your serotonin and dopamine levels
Some anti-anxiety drugs work their magic by improving your mood and making you feel uplifted. For example, buspirone affects your levels of serotonin and dopamine, namely your brain’s main "feel-good" neurotransmitters (via Brain Research). Buspirone functions as a partial serotonin agonist: It increases the activity of serotonin receptors by binding to and stimulating the 5HT1A receptor. It also antagonizes (blocks) dopamine receptors to a lesser degree, increasing the availability of dopamine in the brain. This is how buspirone is thought to help you feel better when stress and anxiety come crashing down.
The anxiolytic is commonly prescribed to alleviate the symptoms of generalized anxiety disorder (GAD), such as fear, tension, and a racing heart. Since it doesn’t act on the GABA receptors, buspirone lacks the hypnotic and muscle-relaxant properties of benzos, notes a 2022 study published in Drug Design, Development and Therapy. Therefore, a chemical dependence and withdrawal symptoms are far less prevalent with buspirone than with benzos or barbiturates.
In addition to treating GAD, buspirone has been used to manage the symptoms of various neurological and psychiatric disorders, such as Parkinson’s disease, attention deficit disorders, and depression (via Brain Research). There’s evidence that it might be helpful in treating the behavioral disturbances often seen in people with dementia, autism spectrum disorder, and chronic schizophrenia (via Drug Design, Development and Therapy).
You may experience sexual dysfunction
Selective serotonin reuptake inhibitors (SSRIs) are sometimes used to help manage anxiety (via Current Psychiatry Reports). Like buspirone, these meds work on serotonin in your brain. In particular, they block the reabsorption of serotonin into neurons. So, when you take an SSRI, serotonin is available in your system for longer. The neurotransmitter can help you feel calmer and happier, according to the Anxiety & Depression Association of America, as well as regulating a number of important bodily functions, such as sleep, arousal, memory, digestion, and circulation. SSRIs are often said to help dampen anxious thoughts, preventing them from escalating.
One of the downsides of antidepressants like SSRIs is that you may experience some unwanted side effects, especially when you first start taking them. Since serotonin plays an important role in regulating sexual behavior, it’s not surprising that antidepressants can cause sexual problems (via Current Sexual Health Reports). This affects people in different ways, but some commonly reported issues include difficulty reaching an orgasm, reduced sexual desire, and an inability to get and maintain an erection.
Your muscles relax
As well as being used as an anti-anxiety and sleep aid medication, benzodiazepines are commonly prescribed as a muscle relaxant (via BMJ). They help treat twitching or aching muscles, and are used to relieve skeletal muscle spasms caused by an injury or a neurologic disorder such as spinal cord injury and cerebral palsy (via Pharmacy and Therapeutics). They’ve been shown to be particularly effective in soothing low back pain. They can also help your muscles go to sleep during medical and surgical procedures.
Similar to how they work as a sedative, benzodiazepines exert their muscle relaxant effects by acting on the GABA receptors in the brain (via Molecular Psychiatry). By increasing the inhibitory effects of GABA, benzos decrease the excitability of nerve cells and lessen their ability to exchange chemical messages. By reducing chemical signaling, GABA can also temporarily reduce the pain and tension in your muscles.
However, benzodiazepines can also negatively impact your muscles (via benzo.org.uk). Withdrawing from these drugs after prolonged use can cause muscle stiffness and pain, as well as twitches and tics that feel like "electric shocks." People may experience sudden muscle jerks, known as myoclonus, as they are about to drift off to sleep. This can happen when your muscles unexpectedly tighten or contract. Although these symptoms are usually temporary, lasting only a few weeks or months, they can be unsettling and uncomfortable.
Your brain can develop a dependency
Many anti-anxiety medications like benzodiazepines are only meant to be used for short-term treatment of anxiety, notes the National Health Service (NHS). This is because drugs that act on the GABA receptors can be habit-forming when used chronically (via Frontiers in Pharmacology). Over time, your brain develops a tolerance to the sedative effects of benzodiazepines, causing you to become dependent on it. A person forms an addiction when their brain and body adapt to regular exposure to these drugs. So, when they don’t maintain the level of consumption they’ve gotten used to, they’re suddenly struck by a storm of withdrawal symptoms.
Benzodiazepines shouldn’t be used for more than six months, say most researchers (via Australian Prescriber). Anyone who’s been taking them for more than three weeks is likely to experience some withdrawal symptoms when they stop. This may include headaches, sweating, and heart palpitations, but more often than not, people return to their previous problems like insomnia and anxiety. Yet, some people become so reliant on their anti-anxiety meds that they have a hard time functioning with them, even where continued use is taking a massive toll on their physical and mental wellbeing. The avoidance of withdrawal symptoms can keep people locked in a vicious cycle of addiction (via Frontiers in Pharmacology).
If you or anyone you know is struggling with addiction issues, help is available. Visit the Substance Abuse and Mental Health Services Administration website or contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).
REM sleep is delayed
Anti-anxiety drugs are often used to promote restful sleep (via Journal of Clinical Medicine). Due to their hypnotic effects, medications like benzodiazepines can help you fall into slumber quicker. Interestingly, though, they can also mess with the quality and quantity of your sleep if they become a crutch at bedtime. Similar to alcohol, these medications trick your brain and body into thinking that you’re getting a better night’s sleep. But in reality, research shows that benzodiazepines can reduce your sleep time, alter the normal stages of sleep, and disrupt sleep architecture. Although they induce the early stages of sleep, they tend to compromise the deep and restorative stages that occur later on. Albeit, any impairments are usually temporary and sleep parameters go back to normal once you’ve recovered.
Selective Serotonin Reuptake Inhibitors (SSRIs) can also have adverse effects on sleep (via Current Psychiatry Reports). These medications interfere with your sleep-wake cycle, since they suppress and delay the onset of REM (rapid eye movement) sleep, which is believed to play a critical role in memory consolidation (via Neuron). Studies have shown that people who knock back SSRIs on a regular basis generally have shorter, less efficient sleep (via Current Psychiatry Reports). They’re also more likely to grind their teeth and have nightmares while sleeping.
Your blood pressure drops
Benzodiazepines slow down the body’s functions and processes and can make your blood pressure drop significantly (via American Journal of Hypertension). In some cases, this could be a good thing, especially when used in the short term. Research has shown that elevated blood pressure, also known as hypertension, can set off chronic stress and cause high sensitivity to anxiety. A study published in the Journal of Evaluation in Clinical Practice found that people who used a benzodiazepine called alprazolam had a lower risk of cardiovascular issues stemming from hypertension, including heart attacks and strokes.
The research on chronic benzodiazepine use and its effects on blood pressure is sparse (via American Journal of Hypertension). Some studies indicate that long-term consumption may cause persistent low blood pressure, which can be dangerous as it deprives your body and organs of sufficient oxygen. Even moderate forms of low blood pressure can cause unpleasant symptoms like dizziness, nausea, confusion, and fainting (via NHS). In addition to hypotension, regular benzodiazepine use can lead to respiratory depression, which is what happens when the lungs aren’t able to properly exchange oxygen and carbon dioxide, causing a buildup of carbon dioxide in the bloodstream (via Journal of Oral Science).
Excessive use can damage the liver
Like alcohol, many anti-anxiety medications are primarily metabolized in the liver, including benzodiazepines (via PsychDB) and antidepressants (via Archives of Toxicology). While these drugs may not harm the liver as severely as alcohol abuse, they can still take a toll when used excessively over a long period of time, per the Rehab Center. They can be particularly toxic when combined with binge-drinking.
Some studies have found that extensive use of antidepressants may increase your risk of liver injury (via The American Journal of Psychiatry). Likewise, medications like benzodiazepines should be prescribed with caution, say researchers, particularly to those with kidney dysfunction (via Case Reports in Gastroenterology). These meds can result in drug-induced liver injury, though such cases are rare. In the case of a 51 year old man who had used benzodiazepines for five months, liver damage was resolved a couple of months after he stopped taking these drugs and started receiving treatment.
Anti-anxiety medications like Xanax can be detected in your system for up to three months after ingestion, per DrugRehab.com. The bodies of people with chronic liver disease due to past alcohol abuse may find it harder to process these drugs compared to those of healthy individuals.
Some people experience cognitive impairments
Just as it impacts your heart and liver, extensive use of anti-anxiety drugs can wear away at your brain, producing cognitive impairments. Taking benzodiazepines on a regular basis may interfere with your ability to think, reason, and process information, according to a review published in the Journal of Clinical Psychiatry. Patients treated with benzodiazepines for a long period of time were found to have impairments in several cognitive domains including processing speed, visuospatial abilities, and verbal learning abilities.
Visuospatial describes the way someone sees, processes, and understands where objects are in relation to one another (via Dementia & Neuropsychologia). Processing speed is the way we complete simple or previously learned tasks (via CogniFit). This might involve identifying or making a decision about a piece of information. And verbal learning refers to our ability to solve problems, reason, and learn new things through speech and language (via Study.com).
Your memory can deteriorate with long-term use
Anti-anxiety medications can play havoc with your memory, especially when they’re used habitually, per the Rehab Center. Some people may notice gaps in their memory or struggle to recall the details of specific events from their past. An impoverished memory has been linked to the chronic use of hypnotics that act on the GABA receptors in the brain and increase the production of GABA, which is believed to slow down the firing of neurons (via BMJ).
For long-term benzodiazepine users, deficits were mostly observed in their recent memory, working memory, and non-verbal and verbal memory, according to a study from the Archives of Clinical Neuropsychology. In fact, benzos were thought to be the culprit behind a number of neuropsychological impairments ranging from attention issues to language difficulties, some of which were found to linger even after withdrawal had passed. On the other hand, some studies have shown that any memory problems induced by benzodiazepines are usually reversible once these drugs are no longer being used and eventually leave your system (via The American Journal of Psychiatry).
Anti-anxiety drugs may increase the risk of dementia
Given the effect that sedative-hypnotic drugs have on your brain, it’s not surprising that these medications may contribute toward the development of a neurological disorder, say researchers (via CNS Drugs). Benzodiazepines, in particular, have been found to increase the risk of dementia in older adults. A study published in the British Medical Journal (BMJ) found a link between long-term benzodiazepine usage and Alzheimer’s disease, a form of dementia that’s marked by short-term memory loss.
But the idea that benzodiazepines may cause dementia has been questioned (via The American Journal of Psychiatry). Some researchers have suggested that people with Alzheimer’s disease who were involved in these studies may have already had some form of cognitive impairment before they started taking anti-anxiety medications. Other studies have not found any real link between benzodiazepine use and subsequent dementia, even among individuals who have been taking these meds for up to a decade.
On the other hand, benzodiazepines may have neuroprotective effects. Both stress and anxiety elevate cortisol levels, which might play a part in paving the way to cognitive impairment and possibly Alzheimer’s disease. It’s possible, therefore, that low-dose benzodiazepine use helps reduce the negative impact of stress, which in turn lowers a person’s susceptibility to Alzheimer’s. So, while there’s little doubt that benzodiazepines may be associated with mild and reversible cognitive impairments like memory decline, say researchers, the causal relationship between hypnotic drugs and dementia needs more investigation.
Beta blockers can help control heart disease
Beta blockers are a slightly different breed of anti-anxiety medications (via Military Medicine). Unlike benzodiazepines and antidepressants, they’re not typically addictive. Yet, like most other anti-anxiety drugs, they’re only recommended for short-term use to avoid any potential complications.
As their name suggests, beta blockers work by blocking the stress-related hormones norepinephrine and epinephrine from binding to the beta receptors. This causes your heart to beat with less force and speed. As a result, beta blockers encourage your blood vessels to relax, allowing blood to flow more easily through your veins and arteries. This helps relieve some of the physical symptoms of anxiety, such as a racing heart, high blood pressure, and tremors or shaking. Sometimes beta blockers are used prior to a stressful event or feared situation, such as a test or performance, as a preventative strategy.
Since beta blockers make your heart work less hard, they’re often used to treat heart disease, arrhythmias, and hypertension (via Revista Española de Cardiología). Although there are some risks associated with their chronic use, there’s also evidence for the beneficial effects of beta blockers in various cardiovascular conditions. It’s important to note that beta blockers aren’t suitable or effective for everyone, though, so be sure to check with your doctor whether or not they are right for you (via NHS).