Anxiety symptoms sometimes become severe enough to disrupt your daily routine, keep you from doing the things you want to do, and affect your general well-being. If that’s the case for you, a healthcare professional might recommend benzodiazepines as an occasional or short-term treatment.
In the cast of anti-anxiety medications, benzodiazepines, like alprazolam (Xanax), take a major role. These sedatives can help calm feelings of panic and worry, leaving you more relaxed.
But they primarily ease physical symptoms, including:
Plus, since they work quickly, many people find them to be effective at relieving severe anxiety. But like most powerful tools, benzodiazepines require a good dose of caution. Long-term or regular use can cause some significant side effects and increase your risk for dependence or addiction.
Stopping benzodiazepines suddenly comes with another risk: rebound anxiety.
Rebound anxiety happens when you stop taking the medication and your symptoms return, often with greater intensity than before you started taking it. Often, this rebound mainly involves physical symptoms, but you could also notice increased feelings of worry, irritability, and fear.
Read on to learn more about why rebound anxiety happens and how to manage it.
In order to understand why rebound anxiety happens, it helps to know more about what benzodiazepines do.
This family of medications works by binding to gamma aminobutyric acid (GABA) receptors in your brain. GABA, an amino acid, acts as a chemical messenger by slowing down activity in your brain and central nervous system.
When you feel anxious, stressed, or afraid, GABA can help block brain signaling of these emotions, so you feel calmer and more physically relaxed. GABA also plays an important part in helping you get the sleep you need.
What if anxiety, stress, or panic attacks have a major impact on your ability to take care of daily responsibilities or self-care, like working, running errands, or even sleeping?
That’s where benzodiazepines come in. By binding to GABA receptors, they boost GABA activity in your brain and help the chemical work more efficiently, easing anxiety, panic, and sleeplessness in the process.
You’ll typically begin to notice relief, including reduced muscle tension and greater calm, fairly quickly.
Yet benzodiazepines have one key drawback: Your brain learns to tolerate them rapidly.
For some people, dependence can happen in just a matter of weeks of regular use. When you stop taking them abruptly — withdrawing their helping hand, so to speak — GABA receptors in your brain might find it difficult to do the same job on their own.
Long-term use can also cut down on the number of binding sites, older research suggests. The remaining sites, then, take longer to bind and synthesize GABA molecules, which can leave you with heightened feelings of anxiety or panic.
Rebound anxiety is mostly linked with benzodiazepines. It can happen when reducing your dose too quickly, or quitting them entirely after taking them for longer than a few weeks.
Still, these medications won’t always have a rebound effect. Rebound anxiety is more likely to happen with short-acting or intermediate-acting benzodiazepines — in other words, those with a shorter half-life.
Half-life refers to the amount of time it takes your body to absorb and process a given medication. Benzodiazepines with short and intermediate half-lives leave your system sooner and carry a higher risk of rebound anxiety and withdrawal.
These include, among others:
Longer-acting benzodiazepines are less likely to cause rebound anxiety. These include, among others:
It’s not uncommon to have feelings of tension, worry, and stress after drinking.
“Hangxiety,” or hangover anxiety, as it’s often called, can happen to anyone. But these symptoms might resemble a type of rebound if you were originally drinking in order to help reduce anxiety.
Plenty of people use alcohol to cope with anxiety, especially in social settings. And in small amounts, alcohol often can help temporarily relieve anxiety.
Like benzodiazepines, alcohol can act on GABA receptors and prompt the release of GABA in your brain. That’s why you might feel calm, even a little sleepy, when you drink.
But alcohol affects other chemical messengers, too, including dopamine, serotonin, and glutamate. Alcohol’s interactions with these systems can easily affect mood and sleep.
Keep in mind, too, that alcohol (unlike benzodiazepines) isn’t an approved treatment for anxiety. Over time, in fact, alcohol can worsen your symptoms — but this isn’t quite the same thing as rebound anxiety.
Symptoms of rebound anxiety tend to appear fairly quickly, often within 24 hours of your last dose of benzodiazepines.
Still, existing evidence doesn’t outline any specific timeline for rebound anxiety. It can last anywhere from a few days to several months or more, depending on a number of factors.
Research from 2005 suggested a few potential factors that can affect how long symptoms last and how severe they become:
Some experts describe rebound anxiety as a milder form of withdrawal. Other older research suggested it’s just one possible pattern of benzodiazepine withdrawal.
You could also experience rebound anxiety before withdrawal. The rebound itself may last just a few days. Soon afterward, though, you could begin to have other symptoms of withdrawal, followed by a return of anxiety symptoms.
Your doctor or psychiatrist will usually try to help you avoid experiencing rebound anxiety in the first place by recommending a slow taper off benzodiazepines.
Another prevention strategy involves switching to a longer acting medication, such as diazepam, before beginning the tapering process.
Your prescriber may also recommend starting a different anti-anxiety medication, such as buspirone (BuSpar) before beginning the tapering process.
Limited evidence suggests certain anticonvulsant and antidepressant medications could help reduce withdrawal symptoms during the tapering process.
Keep in mind that you could still experience some rebound anxiety, even with a successful taper. Older research suggested, though, that any rebound anxiety you experience after tapering tends to ease within a few days.
Therapy for anxiety remains one of the most effective approaches for managing and treating rebound anxiety.
For one, it’s not always easy to recognize what’s going on during tapering. Has your anxiety returned? Or is it withdrawal or rebound? It can take a few weeks to recognize the pattern of your symptoms, but support from a trained professional can make a big difference.
When rebounding anxiety symptoms stick around, a therapist can teach helpful coping strategies and offer more guidance on potential treatments, including other medication options.
These might include specific therapy approaches, like:
Or alternative treatments, like:
Check out our guide to finding the right therapist.
Other coping strategies and lifestyle changes can go a long way toward improving anxiety symptoms.
There’s no denying anxiety can get in the way of a good night’s sleep.
Getting some sunlight during the day, going to bed and waking up at the same time each day, and practicing other healthy sleep hygiene habits can help.
Physical activity can help relieve stress and promote better sleep, but it can also make a big difference for symptoms of anxiety and depression.
Even less strenuous movement, like yoga, can have benefit for anxiety symptoms. Aim for around 2 and a half hours of activity each week, if possible.
Tip: Take your exercise outside to reap the benefits of nature.
Making time to unwind each day might not always seem possible, but it’s an important aspect of self-care.
Taking a few minutes to sit with your thoughts, read a book, write in your journal, or simply daydream about a trip you’d like to take can help you feel less stressed. But building half an hour (at least) that’s yours and yours alone into each day can pay off even more over time.
Feelings of anxiety that surface throughout the day may feel more bearable when you know that, soon enough, the day will end, and you’ll have the chance to catch up with friends over a gaming session, take a long scented soak in the tub, or have some quality Netflix time.
Certain supplements, including magnesium, saffron, vitamin D, and chamomile, among others, could help lessen anxiety symptoms.
Along with trying supplements, it might also help to:
If your anxiety symptoms make it hard to eat or prepare meals, just remember that eating any food is better than eating no food.
Rebound anxiety isn’t an automatic given when you stop taking benzodiazepines, but the possibility exists. Working with your doctor or psychiatrist to gradually reduce your dose can help lower your risk.
Still, even if you taper off medication successfully, anxiety can easily come back — especially if you haven’t addressed the underlying triggers provoking your symptoms.
At the end of the day, working with a therapist to address the root causes of anxiety is usually the best option for long lasting relief.
Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.
Last medically reviewed on September 26, 2021