Benzodiazepines and the Quiet Crisis in Mental Health Care

As a psychiatrist, there is a topic I have wanted to write about for some time: the widespread and long-term use of benzodiazepines. Medications like Xanax, Ativan, Valium, and Klonopin were originally designed for short-term use, meant to ease severe anxiety or panic attacks over a limited period. But in practice, they are often prescribed indefinitely. Many patients stay on them for years, even decades. What begins as a short-term solution can evolve into long-term dependency, and we are only now beginning to fully grasp the consequences.

Recently, this issue has started gaining public awareness. The New York Times has published important articles about the risks of benzodiazepines, including a 2025 piece detailing the severe and prolonged symptoms that can follow withdrawal. The Netflix documentary Take Your Pills: Xanax offers a compelling look at how these medications have become both a cultural phenomenon and a medical concern, revealing just how deeply ingrained they are in American life.

Originally Intended for Short-Term Use but Now Commonly Prescribed for the Long Haul

Benzodiazepines are remarkably effective at relieving anxiety. They act quickly and can provide a profound sense of relief for someone in distress. But I routinely encounter patients who have been taking them multiple times a day for many years. Sometimes, the original reason for starting the medication is long forgotten. The medication has simply become part of daily life.

Many patients tell me, “It’s the only thing that works,” or “When I take it, I finally feel normal.” This sense of normalcy and the feeling of being free from the constant undercurrent of anxiety is deeply meaningful. But over time, the medication becomes less about occasional relief and more about preventing a constant return of discomfort.

One patient I worked with had been prescribed Ativan three times a day. She described waking up every morning in what felt like a mini-panic attack. Her heart raced, her body trembled, and she was gripped by dread until she took her morning dose. The long overnight gap between her evening and morning pills was triggering a form of withdrawal that forced her to start each day in crisis.

A Vicious Cycle of Relief Followed by Rebound Anxiety

Benzodiazepines work by enhancing the effect of GABA, a neurotransmitter that calms the nervous system. Over time, the brain adapts by reducing its own GABA production, making a person increasingly reliant on the medication. The result is a cycle in which anxiety returns quickly and with greater intensity between doses. This prompts another pill, which further deepens the dependence. The line between symptom relief and symptom maintenance becomes increasingly blurred.

From Cultural Icon to Drug of Abuse

The presence of benzodiazepines in popular culture has further cemented their complex role. In the most recent season of The White Lotus, the use of benzos is portrayed as part of the psychological coping tools of the wealthy and anxious. This illustrates how normalized these medications have become in society. But the reality is more dangerous. Benzodiazepines, especially Xanax, are among the most commonly abused prescription drugs. Many are obtained illicitly and taken recreationally.

These street pills are often what are called pressed pills. They are counterfeit tablets that look like the real thing but may contain dangerous contaminants, including fentanyl. When patients are suddenly cut off from a legal prescription, the risk comes not only from life-threatening withdrawal symptoms like seizures but also from the dangers of turning to these illicit alternatives.

The Patient Experience Is Often Misunderstood

One of the most heartbreaking aspects of this epidemic is how it affects patients who are simply trying to feel better. Many fear being labeled as seeking drugs even when they are asking for reasonable and appropriate treatment. They want relief, not a high. But the stigma around benzodiazepines can make it difficult to advocate for oneself without shame or suspicion.

This stigma is not limited to patients. Within the medical community, we are seeing a pendulum swing. In the past, benzodiazepines were often overprescribed with little oversight. Now, many physicians are afraid to prescribe them at all, even when they are clinically indicated. This includes situations such as a short-term course for acute anxiety or the use of a benzodiazepine as part of a slow and medically supervised taper after chronic use. Although this hesitation may come from a well-intentioned place, it can leave patients stranded. They may be forced into abrupt discontinuation or denied a carefully managed path to recovery.

Long-Term Risks Cannot Be Ignored

We now have ample evidence that long-term benzodiazepine use is not without harm. These medications are associated with memory problems and are an independent risk factor for dementia. In older adults, they increase the risk of falls, which can lead to devastating injuries. They impair cognitive functioning, reduce emotional resilience, and can dull a person’s ability to respond to stress in healthier ways.

The most dangerous aspect, however, may be the withdrawal. Benzodiazepine withdrawal can be life-threatening, particularly if stopped abruptly. Even with a slow taper, patients often describe prolonged symptoms including intense anxiety, insomnia, agitation, and a feeling of being emotionally raw. These effects can last for weeks or even months. The nervous system, having become reliant on chemical sedation, struggles to find its balance again.

Toward More Compassionate and Informed Care

This is not a call to ban benzodiazepines. They can be life-changing when used appropriately. But the casual and long-term use of these medications has become a silent epidemic. It is time we take it seriously.

We need better education for both prescribers and patients about when and how these medications should be used. We need tapering protocols that are not only safe but humane. We need to listen to patients when they say they are afraid to stop or afraid to continue. And we need to make room for a more nuanced understanding of what medication dependence looks like, without shame or oversimplification.

If you or someone you care about is taking benzodiazepines long-term, know this: you are not alone. Your experience is valid. There are options. And you deserve a plan for relief that goes beyond survival and helps you build a path toward true wellness.