What Are ‘Benzos,’ and Do They Work for Anxiety?

Benzodiazepines, also known as “benzos,” are powerful medications that treat anxiety very well. There are many different kinds, and the differences among them are important. But here’s the reality: They’re not always the best first-choice treatment when it comes to anxiety. Although they work well, they carry some serious risks. 

Read on for more information about benzodiazepines. We’ll cover what they are, how they work, and the pros and cons of using them to help with anxiety symptoms.

What is anxiety?

For most people, anxiety is a normal response to life’s ups and downs. These feelings serve to protect you from threatening situations. But, sometimes, these feelings of fear and dread can take over your life and prevent you from living how you want to. When this happens, it could be a sign that you have an anxiety disorder, like generalized anxiety disorder (GAD), social anxiety disorder, or panic disorder. 

Anxiety disorders are the most common kind of mental illness. They affect almost 1 in 5 adults in the U.S. every year — that’s 40 million people every year. Almost two-thirds of these are women, and women are almost twice as likely as men to have anxiety. The World Health Organization (WHO) ranks anxiety as the eighth most common cause of disability worldwide.

What are benzodiazepines?

Benzodiazepines are a class of medications that have been around since the 1950s. They’re used to treat anxiety and other medical conditions. But they can cause serious problems, like misuse and addiction (more on this below). 

Examples of benzodiazepines include:

• Clonazepam (Klonopin)

• Diazepam (Valium)

• Lorazepam (Ativan)

• Alprazolam (Xanax)

• Temazepam (Restoril)

• Triazolam (Halcion)

Benzos work by stimulating brain cells that communicate using GABA (gamma-aminobutyric acid), a natural chemical. When stimulated, these brain cells calm or reduce the activity of other brain systems. This can lead to:

• Lowered anxiety

• Relaxed muscles

• Drowsiness

• Sleep

Benzodiazepines are used to treat many different conditions, including:

• Generalized anxiety disorder

• Social phobia

• Panic disorder

• Muscle disorders

• Insomnia

• Seizures

Do benzos work for anxiety?

Yes, and they usually work very well — and very quickly. In general, they’re good for treatment of many types of anxiety problems over short (but not long) periods of time.

Benzos are very helpful for treating panic attacks, at least on an “as needed” basis for the first several weeks. After that, other treatments — like antidepressants or psychotherapy (talk therapy) — should be continued as the main treatment. In some cases, benzos might also be helpful to keep on board as a rescue medication for emergencies.

Benzodiazepines are also helpful for treating generalized anxiety disorder (GAD). They’re usually only recommended for GAD if other things, like therapy or SSRIs, haven’t worked. They can also be used short term while you’re waiting for a daily antidepressant to start working.  

Lastly, benzos can be very useful “in-the-moment” medications for social anxiety and phobias, especially if you take them occasionally and as needed to help you get through difficult situations.

Even though benzos are helpful for lowering anxiety, they’re rarely the best choice alone. Most anxiety disorders are best treated with other medications and psychotherapy.

Benzos are not usually a first-choice treatment for other mental health conditions like depression, bipolar disorder, or personality disorders. But sometimes they’re used in special situations.

Which benzo is best for anxiety?

It depends. The best medication for you depends on your symptoms and the type of anxiety you have. For example, if you have general anxiety, a long-lasting benzo, like diazepam or clonazepam, might be the best first choice. 

Here’s what to keep in mind if you’re trying to choose a benzo: 

• What you want to use it for

• How quickly it starts working

• How long its effects last in your body

Risks of benzos

All benzodiazepines come with an FDA black box warning. This is a special type of warning for medications that can cause serious and life-threatening side effects. 

The black box warnings for benzos are:

• There’s a risk of severe sleepiness (sedation), breathing problems, coma, and death if used at the same time as opioids, alcohol, or illegal drugs.

• Misuse and addiction can occur and lead to overdose and death.

• Physical dependence can happen with use over many days or weeks — even if taken as prescribed. People who are physically dependent on benzos can also have withdrawal symptoms if they stop taking the medication suddenly or reduce their dose too quickly. 

Benzodiazepine withdrawal can have many different symptoms, including:

• Anxiety

• Poor sleep

• Shakiness

• Restlessness

• Nausea

• Depression

• Fever

• Seizures

• Changes in heart rate and breathing

Benzodiazepine side effects

Benzodiazepines can also cause many other side effects, which can lead to problems like:

• Impaired thinking: Benzos can cause you to forget things, think slowly, and get easily confused. In older people, there’s some evidence that they’re connected to dementia, which is a permanent loss of memory and other brain functions.

• Tiredness and sleepiness: This can be dangerous if you need to do things that require you to be awake and alert, like driving.

• Balance problems, slurred speech, and slow reactions: In older adults, poor balance can lead to more falls — another reason older people should not take benzos. Benzos are also linked to car accidents and hip fractures. 

• Altered thinking and mood: This includes doing things you normally wouldn’t do, having unstable emotions, and making poor choices.

• Slow breathing: If you take higher doses of benzos than your prescription, your breathing can slow down or stop. This can lead to coma and even death.

Is it dangerous to mix alcohol and benzos?

Yes. You may notice that many of these side effects are similar to those of alcohol. That’s not a coincidence: Alcohol and benzos act on the same system in the brain. That’s why alcohol and benzodiazepines should never be used at the same time. Combining them can be dangerous — and even deadly.  

Benzodiazepine addiction

Benzodiazepine addiction (a type of sedative use disorder) is a mental health condition where you have a hard time controlling the amount of medication you take — despite it causing problems in your life. When you have a sedative use disorder, it can become difficult — and sometimes dangerous — to stop using the medication. 

If you’re concerned about benzodiazepine addiction, talk to your healthcare provider. They can help you stop taking the medication safely under supervision. They may suggest you switch you to a long-acting benzodiazepine and then slowly lower that dose. They can also help guide you through a medication “detox” where you gradually taper off your medication in a safe, controlled way. 

Need more information on this topic? You can read more about how benzodiazepine addiction is diagnosed and treated in our GoodRx guide to sedative use disorder. You’ll also find resources on how to get help for you (or a loved one) if you need it. 

Does taking benzodiazepines always lead to addiction?

No. For most people, taking benzodiazepines as prescribed will not lead to a sedative use disorder. According to the National Institutes of Health, benzodiazepine addiction is “relatively rare” in U.S. adults who use benzos — even if they’re not using them as prescribed. But the number of people who misuse benzos may be on the rise. 

If you’re prescribed a benzodiazepine for anxiety, you can lower your chances of addiction by:

• Meeting with your healthcare provider regularly

• Taking your medication exactly as prescribed

• Taking benzodiazepines for the shortest amount of time possible

• Being honest with your healthcare provider about your medication use

• Not sharing your medication with other people

• Incorporating other types of treatment, like psychotherapy, for your anxiety 

What are other options for treating anxiety?

There are many options for treating anxiety disorders, including therapy and other medications. Here are some of the other types of treatments currently available as well as treatments that may be an option in the future. 

Medications for anxiety that aren’t benzos

• SSRI and SNRI antidepressants, like fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), duloxetine (Cymbalta), and venlafaxine (Effexor)

• Mirtazapine (Remeron)

• Buspirone (Buspar)

• Clonidine (Catapres)

• Propranolol (Inderal)

• Hydroxyzine (Vistaril)

• Antipsychotics, like quetiapine (Seroquel)

Psychotherapy for anxiety

Cognitive behavior therapy (CBT) is by far the most popular and effective kind of psychotherapy (or talk therapy) for anxiety disorders.

There are other types of therapy that have had some limited research:

• Psychodynamic therapy

• Emotional regulation therapy

• Acceptance and commitment therapy

• Mindfulness

Treatments on the horizon

Scientists are researching many new ideas for treating anxiety besides benzos and the other choices you just read about. These include:

• Pregabalin, a medication currently used to treat seizures

• Ketamine, a medication currently used for anesthesia

• Newer antipsychotic medications, like aripiprazole and brexpiprazole

• Medications that target melatonin, the “sleep hormone”

• Medications that target many other natural hormones in the brain, like CRF, CCK, substance P, and neuropeptide Y

Why trust our experts?

Written by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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