You’re probably familiar with the benzodiazepines diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax). They’re among the most popular drugs worldwide, prescribed most often for generalized anxiety and panic attacks. Xanax has become the fourth most widely prescribed drug in the United States, and it’s no surprise. In a nation where anxiety is as prevalent as the common cold, these medications do their job.

But there is a dark side — many dark sides — that should make you think twice before hopping on the benzo bandwagon. These drugs can be used safely, but the decision to take them shouldn’t be entered into lightly.

How do benzodiazepines work?
Benzodiazepines stimulate the brain’s receptors for a chemical called gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter impacting anxiety, mood, sleep and pain sensitivity. The various benzodiazepines differ primarily in how fast and how long they act.

What are the side effects?
They can decrease your ability to think clearly, impair memory and reduce your ability to respond to emergency situations that may arise (for example, if you are driving a car or operating a dangerous piece of machinery).

These effects can be seen even in the lowest doses that are usually prescribed. In addition, a recent study found that the use of one of these drugs for at least three months increases your risk of Alzheimer’s disease by 50 percent.

In high doses, benzodiazepines can cause life-threatening respiratory suppression or result in a coma. Since 2000, the number of emergency-room visits due to benzo use has doubled. When combined with narcotics, the risk and severity of these side effects is significantly increased.

Are these drugs habit-forming?
Yes. Their continued use downregulates the brain’s sensitivity to GABA, so not only will you need more of the drug to get the same benefit over time, your baseline state of anxiety without the drug actually increases.

It can be very difficult to get off benzos once you’ve started them, and stopping can come with serious withdrawal symptoms. Insomnia, irritability, heightened anxiety, panic and restlessness are among the most common symptoms. More patients now end up in detox for the combined use of benzodiazepines and opioids than for all alcohol-related complications.

Can you use these drugs safely? Are there alternatives?
Benzos can be effective in relieving an acute panic attack or preventing one in a high-risk situation. However, there are almost always better alternatives. Selective serotonin reuptake inhibitors (SSRIs) like sertaline (Zoloft) and escitalopram (Lexapro) and selective norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta) are the first choice in managing generalized chronic anxiety in those patients who require medication.

In the long run, getting to the root of the problem through cognitive behavioral therapy (CBT), counseling and modifying your lifestyle to fortify your defenses against anxiety (getting proper sleep, optimizing nutrition and avoiding caffeine and alcohol) can have a cumulative effect that can lessen or even eliminate your need for these drugs.

Applying skills learned in CBT or using deep-breathing exercises or visualizations (there are many mobile apps that make this convenient) can abort many panic attacks before they become unmanageable. And the more you practice and use these skills, the more effective they become.