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Mixing Adderall and Xanax: What are the Dangers?

Xanax and Adderall are very popular drugs. Xanax  (generic name lorazepam) is usually prescribed for the treatment of anxiety and anxiety-related conditions. Adderall (a combination of amphetamine and dextroamphetamine) is prescribed to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Their effectiveness makes them frequent drugs of abuse, either on their own or taken together in an attempt to enjoy the effects of both. Mixing Xanax and Adderall is a very dangerous exercise that can have drastic consequences. 

What Is Xanax?

Xanax is one of the most commonly prescribed benzodiazepines, a class of drug that works by enhancing the presence and functions of the gamma-Aminobutyric acid neurotransmitter in the brain. This neurotransmitter, known simply as the GABA neurotransmitter, acts to slow down signals between neurons in the brain, with the job of regulating the electrical excitability of nerve cells in the CNS. The brain produces GABA to calm neurons that are responsible for emotional and physical stability. When a person is confronted with a stressful situation, the release of GABA is what helps them control their mood and reactions.

This is the body’s natural defense mechanism to anxiety, pain, or fear. Certain groups of neurons become active, sometimes overactive, in response to these stimuli. GABA intervenes to soothe those neurons, bringing them down to a diminished state of stimulation, which has the effect of inducing a relaxed response. 

For this reason, GABA plays a key role in sleep. As the neurotransmitter moves through the brain, it calms neurons and helps people to fall asleep. 

However, many people have a deficiency of GABA in their brains — either as a result of genetics, substance abuse, or other causes. This means they are likely to experience increased periods of anxiety, stress, and insomnia as a result of their inability to produce enough GABA to moderate their responses to a panic- or fear-based situation.

A lack of the GABA neurotransmitter is the driver behind most anxiety disorders, and this is usually resolved through a combination of therapy, lifestyle changes, and medication. Benzodiazepines work by stimulating the brain to produce GABA to induce feelings of calm. Xanax (also known by the generic name alprazolam) is one of the most popular benzodiazepines that does this.

Xanax Abuse

man with handful of xanax pills

Xanax is an effective medication, and this has made it very in demand. In April 2018, National Public Radio(NPR) wrote that despite the widely known risks of prescription medication, benzodiazepines like Xanax remain “more popular than ever.” Citing research in the American Journal of Public Health, NPR reported that between 1999 and 2013, the number of annual benzodiazepine prescriptions skyrocketed from 8.1 million to 13.5 million — an increase of 67 percent.

Part of the problem is that patients who have been prescribed Xanax find the sedative effects so desirable that they increase their consumption of the medication beyond the prescription limits their doctors set out for them. Patients consume greater amounts of the Xanax, or for longer periods, so they can constantly be in the tranquil state that eludes them when they are not taking the drug. 

This is very dangerous behavior for several reasons. It creates a dangerous association between happiness and Xanax, and it makes the body and central nervous system increasingly dependent on Xanax to manage moods and reactions instead of being a supplement to the appropriate therapy and lifestyle change. 

The other part of the problem is that some people take Xanax recreationally. They have no prescription or medical need for the sedative effects of the benzodiazepine, but they enjoy the powerful relaxation and sleep that come after a dose.

There usually is the perception that because Xanax is a legal drug, it is not as harmful as substances with similar effects like heroin; however, this is a grave misunderstanding because alprazolam is a very strong benzodiazepine that changes the brain’s chemistry.

 For a person who needs the GABA boost, this change is a necessary one; for a person who doesn’t, they are subjecting their central nervous system to a drastic chemical rewrite for anxiety and stress relief to the point where the person can’t feel any sense of calm or tranquility without Xanax. 

Furthermore, going without Xanax causes painful and distressing withdrawal symptoms, which often compel increased use of the medication, thereby deepening the dependence to the point of addiction. 

What Is Adderall?

On the other side of the spectrum is Adderall, the trade name of a combination of amphetamine and dextroamphetamine. Both drugs are stimulants. While Xanax (as a benzodiazepine) works by dampening the electrical activity in the central nervous system, amphetamine and dextroamphetamine excite that activity. The result is that people feel active, alert, and compelled to greater levels of mental acuity and productivity.

Another difference is that while benzodiazepines focus on the GABA neurotransmitter, Adderall works on (stimulate the release of) several neurotransmitters, such as norepinephrine, dopamine, and serotonin.Dopamine is responsible for producing feelings of reward, pleasure, and anticipation, creating a template from the experience so that a person seeks out the activity again. 

Under normal circumstances, the dopamine is reabsorbed by the brain, which coincides with an interest in an activity naturally waning. However, stimulant drugs (whether legal or illegal) force the brain to produce more dopamine than it usually would, and they actively prevent the brain from reabsorbing dopamine, so the feeling of pleasure and the desire for more last for an artificially long time. For people who experience this, the sensation of gratification is beyond anything they have felt before, and it drives them to experience it again.

Adderall also mimics the functions of other neurotransmitters, including epinephrine (adrenaline). The impact of epinephrine ramps up the sympathetic nervous system, putting the body in a ‘fight-or flight’ mode. This stimulates alertness, clarity, and focus. Other neurotransmitters are released when Adderall is consumed to manage all the activities going on; this, in turn, compels the brain to constantly release dopamine and epinephrine. 

adderall and abuse

Adderall Use and Abuse

This makes Adderall a popular prescription for attention-deficit hyperactivity disorder because the combination of amphetamine and dextroamphetamine brings patients down from overstimulation to baseline stimulation. However, the boost of dopamine and the temporary improvement to alertness and mental sharpness make Adderall a very popular drug for recreational abuse.

On college campuses (where it is known as a “study drug”) and in high-stress work environments, a black market exists for the illicit trade and consumption of Adderall to assist with long working hours and intense periods of concentration. 

Out of this has arisen the epidemic of recreational Adderall abuse, primarily among people who don’t have a legitimate medical need for the medication but who want to experience the adrenaline surge and enhancement to their thinking prowess. 

Mixing Adderall and Xanax

Why do people mix Xanax and Adderall (two very different drugs), and what are the dangers when they do? There are multiple reasons. In some cases, people have severe panic or anxiety disorders, and they believe that trying to balance the tranquilizing effects of Xanax with the stimulant effects of Adderall will offer them relief that is instant and more powerful than practicing coping skills on their own. 

There is also the recreational element. Some people enjoy the “downer” effect of the Xanax and the “upper” effect of Adderall and try to combine them into a single cocktail. If Xanax brings them down too quickly, they take Adderall to perk themselves up again, and vice versa. 

Similarly, if they start to experience withdrawal effects from going without one of the medications, topping off with the other medication can temporarily alleviate some of that discomfort. Of course, because the body’s systems are so vulnerable during withdrawal, this merely makes the person more dependent on the other drug, and the problem continues. 

Drug Interactions and Heart Problems

There is also the problem of drug interactions, which is when one drug affects the functioning of another drug when both are present at the same time. Mixing Adderall and Xanax is comparable to “speedballing,” the practice of chasing a nervous system depressant with a nervous system stimulant. 

Speedballing is usually done in the context of illegal drugs (combining heroin and cocaine, for instance, to intensify the respective effects), but it also applies to taking both alprazolam and amphetamine and dextroamphetamine to try and “level out” their respective effects. Columbia University’s Go Ask Alice! column warns that putting benzodiazepines and a stimulant in the same system “can be confusing to the body” at best and “can have serious, if not fatal, effects” at worst. 

One problem with this kind of mixing is that people are typically unaware of how much of a particular drug they are taking, and they tend to go too far in increasing the stimulant or sedative dosage to find the “perfect balance” between the two better. Generally, stimulants tend to be stronger than benzodiazepines (or the effects are simply more noticeable), so a person mixing Xanax and Adderall might think they need more Xanax to counter the boost of adrenaline and dopamine from Adderall. The increased Xanax results in more GABA desperately trying to calm down the frenzy of nervous activity, so they take more Adderall to shake off the tranquilizing effects. This cycle continues, as they never find that perfect balance.

The dangers are manifold. Going back and forth between Xanax and Adderall severely increases the risk of an overdose. People who mix the two medications cannot pace their consumption, typically overcompensating for the dominant effect.

As much as the combination of the stimulant and sedative puts the brain under stress, it also plays havoc with the heart. Adderall speeds up heart rate; even the improper use of Adderall alone raises the risk of a heart attack. The release of the GABA neurotransmitter tells the heart to slow down. Forcing the heart to endure such conflicting and overpowering messages puts a person in serious risk of irregular heart patterns or outright heart failure.

Taking Xanax and Adderall Safely

taking xanax and adderall safely

Is there a safe amount of Xanax and Adderall that can be taken? The answer to that question is yes, but never at the same time.

With Xanax, this depends on a doctor’s prescription for your stress and anxiety, and it also takes into account your age, overall health, family history, and other factors. The dose should always be at the low end of the spectrum, with increases approved only by your doctor. Similarly, when coming off Xanax, your doctor will have you slowly reduce your consumption before you can bring it down to zero. Xanax tablets themselves come in strengths of 0.25 mg (milligrams) to 2 mg. They should never be crushed, chewed, or broken.

Much of the same direction applies to Adderall. The medication should only be taken with a doctor’s explicit approval and prescription. The dosages depend on whether the Adderall is prescribed for the treatment of attention deficit hyperactivity disorder or narcolepsy. Adderall tablets go from 5 mg doses up to 30 mg.

Children who get Adderall should start with 10 mg daily, with 5 mg increases only if symptoms require it. The dose should not exceed 40 mg of Adderall a day. For adult patients who need Adderall for narcolepsy, the maximum recommended dosage is 60 mg a day, divided into dosages that are taken two or three times throughout the day.

However, the same caveats remain for both medications. As much as they should not be improperly used on their own, they absolutely should not be consumed together. Mixing Xanax and Adderall causes extreme danger for the heart and the central nervous system,  and the practice can quickly lead to addiction and overdose.

Sources

Function of the GABA Neurotransmitter and Everything Else About It. Examined Existence. Retrieved December 2018 from https://examinedexistence.com/what-does-the-neurotransmitter-gaba-do/

(July 2018). 4 GABA Deficiency Symptoms You Can Identify Yourself. University Health News Daily. Retrieved December 2018 from https://universityhealthnews.com/daily/depression/4-gaba-deficiency-symptoms-you-can-identify-yourself/

(January 2015). Anxiety Disorders and GABA Neurotransmission: A Disturbance of Modulation. Neuropsychiatric Disease and Treatment. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pubmed/25653526

(April 2018). Benzodiazepines: America's 'Other Prescription Drug Problem'. NPR. Retrieved December 2018 from https://www.npr.org/sections/health-shots/2018/04/26/602213172/benzodiazepines-america-s-other-prescription-drug-problem

(April 2016). Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013. American Journal of Public Health. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816010/

(March 2018). This Is Your Body on Xanax. Vice. Retrieved December 2018 from https://www.vice.com/en_us/article/9kzx8z/this-is-your-body-on-xanax

(November 1994). The Benzodiazepine Withdrawal Syndrome. Addiction. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pubmed/7841856

(April 2014). What is Adderall (Adderall XR)? Everyday Health. Retrieved December 2018 from https://www.everydayhealth.com/drugs/adderall

(December 2014). Adderall's Effect on Your Brain: Whatever Obscure Benefits There Are, It's Not Worth It. Medical Daily. Retrieved December 2018 from https://www.medicaldaily.com/adderalls-effect-your-brain-whatever-obscure-benefits-there-are-its-not-worth-it-313862

(December 2012). Adderall Addiction: Students Misuse Drug to Gain Boost While Studying. Iowa State Daily. Retrieved December 2018 from http://www.iowastatedaily.com/news/article_82ad5eda-3f14-11e2-8788-001a4bcf887a.html

(January 2017). What's Behind the Rise in Cocaine-Linked Deaths? U.S. News and World Report. Retrieved December 2018 from https://www.usnews.com/news/health-care-news/articles/2017-01-03/as-the-opioid-epidemic-evolves-impacts-bleed-into-cocaine-overdose

Mixing Uppers With Downers — Bad Idea? Columbia University. Retrieved December 2018 from https://goaskalice.columbia.edu/answered-questions/mixing-uppers-downers-%E2%80%94-bad-idea-0

(September 2017). Effects of Adderall on the Body. Healthline. Retrieved December 2018 from https://www.healthline.com/health/adhd/adderall-effects-on-body

(2015). Effect of GABA on Blood Pressure and Blood Dynamics of Anesthetic Rats. International Journal of Clinical and Experimental Medicine. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613098/

(May 2017). What is Xanax (Alprazolam)? Everyday Health. Retrieved December 2018 from https://www.everydayhealth.com/drugs/xanax

(August 2018). Adderall (Amphetamine/Dextroamphetamine). Healthline. Retrieved December 2018 from https://www.healthline.com/health/cdi/adderall

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