People search this question with real hope behind it: severe anxiety, panic attacks that arrive without warning, sleepless nights, and the wish for a doctor who will listen and prescribe something that helps. That hope deserves an honest answer.
This article offers one. It comes from the perspective of Mark Leeds, D.O., an osteopathic physician and deprescribing specialist in Fort Lauderdale who spends his days helping patients come off benzodiazepines safely. He has seen where the standard prescribing path leads, and he has seen what actually helps once a benzodiazepine has become part of the problem.
What Does a Psychiatrist Do for Severe Anxiety?
An initial appointment with a psychiatrist usually ends with a diagnosis and a prescription. For panic attacks or severe anxiety, that often means an antidepressant, commonly a selective serotonin reuptake inhibitor (SSRI), and frequently a benzodiazepine alongside it: Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), or Valium (diazepam).
The benzodiazepine is the part patients notice. Benzos work quickly and well for stopping panic in the short term. Patients often describe the feeling as the sharp edges of life being smoothed over.
That relief is real, and it is exactly why the trouble that follows is so hard to see coming.
Why Does the Benzodiazepine Prescription Never End?
The plan is almost always temporary. The benzodiazepine is meant to bridge the first weeks while the antidepressant takes effect, then come off somewhere down the road. But month after month, the patient reports that the benzo helps. The refills continue. Somewhere down the road never arrives.
Prescribing without an exit plan is the core failure here. In 2020, the U.S. Food and Drug Administration (FDA) updated the labeling on all benzodiazepines to formally recognize physical dependence, withdrawal reactions that can last months or longer, and the need for gradual dose reduction. Not every prescriber has revisited the literature since training. A doctor who learned decades ago that these drugs were safe may still prescribe as if that were true.
Polypharmacy compounds the problem. Dr. Leeds has seen patients taking 20 to 30 prescribed medications every day, several of them psychotropic drugs, some prescribed to manage the side effects of the others. He has also seen patients prescribed two or even three benzodiazepines at the same time. He once called the prescribing psychiatrist’s office to ask whether the double benzodiazepine prescription was a mistake. It was not a mistake.
What Happens to the Patient?
Tolerance builds. The medication slowly stops working even at the same dose, a state called tolerance withdrawal, and symptoms start returning between doses. The usual response is a higher dose, which buys time and deepens the dependence.
Some patients go on to develop benzodiazepine-induced neurological dysfunction (BIND): new neurological symptoms that were never part of the original condition. These can include akathisia, a terrifying inner restlessness; depersonalization, a frightening sense of detachment from oneself; insomnia and anxiety worse than anything the patient had before the prescription; and unusual problems such as histamine intolerance. For some, symptoms persist long after the last dose, which is known as protracted withdrawal.
When patients report these symptoms, they are often told their old anxiety is coming back. The dose goes up, or a new diagnosis and a new drug are added. Patients call this experience medical invalidation, and it is one of the most damaging parts of the entire story.
Here is the distinction that changes everything: benzodiazepine addiction is rare, and benzodiazepine dependence is common. A patient who took the medication exactly as prescribed and now cannot stop is not an addict. They have a medical condition caused by the medication itself. At this point, the patient no longer has a psychiatry problem. They have a dependence problem.
So How Can a Psychiatrist Help? An Honest Answer
Now the title question can be answered properly. The help a benzodiazepine-dependent patient needs is not a new diagnosis, a dose adjustment, or another prescription. It is a physician who knows how to take someone off the medication safely.
Psychiatry is capable of this. The Maudsley Deprescribing Guidelines, one of the two essential references for safe tapering, were written by psychiatrists at King’s College London. The field can lead here when it chooses to.
But most psychiatric training emphasizes starting medications, not stopping them, and appointments built around brief medication checks leave no room for the slow, responsive work of tapering. Patients who ask their prescriber for help coming off are too often offered a schedule of weeks when their nervous system needs a year or more. So the honest answer is this: a psychiatrist helps most by prescribing carefully, briefly, and with an exit plan. When dependence has already developed, the patient usually needs something psychiatry rarely offers: deprescribing.
Why Not Detox or Rehab?
The other road patients are pointed down is addiction treatment, and for benzodiazepine dependence it is the wrong road.
Rapid facility detox is dangerous with benzodiazepines. Abrupt discontinuation can cause seizures, and each failed fast taper can make future attempts harder, a phenomenon called kindling. The timelines are set by program design and insurance coverage, not by the patient’s nervous system. And the programming, group meetings and addiction recovery curriculum, treats a medical injury as a behavior problem. A person whose only issue is dependence on a prescribed medication does not belong there.
Should Benzodiazepines Be Banned?
No. Benzodiazepines still have legitimate short-term uses in acute and procedural medicine. More importantly, people in the middle of slow tapers depend on continued access to their medication. A safe taper following the Ashton Manual can take years, and anyone forced to stop faster faces a real risk of protracted withdrawal.
The answer is not prohibition. It is prescribing with genuine informed consent: risks disclosed up front, an exit plan from day one, and the patient’s right to decline respected.
What Deprescribing Looks Like
Deprescribing is the medical specialty of stopping medications as carefully as they were started. For benzodiazepines, it looks like this:
- A gradual, patient-paced taper measured in months to years, never days
- The Ashton Manual crossover to diazepam when appropriate, following the method Professor C. Heather Ashton described
- Hyperbolic tapering: reductions that become smaller as the dose gets lower
- Compounded liquid formulations that allow precise cuts of fractions of a milligram
- Holds when symptoms flare, treated as normal taper management rather than failure
- Recognition and treatment of BIND, instead of dismissal
Patients evaluating their options can read about what to look for in a benzodiazepine tapering specialist before choosing a doctor.
Final Thoughts
How can a psychiatrist help with mental health? By listening more than prescribing. By using medications briefly and carefully when they are needed, with the risks disclosed and the exit planned before the first refill. That is medicine at its best, and it exists.
But when a benzodiazepine has already become the problem, the help a patient needs has a different name: deprescribing, not more psychiatry, and not detox or rehab. Dr. Leeds provides medically supervised benzodiazepine tapering through secure telemedicine throughout Florida, based in Fort Lauderdale, at a pace the patient controls. Contact Dr. Leeds today.
