A clinician explores why women in midlife often reach for substances such as benzodiazepines and kratom to quiet anxiety and fatigue, and what clinicians should consider beyond symptom suppression.
Benzodiazepines can relieve symptoms but carry risks of physical dependence and difficult withdrawal when used long term.
Kratom is unregulated in the U.S., varies in potency, and can interact dangerously with alcohol, benzodiazepines, or opioids.
Clinicians should investigate underlying drivers of distress and offer alternatives beyond indefinite symptom suppression.
Why relief is not the same as treatment
Benzodiazepines have a legitimate medical role and can be essential for acute relief. The article stresses that relief alone is not a treatment plan. Benzodiazepines carry well-documented risks: physical dependence and potentially severe withdrawal. For women in midlife, these medication risks intersect with life-stage challenges such as perimenopausal changes in sleep and mood, combined caregiving and work responsibilities, and cumulative stressors.
Kratom appears in the clinician's caseload as an alternative some women pursue. Reasons include perceived naturalness, tradition, accessibility, and claims of energy alongside anxiety or pain relief. However, kratom products sold in the U.S. are not regulated like prescription drugs and can vary substantially in potency. That variability increases unpredictability of effects and risks.
A serious concern highlighted is concomitant use: people may take kratom while drinking alcohol, using prescribed benzodiazepines, or taking opioids. Because some components of kratom have opioid-like effects and many of these substances depress the central nervous system, combining them can raise the risk of excessive sedation and respiratory depression.
The author urges clinicians to adopt curiosity and patience when a woman presents with new or intensified anxiety. Instead of defaulting to symptom suppression, clinicians should consider hormonal, psychological, medical, and situational contributors. Questions about sleep disruption, onset and pattern of panic or anxiety, life stressors, caregiving burdens, and possible substance use should guide assessment.
Assess underlying causes before committing to long-term benzodiazepine treatment. Discuss the variable nature and regulatory gaps of kratom with patients who report using it. Screen for co-use of alcohol, benzodiazepines, and opioids and educate about interactive risks. When pharmacologic relief is necessary, pair it with plans for addressing root causes and, when appropriate, time-limited strategies to reduce dependence risk.
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