The Benzodiazepine Trap: A Clinician’s Guide to Escaping the Panic Cycle

A Note from the Author: I’m a clinician and researcher with over 15 years of experience in mental health.

This article is the culmination of my professional journey—a journey that began with a conventional understanding of panic disorder treatment and was fundamentally changed by witnessing the profound, often hidden, struggles of my patients.

This is not just a summary of clinical data; it is the story of a paradigm shift, one I believe is essential for both patients and practitioners to understand.

My goal is to share the insights I’ve gained, moving from a model of temporary fixes to one of lasting resilience.

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Part I: My Wake-Up Call: The Patient Trapped by His “Cure”

The Seductive Simplicity of a “Magic Pill”

Early in my career, I viewed benzodiazepines as something of a miracle.

When a patient arrived in my office, ravaged by the sheer terror of a panic attack, I had a tool that offered near-instantaneous peace.

A prescription for a medication like alprazolam (Xanax) or lorazepam (Ativan) felt like handing a life raft to someone drowning.

The relief on their faces was immediate and profound.

These medications work quickly, they are remarkably effective at quelling the storm, and patient acceptance is understandably high.¹

In the face of overwhelming fear, what could be better than a pill that simply makes it stop?

For years, this was my standard of care, aligned with a common practice in medicine.

The approach was simple: a patient has a panic attack, you give them a benzodiazepine.

The panic stops.

Problem solved.

It was a clean, effective, and deeply satisfying feedback loop.

I was providing relief, and my patients were grateful.

But the true nature of this “solution” was a slow-burning crisis I had yet to understand.

The wake-up call came in the form of a patient I’ll call Mark.

The Failure That Changed Everything: My Patient, “Mark”

Mark came to me suffering from classic panic disorder.

His attacks were unexpected and debilitating, leaving him terrified of the next one.

Following my training, I prescribed a short-acting benzodiazepine.

The initial results were, as expected, spectacular.

Mark called it his “magic pill.” The attacks that had hijacked his life were stopped in their tracks.

He could function again.

For the first few months, it was a textbook success story.

But over the next two years, a subtle and insidious change took place.

Mark’s world began to shrink.

The panic attacks themselves were rare, yet he lived in a state of constant, low-grade dread—a phenomenon known as anticipatory anxiety.³

He started avoiding places where he’d had an attack before, then places where he

feared he might have one.

Soon, he was unable to go to the grocery store or drive on the highway alone, classic signs of agoraphobia.³

Worse, he described a “mental fog” that never seemed to lift.

His thinking was slower, his memory less sharp.

He was still taking the medication as prescribed, but it seemed to be losing its power.

Sometimes, he’d feel a surge of intense anxiety a few hours before his next dose was due, a feeling he described as even more unsettling than his original panic attacks.

He was no longer just afraid of the panic; he was terrified of being without his medication.

His “cure” had become a cage, and I had helped build it.

Mark’s case forced me to confront a devastating paradox: the tool I was using to free my patient had, in fact, entrapped him.

This failure compelled me to question everything I thought I knew and to search for a better framework—one that didn’t just stop the panic, but restored the person.

Defining the Overwhelming Force: What Exactly is a Panic Attack?

To understand the solution, we must first have a deep respect for the problem.

A panic attack is not just “feeling anxious.” It is a sudden, overwhelming episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause.⁴

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes.⁶

During this time, a person can feel like they are losing control, having a heart attack, or even dying.⁴

This is not an exaggeration; it is the subjective reality of the experience.

The terror is primal.

While the attack itself is not life-threatening, the experience is so harrowing that one of its worst consequences is the intense fear of having another one.⁴

This fear can lead to Panic Disorder, which is diagnosed when a person has recurrent, unexpected panic attacks, and at least one of those attacks is followed by a month or more of persistent worry about future attacks or a significant, maladaptive change in behavior related to them (like avoiding certain situations).⁵

It’s this cycle of panic-fear-avoidance that can cause a person’s life to unravel.

Table 1: The Anatomy of a Panic Attack (DSM-5 Criteria)

To be classified as a panic attack, the episode must involve an abrupt surge of intense fear that peaks within minutes and includes four or more of the following symptoms.

Seeing these symptoms listed can be validating; it transforms a chaotic, terrifying experience into a recognized medical phenomenon.³

Somatic (Physical) Symptoms	Cognitive (Mental) Symptoms
Palpitations, pounding heart, or accelerated heart rate	Derealization (feelings of unreality)
Sweating	Depersonalization (being detached from oneself)
Trembling or shaking	Fear of losing control or “going crazy”
Sensations of shortness of breath or smothering	Fear of dying
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Chills or heat sensations
Paresthesias (numbness or tingling sensations)

Part II: The “Leaky Dam” Analogy: Why the Conventional Quick Fix Fails

Mark’s story forced me to develop a new way of thinking about panic disorder and its treatment.

The epiphany came in the form of an analogy: Panic disorder is like a structurally weak dam holding back a powerful river of anxiety.

A panic attack is a major breach in that dam.

For years, my approach had been to frantically patch the leaks with benzodiazepines as they appeared.

It was a reactive, short-sighted strategy.

I came to realize that this approach not only failed to address the dam’s underlying weakness but, over time, actively contributed to its decay.

The Allure of the Quick Patch: How Benzodiazepines Work

To understand why benzodiazepines are such a seductive “quick patch,” we need to look at the brain’s neurochemistry.

Your central nervous system has both accelerator and brake pedals.

The accelerator involves excitatory neurotransmitters that ramp up activity.

The primary brake pedal is a neurotransmitter called gamma-aminobutyric acid, or GABA.⁹

GABA’s job is to reduce neuronal excitability throughout the nervous system.

It tells your brain to calm down.¹⁰

Benzodiazepines are powerful GABA boosters.

They don’t act as GABA themselves, but they bind to a specific site on the GABA-A receptor, making the receptor much more efficient.¹

When a benzodiazepine molecule is present, it takes less GABA to open the receptor’s chloride ion channel.

This influx of negative chloride ions makes the neuron hyperpolarized, meaning it’s much harder for it to fire.¹⁰

Think of it this way: if GABA is the foot on the brake pedal, a benzodiazepine is a hydraulic power-assist system.

It dramatically amplifies the braking force, rapidly slowing down the runaway train of a panic attack.⁹

This is why they work so quickly and feel so effective.

They are, in essence, the perfect emergency patch for a breach in the dam.

When the Patches Weaken the Dam: The Cycle of Tolerance and Dependence

Here is the crux of the problem.

Your brain is a master of adaptation.

When it is constantly flooded with the artificially amplified braking power of benzodiazepines, it tries to restore balance.

It begins a process of neuroadaptation, effectively fighting back against the drug’s effects.

This is where the dam begins to weaken.

This weakening happens in three distinct, cascading stages:

1. Tolerance: The brain’s GABA receptors become less responsive to the drug’s effects.¹⁴ The “patches” start to lose their adhesive strength. The same dose that once stopped a panic attack in its tracks now barely takes the edge off. This process can begin remarkably quickly, with some studies suggesting tolerance can develop in as little as 2 to 4 weeks of regular use.¹⁴ This often leads patients and doctors to increase the dose, chasing that initial feeling of relief and beginning a dangerous cycle of escalation.¹⁵
2. Dependence: After a period of regular use, the brain has so fundamentally altered its structure to counteract the drug that it now requires the drug to function normally. This is not addiction (which involves compulsive drug-seeking behavior), but a state of physical dependence.¹⁶ The dam’s own structure has become so weak that it now relies on the artificial patches just to hold itself together. If the drug is stopped or the dose is lowered, the brain’s over-excited state, which has been held in check, comes roaring back, leading to withdrawal symptoms.¹⁶
3. Inter-dose Withdrawal: This is perhaps the most insidious and misunderstood part of the cycle. It occurs most often with short-acting benzodiazepines like alprazolam (Xanax).¹⁶ The drug provides relief for a few hours, but as its level in the blood drops, the brain’s now-weakened GABA system can’t cope. A wave of withdrawal symptoms—intense anxiety, restlessness, palpitations—surges through the body
   before the next scheduled dose.¹⁵ The patient feels this as a return of their panic disorder, only worse. They take their next pill, feel relief, and the cycle repeats. What they (and often their doctor) fail to realize is that this isn’t the original illness getting worse; it is a new, iatrogenic (medically-induced) illness created by the treatment itself. The “cure” is now causing a more frequent and persistent form of anxiety than the one it was meant to treat. This was precisely what was happening to Mark.

The Long-Term Cracks: Cognitive Decline and Other Hidden Risks

The damage isn’t limited to anxiety and dependence.

Over time, the constant patching begins to cause structural cracks in the dam itself.

The long-term use of benzodiazepines is associated with a range of significant harms.

Multiple meta-analyses have confirmed that long-term users show significant impairment across a wide range of cognitive domains.²⁰

This includes measurable deficits in:

• Processing speed: The ability to think and react quickly.
• Verbal learning and memory: The capacity to learn and recall new information.
• Visuospatial ability: The skill of perceiving and manipulating visual information.
• Sustained attention: The ability to concentrate over time.²²

This is the “mental fog” that Mark described.

Disturbingly, while some of this cognitive function may improve after stopping the medication, studies suggest that some deficits may be permanent or take longer than six months to resolve, indicating the potential for lasting changes to the brain.²²

Furthermore, benzodiazepines disrupt healthy sleep architecture.

While they can induce sleep, they reduce the amount of time spent in the most restorative stages: deep slow-wave sleep and REM sleep.²²

Over time, this can worsen mood and cognitive function, creating another vicious cycle where the “solution” for anxiety-related insomnia actually degrades sleep quality and mental resilience.

Part III: A New Blueprint: The “Dam Reinforcement” Framework

My experience with Mark and my subsequent deep dive into the research led me to a profound epiphany.

My entire approach had been wrong.

I had been a frantic dam-patcher, focused only on the acute crisis.

The real, sustainable solution wasn’t finding better patches; it was building a fundamentally stronger dam.

This led me to develop what I call the “Dam Reinforcement” Framework.

It’s a proactive, resilience-building model that shifts the goal from merely suppressing panic to building a brain and body that are inherently less susceptible to it.

It acknowledges the need for emergency measures but prioritizes the construction of permanent, durable strength.

Pillar 1: The Temporary Scaffolding (The Rightful, Limited Role for Benzodiazepines)

In the “Dam Reinforcement” model, benzodiazepines are not the repair material.

They are the temporary scaffolding.

When a dam has a major breach, you need scaffolding to provide immediate stability and safety so that the real repair work can begin.

This is the rightful, and very limited, role of benzodiazepines.

According to a broad consensus of clinical guidelines from the American Psychiatric Association (APA), the National Institute of Mental Health (NIMH), and the American Academy of Family Physicians (AAFP), benzodiazepines are not recommended as a first-line or long-term treatment for panic disorder.²⁵

Their use should be restricted to the short term—ideally 2 to 4 weeks at most—to provide rapid symptom control while longer-term, more sustainable treatments take effect.²⁶

The conversation with the patient must change.

Instead of “Here is a pill to stop your panic,” it must be, “Here is a temporary medication to give you some stability for the next few weeks while we begin the real work of strengthening your system so you won’t need this pill anymore.” A clear discontinuation plan should be discussed from the very first prescription.²⁹

Table 2: Common Benzodiazepines: A Tool Selection Guide

Understanding the different types of benzodiazepines is crucial for using them strategically as temporary scaffolding.

The key difference is their “duration of action,” or half-life, which determines how long they stay in the body.¹³

Medication (Brand Name)	Duration of Action	Typical Use Case & Characteristics
Alprazolam (Xanax)	Short-acting	Use: Very rapid relief of acute panic. Characteristics: Potent and fast-acting. Its short half-life means it leaves the body quickly, which increases the risk of rebound anxiety and inter-dose withdrawal. It is particularly difficult to taper from.16
Lorazepam (Ativan)	Short-to-Intermediate	Use: Acute panic, agitation. Characteristics: Fast onset, but slightly longer-lasting than alprazolam. Still carries a significant risk of dependence and withdrawal issues.2
Clonazepam (Klonopin)	Intermediate-acting	Use: Panic disorder, seizure disorders. Characteristics: Slower onset but longer duration than alprazolam or lorazepam. This provides more stable coverage and slightly less risk of inter-dose withdrawal.2
Diazepam (Valium)	Long-acting	Use: Anxiety, muscle spasms, the gold standard for tapering. Characteristics: Slow onset and very long half-life. Its metabolites are also active, providing a smooth, stable blood level that makes it the preferred agent for gradually tapering off benzodiazepines.30

Pillar 2: The Permanent Reinforcements (Building Long-Term Resilience)

With the temporary scaffolding in place, the real work of reinforcing the dam can begin.

This involves using evidence-based tools that create lasting structural changes in the brain and nervous system, building true resilience against panic.

Structural Steel: First-Line Medications (SSRIs & SNRIs)

If benzodiazepines are the temporary scaffolding, then Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the structural steel and reinforced concrete.

These medications are universally recommended by major health organizations like the Mayo Clinic, NIMH, and APA as the first-line pharmacotherapy for panic disorder.²⁵

Unlike benzodiazepines, which just artificially press the GABA brake, SSRIs work over time to fundamentally recalibrate the brain’s serotonin system.³³

By increasing the availability of serotonin, they help regulate mood and anxiety on a more foundational level, making the brain less susceptible to the misfiring that triggers a panic attack.

This process takes time.

Patients must understand that SSRIs are not a “quick fix”; they can take several weeks to start working, and there may be initial side effects like nausea or jitteriness.²⁸

This is why a short-term course of benzodiazepines can be a useful bridge.

A typical course of SSRI treatment for panic disorder lasts at least 6 to 12 months to solidify the gains and prevent relapse.²⁵

Table 3: Benzodiazepines vs. SSRIs for Panic Disorder: A Comparative Overview

This table starkly illustrates why the “Dam Reinforcement” model prioritizes SSRIs over benzodiazepines for anything other than short-term, acute care.

It is a direct comparison of a temporary patch versus a permanent structural repair.²⁵

Feature	Benzodiazepines	SSRIs / SNRIs
Onset of Action	Rapid (minutes to hours)	Slow (2-6 weeks)
Mechanism	Enhances the brain’s primary “brake” (GABA) system	Re-regulates the brain’s serotonin/norepinephrine systems
Role in Treatment	Short-term “rescue” or bridge therapy (scaffolding)	Long-term prevention and resilience-building (structural steel)
Long-Term Efficacy	Poor; effectiveness wanes due to tolerance	Good; sustained reduction in panic frequency and severity
Dependence Risk	High; physical dependence can develop in weeks	Low; no physiological dependence in the same way, but can have discontinuation syndrome
Withdrawal	Can be severe, prolonged, and potentially dangerous (seizures)	Can be uncomfortable (dizziness, nausea) but is not dangerous and is managed by tapering

The Engineer’s Manual: Cognitive Behavioral Therapy (CBT)

If SSRIs are the materials used to reinforce the dam, Cognitive Behavioral Therapy (CBT) is the engineer’s manual that teaches you how to operate and maintain the newly strengthened structure.

It is considered the gold standard of psychotherapy for panic disorder, with evidence showing it can be as effective as, or even more effective than, medication in the long term.²⁵

CBT doesn’t just soothe symptoms; it gives you the tools to dismantle the panic machine itself.

It works through several key techniques:

• Psychoeducation: The first step is learning the truth about panic. The therapist teaches you that the terrifying physical sensations, while real, are not dangerous.²⁹ Your heart is not failing; you are not going to suffocate. This knowledge alone can strip panic of much of its power.
• Cognitive Restructuring: You learn to identify the catastrophic thoughts that trigger and fuel panic (e.g., “My heart is racing, I must be having a heart attack”). The therapist helps you challenge these distorted thoughts and replace them with more realistic, balanced ones (e.g., “My heart is racing because of an adrenaline surge, it’s uncomfortable but harmless, and it will pass”).
• Interoceptive Exposure: This is the most powerful component. Under the therapist’s guidance, you safely and gradually induce the physical sensations you fear. You might spin in a chair to feel dizzy, or breathe through a straw to feel short of breath.³⁴ By repeatedly experiencing these sensations without a catastrophic outcome, you break the conditioned link between the physical feeling and the terror. You are essentially retraining your brain to understand that these sensations are not a threat.

Routine Maintenance: The Power of Lifestyle

A reinforced dam still requires routine maintenance to stay strong.

A comprehensive treatment plan must include lifestyle factors that support a resilient nervous system.

• Exercise: Regular aerobic activity is a proven anxiety-reducer. It burns off stress hormones like cortisol, releases mood-boosting endorphins, and improves overall resilience.⁴ Even a 10-minute brisk walk can have calming effects.³⁶
• Diet: What you eat directly impacts your brain. A diet rich in complex carbohydrates, lean protein, and healthy fats helps stabilize blood sugar, preventing mood swings.³⁸ Nutrients like magnesium and omega-3 fatty acids are crucial for brain health.³⁷ Conversely, stimulants like caffeine and depressants like alcohol can trigger or worsen anxiety and should be limited or avoided.⁴
• Sleep: A sleep-deprived brain is an anxious brain. Prioritizing 7-9 hours of quality sleep is non-negotiable for emotional regulation.⁴¹
• Mindfulness and Meditation: These practices train your attention and change your relationship with your thoughts. Instead of being swept away by anxious thoughts, you learn to observe them with non-judgmental awareness.⁴³ Grounding techniques, like the “5-4-3-2-1” method (naming 5 things you see, 4 you can touch, etc.), can be incredibly effective at pulling you out of a spiral of panic and back into the present moment.⁴⁴

Part IV: The Deconstruction: A Compassionate Guide to Tapering

For the person reading this who is already on long-term benzodiazepine therapy, the “Dam Reinforcement” framework might sound good in theory, but the immediate reality is the fear of stopping.

I want to speak directly to you.

Your struggle is real.

The process of withdrawal can be incredibly challenging, and you are not alone.

Honoring the Challenge: Voices from the Withdrawal Journey

A quick search of online forums reveals a world of suffering that is often invisible to the medical establishment.

People describe a host of debilitating physical and psychological withdrawal symptoms: intense anxiety, insomnia, muscle pain, tremors, digestive issues, sensory hypersensitivity, and a feeling of being detached from reality.¹⁴

They share stories of feeling dismissed by doctors who don’t believe their symptoms are real or who prescribe dangerously fast tapers.⁴⁷

One survey of forum users found that 66% reported their provider did not believe their symptoms were related to withdrawal.⁴⁸

This systemic gap between the lived experience of patients and the knowledge base of many prescribers is a critical failure.

It forces patients to become their own experts, navigating a complex and potentially dangerous medical process with peer support from the internet.⁴⁸

While these communities can be a lifeline, they are also a sign of a broken system.

Safe withdrawal requires a compassionate, knowledgeable medical partner.

The Ashton Manual: A Blueprint for Safe Deconstruction

Fortunately, there is a gold-standard blueprint for safely deconstructing the benzodiazepine dependence: The Ashton Manual.

Developed by the late Professor Heather Ashton, a British clinical psychopharmacologist, this protocol is based on decades of experience running a benzodiazepine withdrawal clinic.⁵⁰

It is a compassionate, evidence-based guide that has helped thousands of people successfully and safely taper off these medications.

The core principles are simple but profoundly important:

1. Switch to a Long-Acting Benzodiazepine: Before starting to reduce the dose, the patient is typically switched from their short- or intermediate-acting benzodiazepine to an equivalent dose of a long-acting one, usually diazepam (Valium).³¹ Because diazepam and its metabolites leave the body very slowly, this creates a much smoother, more stable level of the drug in the blood, preventing the brutal up-and-down cycle of inter-dose withdrawal.⁵²
2. Slow, Gradual Tapering: The dose is then reduced in very small, pre-planned steps. The process is a marathon, not a sprint, often taking many months or even over a year.¹⁷ This allows the brain’s GABA receptors the time they need to slowly heal and up-regulate, gradually resuming their natural function.⁵⁰
3. Patient-Led Pace: This is perhaps the most crucial principle. The rate of tapering should be flexible and controlled by the patient, in collaboration with their doctor, based on their individual symptoms and tolerance.⁵¹ The patient is in the driver’s seat.

Table 4: Example of a Slow Tapering Schedule (Adapted from the Ashton Manual)

To make this concrete, here is a simplified, illustrative example of what the beginning of a taper might look like for someone on 6mg of lorazepam (Ativan) per day.

Note the slow, methodical substitution with diazepam before any significant reduction begins.

The full process would continue with very gradual reductions of the diazepam dose over many more stages.⁵²

(Note: 1mg of lorazepam is roughly equivalent to 10mg of diazepam).

Stage	Duration	Morning Dose	Midday Dose	Evening Dose	Total Daily Diazepam Equivalent
Starting	–	2mg Lorazepam	2mg Lorazepam	2mg Lorazepam	60mg
Stage 1	1-2 weeks	2mg Lorazepam	2mg Lorazepam	1mg Lorazepam + 10mg Diazepam	60mg
Stage 2	1-2 weeks	2mg Lorazepam	2mg Lorazepam	20mg Diazepam	60mg
Stage 3	1-2 weeks	2mg Lorazepam	1mg Lorazepam + 10mg Diazepam	20mg Diazepam	60mg
Stage 4	1-2 weeks	2mg Lorazepam	20mg Diazepam	20mg Diazepam	60mg
Stage 5	1-2 weeks	1mg Lorazepam + 10mg Diazepam	20mg Diazepam	20mg Diazepam	60mg
Stage 6	1-2 weeks	20mg Diazepam	20mg Diazepam	20mg Diazepam	60mg
Stage 7	1-2 weeks	20mg Diazepam	20mg Diazepam	18mg Diazepam	58mg
Stage 8	1-2 weeks	20mg Diazepam	18mg Diazepam	18mg Diazepam	56mg

This table demystifies the process, showing that a safe taper is a meticulous, patient, and collaborative effort, not a rapid plunge into withdrawal.

Part V: Conclusion: From a Fragile Dam to a Fortified Reservoir

The Success Story: “Mark,” Revisited

Let me finish the story of Mark.

After he hit his lowest point, trapped by his medication and his fear, we threw out the old playbook.

We adopted the “Dam Reinforcement” Framework.

It was a long and arduous journey.

We used the Ashton Manual to execute a slow, nine-month taper off his benzodiazepine.

It was not easy; there were difficult weeks with heightened anxiety and poor sleep.

But this time, we understood what was happening.

It wasn’t his illness returning; it was his brain healing.

Simultaneously, we started him on an SSRI and began intensive CBT.

He learned to challenge his catastrophic thoughts and, through exposure therapy, to face the physical sensations he feared.

He started walking every day, then jogging.

He cleaned up his diet and prioritized sleep.

I saw him a year after he took his last dose of diazepam.

The transformation was astonishing.

He wasn’t just free from panic attacks and free from the medication.

He was more confident, more resilient, and less fearful than he had been even before his panic disorder began.

He had confronted his deepest fears and learned that he was stronger than them.

His dam wasn’t just patched; it was rebuilt, stronger and more fortified than ever before.

He was no longer a hostage to his anxiety; he was the architect of his own resilience.

A Final Word: Empowerment Over Fear

The journey from the terror of panic to a place of stable well-being is challenging, but it is absolutely possible.

The seductive promise of a “quick fix” in the form of a benzodiazepine, while understandable, is often a trap that leads to a weaker, more fragile state in the long R.N.

True, lasting freedom is not found in a pill that silences fear, but in the courageous work of building a mind and body that can withstand it.

It lies in understanding the science, embracing evidence-based treatments like SSRIs and CBT, and committing to the foundational practices of a healthy lifestyle.

If you are struggling with panic, know that you are not broken.

Your system is sending a powerful, albeit terrifying, signal.

The goal is not just to mute that signal, but to listen to it and respond by building a stronger, more resilient self.

Have open, informed conversations with your healthcare providers.

Advocate for a comprehensive, long-term strategy.

Seek out therapy.

Be patient with yourself.

The path to recovery is not about finding a magic pill, but about embarking on a journey of empowerment.

Resources:

• NIMH – Panic Disorder: For authoritative information on panic disorder and its treatment.³⁴
• Behavioral Health Treatment Services Locator: To find mental health treatment facilities and programs in the U.S..²⁸
• Benzodiazepine Information Coalition: For information and resources related to safe tapering and benzodiazepine awareness.⁴⁸
• National Suicide Prevention Lifeline: If you are in immediate distress, call or text 988 in the U.S. and Canada, or call 1-800-273-TALK (8255).²⁸

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