For starters, "dependency" and "addiction" are two different things. We're discussing dependency, not addiction. I get what you're saying about the psychological factor (not an "addiction"), but there is also something called rebound insomnia, which is not in your head. That results from the use of sleep aids on a regular basis for an extended period of time. Basically, upon cessation of the sleep aids, the insomnia returns, and often times is worse than when you started.
Everyone is different for sure, but when any habit-forming med is taken on a regular basis (even once a day), there is a risk for withdrawals if stopped abruptly. I do get what you're saying about the half life and how the med works, but you're still putting it in your system regularly.
I'll give you an example. My dad has been an insomniac as long as I can remember. He has taken Xanax at bedtime every day for decades. It's the only thing that has worked for him (and he's tried a lot of stuff). One time, when he was travelling, he forgot to take his Xanax along...so he assumed he was just in for a few sleepless nights (as he understands about the rebound insomnia that occurs with the cessation of any sleep aid). Well, unfortunately, he went through some pretty intense withdrawals for a few days. He actually thought something was wrong with him, and went to the ER, as he didn't even think w/ds were a possibility. Sure enough, as soon as he took a Xanax when he got home, all of the symptoms disappeared within 20 minutes.
Whether or not a person will actually experience w/ds depends on a whole bunch of things....length of time a person is on a medication, the dose, other medications they make be taking, just to name a few. So, while you may not experience w/ds when stopping the Ativan, it's still adviseable to taper off if you decide to stop taking it, to be on the safe side.
Also, you recognize the issue with rebound insomnia that occurs when using sleep aids for an extended period of time. I personally have no issue with people who need to take a med to help them sleep, but if at all possible, it's best to limit the courses of those meds to a shorter length of time, as to not make the original problem worse. The other option is to just resign yourself that you will take the med indefinitely. I would just encourage you, if you haven't already, to look into some other alternatives for sleep. I too am a pretty bad insomniac, and have learned some tricks of the trade. TRULY there are techniques that, with practice and consistency, will improve your sleep. I'll post them for you in the next reply (it's a long post).
Here's to a good night's sleep!
If your doctor has prescribed it, and you need it during an especially stressful, anxiety producing time, then take it as directed. Don't be afraid of taking a medication prescribed to help you, just be aware of the considerations and precautions (like we talked about in this thread).
If you need any more info or support, please start your own thread, it's far easier to follow along when a post isn't tacked onto an older thread, plus, you'll get more replies.
You have received great advice above. I also, have experience with Ativan. It was a GODSEND during times of panic.
There are many different kinds of benzodiazepines. Ativan and Xanax are shorter acting benzos, and they leave the system pretty fast. They don't build up in the plasma, like Klonopin, which is a benzo that is better suited for more long term use. Now, the medication leaving the system more quickly isn't the same thing as the duration you will get relief with it. It just means it has a shorter half life. For the reasons above, Ativan is best used as a "rescue" drug to be taken "as needed' rather than a regularly scheduled dose. It actually works much more optimally when taken here and there. Klonopin, on the other hand (to give you a comparison), since it builds up in the plasma, is more effective when taken regularly.
I understand your concerns about taking ANY medication. You're not alone, we see people all the time who worry themselves sick, more over the med than their actual anxiety. Ativan, when taken "as needed" will allow you to stop the panic in its tracks, or in the least, reduce it to a much more comfortable level for you. If you're only taking it when you need it, you won't have any concerns about dependency or tolerance (where a higher dose is needed to maintain the same effectiveness).
As far as adjusting to the medication...even if you're not taking it all the time, your body will still adjust, meaning any drowsiness you may have at first will improve, as your system gets used to the med. It will not "shock your system" in any way, either when taking it, or when you don't take it. The most common side effect is drowsiness, which, for someone with panic attacks, is usually a blessing. It was for me. Therefore, just be cautious when you first start taking it, not to drive, or operate a jackhammer. Staying away from MY jackhammer was the most challenging aspect of adjusting for me (insert a well needed laugh here).
Do NOT be afraid to take it when you feel you need it. You actually will get better relief if you take it before your panic peaks. If you take it earlier on, when you feel the panic start, it will hekp to control it much better, PLUS, it will start taking some of the power away from the panic attacks, making them less frequent.
You can also take it in anticipation of a panic inducing situation. If you have REALLY bad attacks at lunchtime, take one about an hour before. Preventing attacks with a benzo is also very helpful. You have no worries about withdrawal if you are taking it here and there...even if you took it for several days straight. When my panic was at it's worst, I was taking it 2-3 times a day for about 2 months, gradually, I didnt need as much, and had no problem just decreasing the frequency and amount I needed to take. It's when you take it several times a day for many months in a row (usually more than 3 or 4) where you start having some concerns about dependency and tolerance. You may also find you need a smaller dose to give you the desired effect, so with your doc's okay, you can play with the dosage a bit. People have been on benzos "as needed" for years. Just don't be afraid to take it...you'll be so amazed at how well it works.
Also, you can ask your doc about using it sublingually. My p-doc told me that in the event of a severe panic attack, in order to get it into your system faster, you can let it dissolve under your tongue. It's actually an approved route of administration, but again...get your doc's okay first. I have to tell you that when I would take it SL, I would start to get relief in about 5 minutes, versus the 10-15 with the oral route. 10 minutes when in the throes of panic is a lifetime.
This is a GOOD thing,,.you reached out for help. There is NO need for you to suffer when there is so many different appraoches to treating anxiety and panic. I would also recommend therapy (specifically CBT, or cognitive behavioral therapy)...it's a must in learning how to cope and manage panic.
Best of luck...you'll be feeling much better soon! Please update us!
Hey everyone and thank you so, so much for all your advice and kind encouragement. Because of you all, I finally summoned the courage to try my Ativan. However, despite the fact that my hesitation to take it stemmed from the certainty that I would feel its effects too strongly, I found just the opposite to be true.
The first time I tried my 0.5 mg dose, I did feel a little better. I took it sublingually, so I was expecting fast results. I didn't experience the intense sensation of calm that I was waiting for, but it did take the edge off my panic, so that I was able to go about the rest of my day without falling apart. My state of relative calm lasted for about eight hours, though as I say, because I didn't feel as different as I thought I would, it was difficult to say when the effects of the medication ebbed. At the time, I was so grateful for the lack of side effects that I didn't begrudge the fact that the medication did not calm me as much as I had hoped. However, when I tried it again today, in the middle of an especially bad panic attack, I felt no better at all. My panic continued, and my heart rate stayed around 160 until I got home. I calmed down at that point, but as my anxiety is of the agoraphobic variety, I am always calm at home , so I doubt that my state of mind had much to do with the medication at all.
As you can imagine, I'm pretty discouraged. I am glad that I am able to take this medication without anything horrible happening to me, but as nothing really good happens either, there doesn't seem to be much point in continuing it. I don't know what to do. Why didn't my body react to Ativan in the way it was supposed to? Do I need a stronger dose? Perhaps I need a different medication altogether? I fear that I will never be able to leave my house again without freaking out. I am so sick of this. I want to start living my life! I was certain that I was on the brink of recovery, and now I feel trapped in my panic once more. Does anyone have any further advice on the subject??
You may need a higher dose. When I was in the height of my worst panic, I sometimes needed 1.5-2mg of Ativan to really work (that was after taking it here and there for a few months). Definitely ask your doc if you could perhaps try 1mg dose the next time you feel you need it.
VERY glad you got the courage to at least try it! The rest of the details can be worked through.
Thanks nursegirl! Should I just go ahead and try the 1 mg dose, or wait until I have the chance to talk to my doctor about it?
Hi I am currently taking .5 my of Ativan most nights as an aid in falling asleep, though sometimes I only need half the .5mg tablet. But I went to see a PA the other day and she tried to care me into considering thyroid medication by horrifying me about the possible addictive qualities of Ativan and about the fact that it could possibly depress the respiratory system. Basically, added to my normal anxiety surrounding sleep, I'm now afraid that if I continue to take my Ativan, I might just stop breathing in my sleep. Is this reasonable at all? I do not drink any alcohol or take any other sleep aids and my dosage is very low. My anxiety has been getting gradually better and i dont intend to be on Ativan forever.I guess I'm just looking for some reassurance from someone who knows what they're talking about and has some empathy.
I've been taking Ativan for a little over a year for sleep. I take 0.5mg or 1mg a night. 3 different doctors have told me the same thing:
Taking one dose a day only is fine since it breaks up the cycle that it stays fully in your system. I think the half life is 12 hours. You get physically addicted when a high level of the drug is in your system at a constant rate, like if you were to take Ativan every 8 hours, every day. Your body adapts to that level and gets used to it. So when you remove that "constant level", your body gets shocked and you get physical withdrawls. But this should only occur if you take it 2-3 times a day, every day. Taking it once a night for sleep breaks up the cycle enough to prevent physical addiction, but you will become psychologically addicted....which means when you stop taking it you will have trouble sleeping for a few days. But no drastic physical withdrawls. I have stopped taking Ativan for 3-5 days at a time, several times, and the only side effect was really bad stressful sleep the first 2 days. No physical withdrawls at all.
I'm not a doctor, but these are my personal experiences with Ativan and is also what doctors tell me. Reading about this stuff online is not good because people who go into withdrawls that say they only take one pill a day may not be telling the truth, or they may have been taking other medications that they stopped which caused the withdrawls, or they are recovering drug addicts or alcoholics which causes the withdrawls. Don't fully believe what you read on the internet that people say, there are so many other things going on that could cause withdrawls than just Ativan, especially if they say they only took it once a day and got physical withdrawls, and are not recovering addicts and weren't taking any other medications. The generic data on Ativan is that it's to be taken once every 8 hours for no more than 5 months. This is the FDA approved method. But no long term studies have been done on alternative uses, such as using it once a day for sleep. So when doctors hear that you take it every day for a long period of time, and then freak out, they probably either assume you're taking it every 8 hours, or they are not fully informed of alternative, non-FDA approved, methods of using it. Because all 3 of the doctors I've asked about once a day use had said there are really no side effects other than psychological addiction, which is very short term and not physically unhealthy, I believe them, not what random unkown people on the internet say. Doctors know the full extent of the issues people have, the internet only gives you a portion of the whole truth that people put forth.
Only take Ativan as needed, as like any other benzodiazepene, it can be habit-forming. This drug is not in the same class as SSRI's (other anxiety drugs like Lexapro, Zoloft, Prozac, etc.) and you will feel the effects in about 10 - 20 minutes. I have never taken Ativan, but have a prescription for Xanax (they're basically the same thing) and the calming effect lasts for several hours. I'm an extremely anxious person, and I've never taken more than one in a day. When I first started taking Xanax, I would fall asleep within the first five minutes of taking it because it calmed me so much. I also have a very difficult time taking drugs, and I've never had any bad side effects from Xanax, whereas with SSRI's, I can barely function. Xanax is the only thing that gives me any kind of relief, so while I only encourage taking Ativan when absolutely necessary, I'd at least try it. You will know after one pill how it's going to make you feel. And since it's not super long-lasting, worst case scenario is you'll have whatever side effects you're going to have for no more than probably eight hours.
Before turning to potent meds, I would advise one to exhaust all other methods, including the more natural or OTC remedies (which, you should also limit as much as possible, because rebound insomnia will occur with those too, after enough regular use).
Here are some tips to help with your sleep:
1. Avoid any and all stimulants (caffeine, nicotine, energy drinks, etc) as much as possible, especially within 4+ hours of bedtime.
2. Exercise is a great way to induce sleep, as it releases natural endorphins. Even a brisk evening walk will help. Your exercise should be an hour or more before your bedtime..you don't want to exercise right before bed.
3. Try to avoid eating a heavy meal close to bedtime. If you're hungry, stick to a light snack an hour or more before bed. Avoid ALL fluids 3 (or more if you can) hours before bed. Nothing worse than finally getting to bed and have mother nature wake you up!
4. Stick to a consistent bedtime and a consistent bedtime routine. Even on days when you don't FEEL tired at your bedtime, try to stick to your routine...that conditions your body and brain. Pick a reasonable time. If you work 3-11:30 and get home at 12, a reasonable time isn't 12:30, as you would need time to unwind after getting home.
5. Create an environment conducive to sleep and relaxation. Your bedroom and bed should be an inviting place that you look forward to retiring to. Keep the room clean and clutter free, keep dust levels down. Keep your bedding washed with clean or fresh smelling scents. Choose comfy, non-binding clean smelling PJs. ALL of our 5 senses affect our mood, and also our sleep. If you have a quiet room, but your sheets smell like feet (lol), that won't be very relaxing. Keep the room DARK. Keep weather in mind. In the summer, you would only need a light sheet or blanket, in the winter, heavier blankets are necessary to keep you comfy. Again, back to the senses...if you create a bed that keeps you too hot or too cold, that will interfere with your sleep. Keep a glass or bottle of water at your bedside, in case you awaken with that dry mouth and need for a drink. This way you don't have to get out of bed to get something to drink. Light soothing music or white noise machines for LOW (not blaring) background noise can be helpful. Try to avoid using TV as a background noise, as our brains are still working while asleep, and the things you hear from the TV could affect your anxiety levels and even dreams. Basically, sleeping with sounds of "The Chainsaw Massacre" in the background won't lead to happy thoughts. ;0) A warm bath or shower is great before bed...dry your hair. Never go to bed with wet hair. NOT comfy!
6. Ignore the urge to get out of bed. Even when you're feeling frustrated, try to remain in bed, reposition yourself, adjust your sheets, read a book if you are not falling asleep, but the more up and down you do, the harder it is to get and stay asleep it is. The same goes for nighttime awakening. If you DO fall asleep and wake up in the middle of the night, ignore the urge to get out of bed...again, reposition yourself, adjust the sheets, and try to go back to sleep. When you get up out of bed, you're waking yourself more. If you stay lying in bed, you are not as awake. If nature calls...go to the BR, and get right back to bed..no snacking, no smoke breaks (I'm bad at this...lol). Those things are murder for sleep. Get up...go potty, right back to bed.
7. When you DO manage to finally start on a consistent routine, you'll find things that help and hurt your sleep. Take note of them and adjust your regimen as needed. Sleep patterns will change, and life happens, so sometimes, adjustments need to be made. Consistency is TRULY the key..I cannot stress that enough.
8. Listen to your body. For a while, while your sleep is lousy, you will feel tired at odd times of the day. Your body is telling you it needs rest, so heed the wanring...take a nap. Lie down on the sofa, and catch a 1 hour (or less) nap. Don't nap for hours at a time, that will interfere with your nighttime sleep. An hour is the perfect amount of time for a refresher. Also, don't nap in bed. Once you're conditioned, your bed should be for nighttime sleeping only.
Hope these tips help some...I know these are the things I do that help me get some decent sleep. It's not always foolproof, but it works pretty well. Please be patient for a while too...your body is getting back to normal, and that takes some time. If you are going days without any sleep, definitely see your doctor. Sleep depivation is a whole other ballgame, it can be dangerous.
Best to you...sweet dreams!
Hey there. Reading all these answers has been very helpful for my case too. I take it as when needed and it really helps me. I was a bit worried recently where i was using it quite a bit. 7mgs in two weeks with a couple of days doing 2mgs a day. I was worried about withdrawal symptoms with this type of usage? Any thoughts?
Is there something going on where you're needing more of the med? Are you taking it as directed, or have you been taking more than prescribed? Are you taking it every day?
I just had a few bad weeks out of the blue. 1 mg a day for three days then none for a week then 2mgs one day then two days off then another 2mgs. I'm allowed up to four a day but no way am i going there. No not taking it everyday.
I just had a few bad weeks out of the blue. 1 mg a day for three days then none for a week then 2mgs one day then two days off then another 2mgs. I'm allowed up to four a day but no way am i going there. No not taking it everyday.
You should be fine, since you haven't been taking them regularly. You may feel a little increased anxiety when you reduce back down to your typical amount, but you shouldn't have any w/ds. Are you in therapy? That's very important. How about any other meds? Like an antidepressant? Just be sure you're talking to your doctor so that you continue to address the anxiety. As long as you continue taking them as directed, and only when needed, you shouldn't have any worries about dependency.
Hope you feel better soon!
I'm glad to find this discussion about Ativan. My 19 year-old daughter has an anxiety disorder. Right now she's taking 75mg of Zoloft. Her therapist just prescribed her Ativan as a "rescue pill" to take as needed. My concern is this: when she's in the throes of a severe anxiety attack, she cuts, and has suicidal thoughts. I feel, because of this that I need to keep control of the Ativan and just let her have 1 pill at a time in her possession, so she won't feel the urge to take more. When she uses that 1 pill, I'll give her another one to have for the next time. Is my concern justified?
I'm updating this post because the information I posted I feel is incorrect. I had listening to the doctors on this not being addictive when taking it only once a day, and also the fact that I would stop taking it for a day or two to lessen my tolerance and the only effect was loss of sleep.
But a few weeks ago I went to a sleep specialist psychiatrist and he put me on Trazodone for sleep, and told me I should wean off the Ativan because it's not good to take it everyday and it provides no long term solution. So I did and after the 3rd or 4th day of reduction my anxiety was through the roof. I upped the dose back to 0.5mg and normalized again and then gradually reduced the dose (shaving the pill with a razor) over just a few days until this past Wednesday where my last 0.25mg dose. I was fine until Saturday night when I started getting panicky. Then this morning has been really bad, i.e. very panicky, anxious, stomach pain, diarrhea, no appetite. I was not "panicky" like this ever, before taking Ativan. This is tough. And I'm very disappointed that the doctor who told me to take Ativan once a day and said I wouldn't get physically addicted was just dead wrong.
The sleep spcialist doctor said you can get phsyically addicted by just taking it once a day. He said you should only take it as needed, no more than 2-3 times a week.
So I stand corrected. Be careful on this stuff, it's nasty.
Hey, thanks for the update!
I had initially responded to your first post with this comment:
"Everyone is different for sure, but when any habit-forming med is taken on a regular basis (even once a day), there is a risk for withdrawals if stopped abruptly. I do get what you're saying about the half life and how the med works, but you're still putting it in your system regularly."
I agree it's unfortunate that your doc gave you the info he did. This is not uncommon, as many docs would tell you the same thing. This is why it's so important to do a little bit of your own research when possible. I get it though, you were kind of misled and that's unfortunate.
A good rule of thumb (for future reference), regardless of half life and such, a habit forming med is going to cause tolerance and dependency if it's taken with any regularity. In some cases, even taking something every other day, if done regularly, could also cause some issues. Basically, your body gets used to it, and when you stop, w/ds ensue. This is why these shorter acting benzos are best taken only when needed )here and there), or as a short term course of treatment (a few weeks or so).
The medication itself is not inherently bad, it's the misinformation and poor management of these meds that ends up being the problem.
Sorry you went through what you did...take care!!
Hi Nursegirl, thank you for taking the time to respond, both times. I thought that I'd get an email notification when someone posted in this thread, so when I didn't get the email I didn't check. I wish I did though. You are definitely right, especially when you say benzos aren't bad, it's the people advising poorly on them and the people using them....or should I say, misusing them. I misused and paid the price. Live and learn. I just felt bad that I posted that bad information here and wanted to make sure it was corrected. Glad you were also here to fact check the information.
I'm going through a particularly stressful time at the moment and am considering taking ativan daily for the next week or so, but am worried that this is a bad idea. I'm not on any other drugs, don't drink or smoke etc.... but I really do rely on ativan for those times of intense panic. Still, this is the end of my semester at school and I'm not getting anything done because of shame and anxiety, and when i took an ativan last night, i got so much done because i wasn't anxious anymore. I usually take .25-.5 mil as I am a small creature. Thoughts?
I have a first hand experience with Ativan... I have taken both 0.5 mg and 1.0mg and had absolutely no negative side effects while taking either dose. I too recommend only taking it when necessary which is what I did and there were no withdrawal symptoms... If you find that you have to take it daily then I recommend only doing that for a short period of time and then having your doctor switch you to something else.... When I was taking Ativan it worked fairly quickly and lasted for 8-10 hours for me which is amazing when you are feeling anxious all the time.. Don't worry it won't be a shock to your system I am sure your body will be more than happy to relax for once... I was very nervous about taking Ativan the first time which was in the ER after an anxiety attack and it helped so much and it felt good to just be calm and relaxed for once.. I think you should give it a try and see what it does.. I didn't have as much success with the 0.5mg compared to the 1mg but we are all different so just try and relax and try it and you might be surprised by the results! Best of luck to you and keep us updated :)
I used to take klonopin to help with nighttime anxiety that prevents me from sleeping. I got to a point where I simply didn't want to take any meds anymore so came off of that, Effexor, and adderall. I was completely med free for over a year and in general have handled it well despite consistent anxiety keeping me from getting to sleep and lack of ability to concentrate which I believe is fueled more by anxiety. I have been under an enormous amount of stress and finally went back to my dr. He started me on .5 to 1mg if ativan prn. It did help me relax to get to sleep but did not help me stay asleep through the night and upon waking up I feel such anxiety that its very difficult to get back to sleep, even on nights I took the ativan. Went back today and he is putting me back on klonopin on prn basis.
My question is, if I take a very low dose of the klonopin only a few nights per week, but end up pregnant (husband and I are just letting it happen if it does), would it be a huge concern?
I have taken one table of 0.5 mg of lorazepam (Ativan) daily off and on for 25 years to manage what is mostly mild anxiety. More recently, in the midst of some rather unsettling physical problems and temporarily unable to exercise, I have on occasion increased my dosage to 1 mg.in the morning. As I have begun to approach retirement I have been more regular in my use of lorazepam and even after such an extended period of taking it I have not noted any lessening of its effectiveness.
I would not pretend that I could stop taking lorazepam tomorrow, but after 25 years I probably worry less about issues of dependency than other commenters on this forum. Lorazepam was part of a treatment regimen (that included a similarly small dosage of an SSRI through 1999) that I believe made it possible for me to work regularly and I believe successfully, raise three children with my wife, put those children through college and reach early retirement age more or less intact. I am grateful for these medications and fortunate to have a competent therapist. But what is odd, and one of the reasons I have started visiting these forums in the first place, is I thought that with the prospect of retirement and the less stressful life it promised my anxiety would slowly dissipate. Unfortunately, I have found just the opposite to be true, though as I mentioned above, I have had heart and esophageal procedures within the past 12 months and I don't believe they can be entirely separated from my long-standing genrealized anxiety disorder. For the older commenters on this forum, is it common to experieince heightened levels of anxiety, regardless of specific circumstances, as one ages? As I mentioend above, I have found this to be the case, much to my surprise.
So, it apprears that I will remain with the lorazepam some while longer. Do I wish it were otherwise -- absolutely --but what I can tell you is that faced with the prospect 25 years ago of trying to work and support a family with a life beginning to spin out-of-control, the decision to take a medication with known beneficial results was an easy one for me. And one I do not regret.
I take 1mg of Ativan at 8 am and 2 pm to last me all day. So as I was reading it won't make me have withdrawals when I eventually stop using it?