A few questions about Ativan
by gothic_beauty, Jun 15, 2012
So, I have suffered from panic attacks for some time now. However, they have recently gotten so bad that after a lifetime spent in adamant opposition to all forms of medication, I have decided to take the plunge and give it a try. I went to my doctor, who prescribed Ativan. I have heard that it is pretty safe, and I have a low dosage (0.5 mg) but I am still very nervous about taking it. I have a few specific concerns that I was hoping to address.

First of all, is Ativan best to take regularly or as needed? I am hoping to take it only for the worst of my panic attacks. On the other hand, I am afraid that such a decision might cause a shock to my system: if I am in the throes of anxiety and take the drug, won't the abrupt sensation of calm be hard on my body? Also, if I take it once and then do not take it again for several days, I fear that it will cause all sorts of strange withdrawal effects , or a rebound effect, in which my anxiety levels after the drug wears off become worse than they were before I took it in the first place. I have heard of instances of this happening, and I don't want it to happen to me.

Secondly, how long does it take to feel the effects of this drug? I have heard that for some people, it takes quite awhile. I can just imagine my panic rising as I wait for it to work, fearing that it will not work at all.

Thirdly, how long can the effects of the drug be felt? Will I get a good long period of calm, or will I be tempted to re-dose within an hour or two?

Finally, like almost everyone else who has a fear of medication, I worry about side effects. I have done a lot of reading about the various side effects of Ativan, from drowsiness to dizziness to worse, and I don't know which I will experience. I know that it is different for everybody, but I'd love to hear some feedback from anyone here.

Again, I realise that my reaction to medication will not be identical to anyone else's, but the more I know, the less scared I will be. If anyone could share their stories with me and reassure me that this drug will not kill me and may actually help me live my life without the constant terror of anxiety attacks,  I would be grateful. Thanks!
Member Comments (31)
by kickanxietysbutt, Jun 17, 2012
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.
by XxBrokenInsidexX, Jun 17, 2012
      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 :)
by nursegirl6572Blank, Jun 18, 2012
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'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)'s a must in learning how to cope and manage panic.

Best of'll be feeling much better soon!  Please update us!
by gothic_beauty, Jul 02, 2012
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??
by nursegirl6572Blank, Jul 02, 2012
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.
by gothic_beauty, Jul 02, 2012
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?
by Rhonwen, Apr 04, 2013
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.
by toddone46, May 02, 2013
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.
by nursegirl6572Blank, May 02, 2013
Hello there!

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 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!