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Safest benzo to use for panic? XANAX or Ativan???
Hi,
So as I am daily struggling with panic attacks and anxiety attacks that have me on the verge of going to the ER a few times a week, I have been forced to rely on benzos almost every day.  I have been suffering from panic disorder for at least 17 years and it is so bad right now I am becoming agoraphobic.  Over the years, I have only taken xanax when i was on the verge of an attack-- about .25 to .75 and that would normally help. Never used them daily.

Recently, the attacks have been so bad that I have had to up them to 1mg to 1.25 mg and I'm getting nervous about addiction and relying too much on these. And also the fact that my body is becoming used to them and not responding as well during a panic attack as it used to.

  The psychiatrist had also given me .5 ativan which he wanted me to take on a daily basis 3x a day and then just use the xanax for any 'breakthrough' attacks.  I will admit I have not been taking the ativan 3x a day...only once in the morning as I'm afraid of addiction with this as well.  Sometimes I will take a 2nd one.  

Is this safe to be using both????  AT the most i have taken 1 mg of ativan and 1mg of xanax throughout a day if I have a very bad panic attack.  

Obviously, my doctor is still trying to find the right anti-depressant that works for me (i've exhausted all SSRIs and SNRIs at this point) so he is trying to keep me from having anxiety attacks on a daily basis.  But I'm worried about this... I'm also taking 10 mg of Inderal if I have an attack.  

Also, I don't know if this happens to any of you, but when I have an attack they don't just last for 5 -10 minutes...I am WRECKED for hours.  My body is shaking and I feel so weak and like I can barely speak because I feel short of breath.   I have to just lie in bed as if I'm an invalid and they come and go in waves.  Constant anxiety that just lessens and worsens as the hours go by...

Anyone have any thoughts/advice and what are you all taking to cope on a daily basis when the anxiety is so intense like this?

thanks in advance,
k
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246464 tn?1249455747
Klonopin works for me.
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4812794 tn?1359500746
Interesting to know. I have been suffering mostly mild attacks for about 10 years, due to a bad reaction to Tegretol. This last year I had stopped seeing my Psychiatrist due to insurance. Guess what I started 2 weeks ago having very severe Panic Attacks. I can't get my breath, can't lie down as I feel even worse with my breathing I am extremiely claustrophic with the attacks. I have .25 Xanax and .5 Ativan, and was wondering about dosage, as my phschiatrist will not see me until Jan 26, treating me as a new patient. I also have some old Buspar, which isn't helping now. At least I now know I will not kill myself by taking an extra pill here or there. It is either that or have myself commited. The pills just help calm me down a little, I have been fighting it constantly since it started.
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I found that I couldn't use xanax because it made my body start tweeking so much I had to go to bed.  Ativan works well.  It IS addictive, but more likely addictive if you are on 1MG 3 times a day or more for 2 months.  It's safe to use the recommended dose you are on for a while.. If you feel like you don't need the 2nd or 3rd one.. don't take it!  But if you are suffereing,, take it!   I have been taking it on and off for 5 years and I don't think I was ever addicted.  When I first was on it I took .5mg 3x a day for 3 months.  Then I went down to one time daily and more as needed and I was fine.  

If you do end up getting addicted, you will be fine.  It is not an aweful withdrawal.  But I don't think you will that fast.  I am actually on lorazepam again 1MG 3x a day because of a huge anxiety attack I had.  I was feeling like I was on the verge of a panic attack for 2 weeks!  

I do think that xanax is stronger, but your body is used to it, so ativan should work well too, because it is new.  

Good luck, and if you have any questions feel free to ask.  Good luck!  You'll be ok!
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Oh, and my panic attacks are like that too.  Once they stop, I feel on the verge of one for the rest of the day.  The used to finally go away when I would get home.. kinda like my safe haven... but now, no.  I am on lorazepam all day long.. keeping calm but still anxious... and even home right now doesn't make me feel better.

What meds have you tried?  I'm curious?

Feel better.
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195469 tn?1388326488
I have to agree with your doctor about taking Ativan 3 times a day and Xanax for breakthrough anxiety.  Why not follow his instructions to the letter and see how you really are feeling after a few weeks.

You are doing everything right, by getting therapy in addition to medication.  That's the smart way to approach anxiety.  I am sorry to hear that you are house bound.  It must be so hard for you.  I hope that is something you can get a handle on, with your therapist.  You are missing so much of life...and so much fun.

I wish you much luck and much success with your therapy.  I do hope it won't be long before you are outside enjoying other people and the beautiful sites of the upcoming Fall season.  Good luck to you.

Best Wishes,
Heather

P.S. You are having to take more of an increasing dosage of Xanax, because you are not keeping the Ativan running through your system.  Try the doctor's schedule and I think you will see that you need less of the Xanax.  Xanax is a very short acting drug and leaves your system in as little as 8 hours.  Your doctor is trying to keep medication in your system 24 hours a day to keep your anxiety at bay.  All the more reason to stay on HIS schedule.  Right?
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600041 tn?1356163729
Benzos in general get a rather large amount of 'bad press', but xanax is the one that stays in your body the shortest, and is the most addictive. Most people tend to think it has the harshest withdrawals too.  My doctor was frustrated when we finally had to reach the conclusion that no school of antidepressant did anything for me, or I experienced incredibly negative side effects. I have not been on ativan myself, just xanax and klonopin. You definitely do want something with a longer half-life than xanax so you can hopefully stay more settled. I know, the impulse in all of us as people with anxiety disorders is to panic over the long term of addiction/withdrawal/etc.  But if you can't find some relief each day, then a change in medication is needed. It is possible you will become dependent. If you do,  when you switch to a different medicine, you may go through a couple rough weeks of withdrawal.... but you're living every single day roughly as it is right now. In the end, you have to weigh whether those POTENTIAL two weeks later is worth having some relief now.  If you stick with your psychiatrist, they'll help you through the changing of any medications in the future and continue to try to help you find some sort of peace. It's worth trying the medication as prescribed. You could find out that it really helps. Some people do have to be on anxiety medicine for the rest of their life. It's frustrating, but that medicine may make it so that you CAN have a life. So give it a chance. If you're anything like me, anxiety has likely taken so many things from your life as it is. What do you really have to lose in following the psychiatrist's plan?
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433485 tn?1321816990
Hi.  I take Klonopin .5 mg 3 times a day.  My doc says that it has a longer half life so is a better long term.  The others, xanax and ativan are good, he says, for immediate relief but leave the body sooner.  You may want to check into it.  Hope this helps.  Also, I agree with the other posters who suggest following his advice, first.  I have dealt with life without benzos and definately prefer the quality of life I have now.  I also take Celexa 6o mg a day for depression.  
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I read your post with deep interest.  I also feel you should follow your physician's recommendations in regard to medication/dosing schedule.  I also think that right now, if you do follow his/her recommendation to the letter, you are in a somewhat 'safe', for lack of a better word, spot.  I cannot even bring myself to admit here how high my tolerance is regarding alprazolam; I feel it would most probably blow most people away.
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212161 tn?1432037254
if this is a long term you ned to be on a long term med, ativan and xanax is not it, your dr should put you on klonopin its a long term and works great. yes you will have to wing off it if you ever come off of it , but with the others your taking your body will get use to that dose and need more with klonopin it does not. i would be very concern, ask your dr for a long term med not one that you will have to come off of and withdraws are bad. good luck.
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Thank you everyone for all your comments,
well after having another attack for the 3rd night in a row I spoke to my shrink this morning and he has taken me off the ativan and the xanax and put me on klonopin .5 2x a day.  He had been trying me on Neurontin as well which hasn't been working, so he is weening me off that and we decided I should go back on Prozac which is what I had been on 17 years ago when the panic/anxiety attacks were at this same level that they are now.  I had been on it for some time (suffer from depression as well) and of course after a few years had to get off as these drugs always seem to poop out.  
CMSliwa, you had asked me what drugs I've been on...
well after I began on Prozac 17 years ago (and xanax whenever I had the attack)  I then moved on over the years to try the following:
Celexa
Paxil  (allergic rash to this)
Zoloft
Effexor
Lexapro
Wellbutrin
Remeron
Abilify (only 1 month- couldn't tolerate)
Lamictal (only 1 month- couldn't tolerate)
Pristiq  (did nothing)
Neurontin

The last 5 have been what I have tried since beginning of this year since the panic/anxiety/depression came back full force.  These past few months the anxiety/panic is killing me--- having these attacks almost every day and in CONSTANT state of anxiety.  I feel as if there are very few moments of relief and my brain is in constant OCD mode of being incapable of breaking the catastrophic cycle it goes into when I have an attack...and when I don't...well i can't stop worrying about it.  It's so hard to explain this to people who have never suffered from it. I realize how ridiculous it all sounds but it's hard for brain to focus on anything else. I'm so upset that I've been working on meditation and yoga breathing (doing yoga classes 3-4 times a week) and this is not helping or giving me relief.  There are days i come home from yoga and have an attack!
Last night, I felt myself beginning one, and rather than take the meds I thought maybe I can 'breathe through this', do some pranayama and a little meditation...
has anyone tried this and found it's almost impossible to meditate with your heart pounding in your ears????  After 15-20 minutes of trying this method i literally ended up with a faster heart rate and my bp went up (yes, i'm a hypochondriac so I'm constantly checking both).  This is just miserable.  How are you all dealing?
I'm doing my weekly therapy and my therapist is sending me to take a class with this famous doctor who works on breathing methods to get through anxiety/panic attacks...will also take an 8 week 'mindfulness-stress reduction' course that is based on John Kabat-Zinn...
are any of you familiar with this?  Would love to hear your coping mechanisms and what it is that I'm missing here.  Have done CBT (not very helpful for me when it comes to these attacks i have to admit)...
thanks so much for listening and sharing...
best to all you and much thanks for everything.
kim
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I'm new to this forum (joined today) and although I'm very sorry to hear anyone going thru this stuff, it does relieve me to know there are others out there who are/have experienced the same things I am. I actually found this site trying to find answers to whats going on with me.

About 10 months ago I started having what I call my "little episodes". Since then it's gotten worse up to today when I feel like I'm going to lose my mind. My blood pressure bottoms out but my heart races. The thoughts of "I'm going to die" will not leave my head, I shake uncontrollably, and I'm chain smoking to try and calm myself down. Last month I ended up spending the night in the ER because I thought I was having a heart attack. They said it was a panic/anxiety attack. My Dr put me back on Serzone (which I had previously taken for years along with Welbutrin for depression) but after a couple weeks I quit taking it because all I did was sleep. Over the past 13 years I have tried at least 15 different meds but had to keep changing because I got such bad side effects. I stuck with the Serzone and Welbutrin because I didn't with those. After I changed jobs and didn't have the stress, I came off them. Now after finding a job I love, I'm having anxiety/panic attacks. I don't understand where it's all coming from. I have such an overwhelming feeling of doom/dying, I'm afraid to take anything. I've seen 2 neurologists, have CT scans, MRI's, EEG's, stress tests...all with a months time. Every test has come back normal but now my neurologist wants to put me on Depakote. He says even though all my tests are normal he thinks I may be having mini seizures along with migranes and that this med is given to people with manic depression, Bi Polar disease, and schitzo also so it "should" help my anxiety also....??? He also said not to take the latest perscription my family Dr gave me which was Buspar because it can make people who don't have seizures have them. Now I'm really confused on what to do.

I don't want to take medicine but I know I can't go thru another day like I had today. The attacks are coming more and more often and I'm too frightened to even try the meds these Dr's are giving me because I think I'm going to die. I can't find anybody whose taken Depakote and all the literature I find scares me half to death. I've tried every home remedy I can find (with the exception of supplements). I carry a bottle of lavender lotion with me to sniff, I've tried I don't know how many breathing exercises that NEVER work, smoking doesn't help, I've even tried eating to the point of making myseld sick just to try and take my mind off of it and NOTHING is working. I'm freaking out just thinking about going to work tomorrow. Even though only 2 people there know whats going on, I feel like everybody is looking at me and thinking I'm crazy. I can't function like this. My minds in a constant fog, I can't think clearly, I shake, my hearts racing, and I can barely breathe.
UGH...can anybody help????
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My heart goes out to you. Believe me I understand exactly what you are going through.  And most people on this board do as well.  So take comfort that you are not alone and you are ok.  We all tend to go through these cycles of having every medical test known to man done because part of the illness of panic/anxiety disorder is to think we are dying.  And I know what you mean- because I am CONVINCED i'm going to die during these attacks...and well pretty much all the time as I wait for one to come on now. They are terrifying, but if all your tests are coming back normal there is one thing to remember---physically you are FINE. Nothing will happen to you.  You need to find the right meds as I do and the right kind of therapy and coping mechanisms.  We are all in the same boat.  
I, like you, am TERRIFIED of all the meds.  I would definitely suggest getting a second opinion if it would make you feel better.  I am not sure why your doctor thinks you are having mini seizures...what does that mean and where did they get that from? Did he explain it to you?  In any case, get another opinion.  I live in New York so just about everyone I know has been on a ton of these drugs at one point or another (i work in a creative field...goes with the territory i suppose ;-)  I had a friend on Depakote for awhile.  I think she did fine on it!  But you, like me, are going to have to learn how to 'let go' and start thinking more positively and give these meds a chance.  Luckily, I am because i work in creative field just about everyone i work with knows i am having these attacks because i talk about it and i'm very open.  The last thing you should worry about is anyone at work being able to tell or judging you. Trust me...people aren't noticing the changes in you or what is going on inside your head (and body) adn that's nothing for you to be concerned with anyway!  You must focus on letting these thoughts go as they come...just keep reminding yourself YOU ARE HEALTHY. You have had every test done and they have all come back to confirm this.  The fear of dying is part of the panic disorder, but it doesn't mean you are.
Please take care of yourself and keep writing. We are all in the same boat.  I am exactly where you are now but i am determined to keep going.  YOu have to work at this and fight the fear.  
I am wishing you the very best and much peace. Check back in!
best to you,
k
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Was your friend on Depakote for anxiety? I just feel like the Dr's comment that it "should" help the anxiety was blowing it off. I KNOW anxiety/panic is my problem and I don't want to take something thats not really going to help
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You mentioned you tried Abilify and Lamictal and couldn't tolerate either med...can you elaborate on what happened?  The reason I'm asking is because I suffer from panic disorder w/ agoraphobia as well and have been on Zoloft, Paxil, Prozac, Wellbutrin and Buspar - none of which helped to any degree.  And my Dr. has suggested that I should try a mood stabilizer (either Abilify or Lamictal) but I'm scared of all the potential side effects!!!!  I also suffer from depression...as to whether it's the the root cause of my anxiety  - or the result of it - I can't tell for sure (neither can my Dr.).  Right now, I'm currently taking 5mg of Valium 3x a day but it's not doing much good.  Perhaps I should try Klonopin?  (My Dr. has mentioned that it has a mild antidepressant effect.  I don't know how true that is though!)
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390140 tn?1219887489
HI, I only know too well about what you describe as "waves" of anxiety. It is basically having a panic atttack 24 hours a day. I am glad to see that you have a doctor who seems to be really trying to work with you. At one time, I was taking 5mg of diazapam (valium) 3x day when my anxiety was that bad. I took that as I began taking Effexor so that I could get some relief until the Effexor kicked in. My doc advised me that I needed something more longer lasting than xanax, thus we went with diazapam (klonipin was another option we discussed). The diazapam was a life saver for me--I could finally sleep!!! I was then able to gradually wean off of it without any problems after maybe 2-3 months. I now continue with Effexor 75mg but still have diazapam if needed (sometimes a couple to three times a month to not at all).
  I took the 8 week MBSR course developed by Jon Kabat Zinn. I found it extremely helpful. It really helped me to understand how the body reacts to stress and anxiety and the mind-body-emotion connection.  I also met alot of other people who suffered from anxiety too, and we still keep in touch to support one another. I still use what I learned every day. I hope you find it as helpful as well.
Osceola
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I believe my friend was on Depakote more for depression, but i will ask her and find out. If I remember correctly she was on it for years and didn't have any problems with it.  Can I ask you who suggested the Depakote for anxiety?  It may work, but I really don't know.  The funny thing about these drugs is that they have a different effect on everyone and you just never know - it may be the drug to help you!  I foudn a site where people rate these different anti-depressants and tell what their experiences are but I don't think it's worth even looking at because what it comes down to is...everybody has a different response!

Definitely talk to a psychiatrist about Depakote and the properties it has and why they think it's a good choice.  

I am guilty of the same things you are with these meds...I'm hyper sensitive to every change in my body and I believe i am having reactions or side effects when it actuality it's probably nothing.

MYSTICMOON... I got off abilify and lamictal exactly for the reasons you mentioned.  I got terrified of the side effects.  Abilify just didn't seem to work for me (but I wasn't on it for very long) and i got scared with the lamictal although it did seem to have some good effects.  I started getting headaches on it that I never get.  Same thing happened to a friend of mine who was on it. BUT having said all that...I'm afraid I didn't give these drugs a fair chance because I spent too much time reading up on side effects and obsessing over what was going to happen in my body.  IT's really kind of ridiculous.  We have to at least give it a try. ( I know, easier said than done)...but if you do have a reaction, you're not going to die from it...you'll just stop the drug and be fine.  My shrink has  a difficult time with me because i do say "no" to a lot of things he wants me to try and i'm probably just hurting myself in the end.  At this point, even over the counter meds have a list a mile long of side-effects so maybe it's best for people like us who are so focused on every little thing in our body NOT to read any of that!

My doctor wanted me to start taking beta-blockers because my heart would race so fast it was scaring the hell out of me and the way i would panic during it would just make it escalate further. I was scared to even try those!  Now I realize how silly that was!  I went to see a cardiologist to double-check everything and he recommended the same thing.  Now I"m taking the inderal every day so i don't have the racing heart to add to the panic attack.  It really works! (For the heart racing anyway, but sadly I'm still getting 'attacks' all the time--they are just manifesting in different ways physically now)   But my point is, there were so many times I suffered with this racing heart and ended up in the ER all because I was afraid to try the inderal. Sometimes these drugs do work :-)

I am suffering we are all suffering so much.  Living with this is hell, but i also know it passes somehow with meds and therapy in time.  I know I was living this kind of hell for a long time 17 years ago when it first began, but then it subsided for over 15 years until it kicked back in again.  IT will END again. I know we all have to just hang in there.

As for the Klonopin, i did use it at the beginning of the year-- i was also very depressed at the time so it's hard to tell if the Klon was the cause or not. I will say though that I had far fewer anxiety, panic issues and at this point I will take a little of the depression to be relieved of panic if that makes any sense :-)  I'm hoping the Prozac will work again and balance it all out.

Osceola, thank you for the infor on the MBSR course! Believe me, it can't start soon enough!!!!

By the way, I'm not sure if any of you are New York based, but I've been hearing a lot about this psychiatrist who is at the forefront of using alternative meds/methods to deal with panic, anxiety, and depression.  Of course this appeals to me because I don't enjoy taking meds either.  Well, from what I heard, he has been doing a lot of work with breathing techniques and the PET scans they've done on the brains of people who have been using them are apparently incredible.  It has actually helped changed the structure of the brain...i suppose much like a Buddhist monk can do in meditation.  Anyway,  I am planning to take a class he is giving to therapists using this technique.  I believe there is info on him on the web-- his name is Dr. Richard Brown I believe and he is connected with Columbia University.  Whatever I learn from this class I will be sure to pass on!  Keeping my fingers crossed that it will be helpful!

In the meantime, thanks again for all of your support.  I'm sorry you all have to deal with this too...but this really is a great place to know you are not alone and to realize how wonderful and caring strangers can be!
best to you all,
kim
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By the way, I forgot to mention...lamictal is actually supposed to be amazing!  I did some reading up on it - very interesting stuff.  There is a psychiatrist who has this website about bipolar II (a bit different from bipolar I)  which my shrink and I discussed I could possibly be.  Well, i can't remember the name of the psychiatrist who has this website all on bipolar II but I will say that he RAVES about the effects of lamictal.  Also, he said that too many people are afraid of this drug because of the 'rash', but if you increase it slowly you really diminish the possibility of the rash developing.  It really may be worth a shot!  I have read many positive things about it!  good lucK!!!!
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246464 tn?1249455747
I hope the Klonopin works. Between that and Lexapro, it has brought me some good days.

I hope good days are ahead for you too.
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According to the FDA, Depakote is indicated to treat the following:
1) Manic episodes associated with bipolar disorder.
2) Migraine.
3) Epilepsy.
Manufactured by:
Abbott Laboratories
North Chicago, IL 60064, U.S.A.
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Different meds work for different people; I know that is a very confusing piece of advice, but between Ativan and Xanax they both have fairly short half lifes and are good for what they are designed to do.  These meds can be prone to addiction but remember millions of people have used them both safe and effectively.  In my opinion you are doing the right thing by working through this with your psychiatrist.  Working with a doctor that understands the use/side effects of these medications will only help; keep on working with him/her...I know patience is a very hard thing to do when you are going through this.  Please keep us informed.

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ADVISE SEEKER I completely understand what your going through because I'm going through the same debilitating panic attacks, in my case my Dr won't spare me mercy and prescribe me xanax, she says she wants to control the frequency of the panic attacks so I'm on 40mg pail and 40mg latuda, my anxiety and panic attacks are still alive and kicking and at this point I'm house biund, its a frustrating process and I fear there is no real control over panic attacks
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ADVISE SEEKER I completely understand what your going through because I'm going through the same debilitating panic attacks, in my case my Dr won't spare me mercy and prescribe me xanax, she says she wants to control the frequency of the panic attacks so I'm on 40mg pail and 40mg latuda, my anxiety and panic attacks are still alive and kicking and at this point I'm house biund, its a frustrating process and I fear there is no real control over panic attacks
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