Ativan/Lorazepem experiences?

[Newscott39]

Hi all,

I am going on my third week of Sertraline for some Anxiety/Health Anxiety issues and I have had some rough days. Doc prescribed me Ativan to take as needed twice a day to help get me through to the therapeutic dose.

Anyone have experience taking Ativan/Lorazepem? So far, I have taken no more than one .5mg a day about 5 days that were pretty bad. I know this is a short term drug, but I'm scared to take it too much.

Any advice?

[PASchoolSyndrome]

Hi all,

I am going on my third week of Sertraline for some Anxiety/Health Anxiety issues and I have had some rough days. Doc prescribed me Ativan to take as needed twice a day to help get me through to the therapeutic dose.

Anyone have experience taking Ativan/Lorazepem? So far, I have taken no more than one .5mg a day about 5 days that were pretty bad. I know this is a short term drug, but I'm scared to take it too much.

Any advice?

Hello!

I too have low dose lorazepam for acute anxiety situations! The way that the drug works is it quite literally calms your brain down. It stops it from firing all of those signals which can cause some of us to have anxiety! You're right, its a short term, as needed drug! If too much is taken it might zonk you out a bit - some people use it as a sleeping pill which is a no no. If you follow your doctor's prescription you will be fine. Your doctor is the best person to talk about your medication concerns with!

They do have a habit of building up a tolerance, which is why it is not a maintenance drug but more for those high anxiety/panic attack situations.

I hope you feel better soon!

[Newscott39]

Thank you very much for your reply . I guess my problem started when I did my own "research" after it was prescribed lol. Horror stories for this drug are numerous, but of course that isn't always reality and there are lots of different variables in ever individuals situation. This is my first experience with prescribed medicine and I have always been hesitant. But you are right, I just need to trust my doc.

[PASchoolSyndrome]

You're welcome!

It's scary taking a drug for the first time!

[Fishmanpa]

I have Xanax to help with the stress I'm under with my wife's illness. Common sense use is in order using it and I've had no issues. I'm just glad I have it if I need it.

My wife is on .5 grams of Klonopin 1x a day and we have Ativan should she need it for catatonia. That's what they gave her in the hospital when she had her "episodes". Fortunately, we've only had to use it a couple of times since she came home. It basically knocks her out within 30 minutes.

Positive thoughts

[Josh1234]

I use ativan as needed. Just be sensible. Use it on the BAD days, and practice good self talk on the others.

[Sphincterclench]

I have valium for as needed and used to have Klonopin both serve the same purpose but they changed it up when it stopped being as effective as it was once.

I am thankful beyond words to have them in combination with my maintenance drug (Zyprexa)

I never take them as often as it states on the bottle and instead take them truly "as needed"

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

[panic_down_under]

I know this is a short term drug, but I'm scared to take it too much.

If you were to take lorazepam daily for more than a month or so you would likely develop dependence and need to wean off it. This is also true of the sertraline. Some antidepressants, though not usually sertraline, can be as difficult to quit as the benzodiazepines (BZDs), and a few find them all difficult to discontinue.

Horror stories for this drug are numerous, but of course that isn't always reality and there are lots of different variables in ever individuals situation.

The strange thing about this issue is that almost all the BZD horror stories come from those prescribed them for anxiety. Check epilepsy forums and you get a different picture yet epileptics are often prescribed these meds at much higher doses than those typically prescribed for anxiety.

In your research you may have come aware of Heather Ashton, the leading proponent of the BZD prolonged withdrawal syndrome. She supposedly ran a BZD detox clinic for 12 years. Curiously, in none of her studies about the cases she handled does she list an epileptic.

So why are epileptics apparently less affected by withdrawal? Well it isn't because their brain are different to ours, in fact they share much the same density and sensitivity deficits of benzodiazepine binding sites on GABA receptors as we do. [1],[2] Indeed, until around the late 1930s, early 1940s medical students were still being taught epilepsy was an anxiety related 'mental' illness.

The more likely explanations are that they aren't anxious so don't get spooked by every symptom, nor do they expect to suffer greatly. A number of studies, for example Tyler P, 1983, were conducted in the 1980s in which inpatients on BZDs were told their med dose was unchanged. Many soon developed some, though not all, of the typical withdrawal symptoms even though their dose was not reduced. The anxious mind is very capable of delivering the full catastrophe of our worst nightmares if given half a reason.

Another factor, and possibly the main one, is epileptics are generally cared for by neurologists who may simply be better at managing the weaning process.

HOWEVER, there is a more significant reason to limit BZD use than concerns about withdrawal issues. There is now good evidence that BZDs can significantly reduce the effectiveness of antidepressants (AD) by blocking hippocampal neurogenesis the mechanism by which antidepressants produce the therapeutic response (see: Stefovska VG, 2008; Wu X, 2009; Sun Y, 2013; Nochi R, 2013; Boldrini M, 2014).

This doesn't mean BZDs shouldn't be taken at all. Imho, it is better to take them to get past the common increase in anxiety when first taking ADs than to quit taking the med because it all becomes too difficult (there are alternatives to BZDs though such as hydroxyzine (Vistaril)). And taking BZDs occasionally for breakthrough anxiety probably won't matter much, but taking them all the time is almost certainly counterproductive.

References:

[1]
Hasler G, Nugent AC, Carlson PJ, et al. (2008)
Altered cerebral gamma-aminobutyric acid type A-benzodiazepine receptor binding in panic disorder determined by [11C]flumazenil positron emission tomography.
Arch Gen Psychiatry. Oct;65(10):1166-75 (Abstract)

Geuze E, van Berckel BN, Lammertsma AA, et al. (2007)
Reduced GABAA benzodiazepine receptor binding in veterans with post-traumatic stress disorder.
Mol Psychiatry. 2008 Jan;13(1):74-83 (Abstract)

Cameron OG, Huang GC, Nichols T, et al. (2007)
Reduced gamma-aminobutyric acid(A)-benzodiazepine binding sites in insular cortex of individuals with panic disorder.
Arch Gen Psychiatry. Jul;64(7):793-800. (Abstract)

Bremner JD, Innis RB, Southwick SM, et al. (2000)
"Decreased benzodiazepine receptor binding in prefrontal cortex in combat-related posttraumatic stress disorder."
Am J Psychiatry Jul; vol 157(7):1120-6 (Abstract)

Bremner JD, Innis RB, White T, et al (2000)
"SPECT [I-123]iomazenil measurement of the benzodiazepine receptor in panic disorder."
Biol Psychiatry Jan 15; vol 47(2):96-106 (Abstract)

Malizia AL. (1999)
"What do brain imaging studies tell us about anxiety disorders? "
J Psychopharmacol Dec; vol 13(4):372-8 (Abstract)

Morimoto K. 1999
Benzodiazepine receptor imaging in the brain: recent developments and clinical validity
Kaku Igaku. May;36(4):307-13. (Abstract)

Malizia AL, Cunningham VJ, Bell CJ, et al. (1998)
"Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder: preliminary results from a quantitative PET study."
Arch Gen Psychiatry Aug; vol 55(8):715-20 (Abstract)

Tokunaga M, Ida I, Higuchi T, Mikuni M. (1997)
"Alterations of benzodiazepine receptor binding potential in anxiety and somatoform disorders measured by 123I-iomazenil SPECT."
Radiat Med May-Jun; vol 15(3):163-9 (Abstract)

Uchiyama M, Sue H, Fukumitsu N, et al. (1997)
"Assessment of cerebral benzodiazepine receptor distribution in anxiety disorders by 123I-iomazenil-SPECT: comparison to cerebral perfusion scintigraphy by 123I-IMP."
Nippon Igaku Hoshasen Gakkai Zasshi Jan; vol 57(1):41-6 (Abstract)

[2]

Vivash L, Tostevin A, Liu DS, et al. (2011)
"Changes in hippocampal GABAA/cBZR density during limbic epileptogenesis: relationship to cell loss and mossy fibre sprouting."
Neurobiol Dis. Feb;41(2):227-36. (Abstract)

Morimoto K. (1999)
"Benzodiazepine receptor imaging in the brain: recent developments and clinical validity."
Kaku Igaku May; vol 36(4):307-13 (Abstract)

Savic I, Pauli S, Thorell JO, Blomqvist G. (1994)
"In vivo demonstration of altered benzodiazepine receptor density in patients with generalised epilepsy."
J Neurol Neurosurg Psychiatry. Jul;57(7):797-804. [Abstract]

[Newscott39]

Wow. Thank you to everyone for the responses and all of the great information. I am going to just use it "as needed" when things get untolerable and stop overthinking it.