Should I ask to switch from short acting ativan to long acting benzo?

[crazyguy]

As per the thread title really.  

About 5 months ago I was given ativan to help with general and social anxiety.  1mg three times per day as required but I don't use the full dose daily and some days I take none.  

 

It does work well but I have to double up dose if I'm entering a particularly stressful situation as 1mg isn't enough, my doctor is OK with this.  The downside is 2mg definitely gives some inhibition and euphoria so I have to be careful about how I behave on the rare occasions I take 2mg.

 

My problem is I'm going through a very stressful patch at the moment that will last for at least another month.  I think I would benefit from sustained relief from anxiety rather than the peaks and troughs ativan gives.   I'm wondering if asking my doctor to switch me to a long acting Benzo (diazepam, clonazepam, etc) is the way to go?  Or if long acting meds just  increases the risk of dependence?  

 

I do not want to change my antidepressant at this time and I have never had any anxiety relief from antidepressants anyway.  Strangely enough my mood is quite good at the moment I just have that sick feeling in my stomach and constant worries, racing thoughts, rumination, etc.  

 

The only concerns I have is are the long acting benzos as good for social anxiety, and how to make sure I get the correct dosage equivalent.  (1mg ativan is barely effective so I don't want a lower equivalence). 

 

Any thoughts please? 

Edited April 1, 2014 by crazyguy

[Unstrung Harp]

I generally take clonazepam at night with the idea that the benefit will last into the morning a bit. I have always been a reluctant and sparing benzo user, and thus a small amount tends to carry me a long way, but I do find that on the days after I've taken it the night before I often have less anxiety out of the gate, which helps me get through the day without having to medicate as much. I do find clonazepam somewhat more sedating than I find comfortable in the daytime, however, so my current strategy along with taking the clonazepam at night is alprazolam during the day PRN, because it is faster and shorter acting and doesn't zonk me out as much. I don't know about the dependency issue, whether it is of more concern with the longer acting meds, though that has not been a problem for me personally. In fact, taking the longer acting med prophylactically tends to decrease my need to take more throughout the day.

[melissaw72]

I take klonopin twice a day to get me through the day, and use xanax (not Ativan, but still a short-acting benzo) for breakthrough anxiety.  They've worked well together for years.

[mcjimjam]

Longer acting benzos are actually supposed to have a lower risk of dependence. 

[jt07]

I took clonazepam for 3 years at 1 mg three times a day. I never got an euphoria from it, but it did make me tired. It was effective for anxiety though. In the past, I also took Ativan and Xanax. I really can't say that I prefer one over another. However, if you want longer coverage then something like clonazepam or Valium is the way to go.

 

The benzo that I found the most helpful was prazepam (Centrax), and it has a long half-life. Unfortunately, once Xanax came out and became more popular, Centrax was discontinued in the United States. It is still available in Europe.

[crazyguy]

It sounds like all the benzos act very similarly really...........  IDK.  I think I will stick with the ativan but try taking it more regularly rather than 'as required'.   One thing I do like about the ativan is it does not make me sleepy or doped up at all.  I hear Diazepam can do that. 

[jt07]

It sounds like all the benzos act very similarly really...........  IDK.  I think I will stick with the ativan but try taking it more regularly rather than 'as required'.   One thing I do like about the ativan is it does not make me sleepy or doped up at all.  I hear Diazepam can do that. 

I think how doped up you feel is a function of your dose and not so much the benzo. I will say that the benzos with the longer half lives do make living a little more easy because they stick around in your system longer. You just get smoother and longer lasting relief. The downside to them is that they tend to have a longer onset of action than, say, Xanax.

[Spadez87]

As per the thread title really.  

About 5 months ago I was given ativan to help with general and social anxiety.  1mg three times per day as required but I don't use the full dose daily and some days I take none.  

 

It does work well but I have to double up dose if I'm entering a particularly stressful situation as 1mg isn't enough, my doctor is OK with this.  The downside is 2mg definitely gives some inhibition and euphoria so I have to be careful about how I behave on the rare occasions I take 2mg.

 

My problem is I'm going through a very stressful patch at the moment that will last for at least another month.  I think I would benefit from sustained relief from anxiety rather than the peaks and troughs ativan gives.   I'm wondering if asking my doctor to switch me to a long acting Benzo (diazepam, clonazepam, etc) is the way to go?  Or if long acting meds just  increases the risk of dependence?  

 

I do not want to change my antidepressant at this time and I have never had any anxiety relief from antidepressants anyway.  Strangely enough my mood is quite good at the moment I just have that sick feeling in my stomach and constant worries, racing thoughts, rumination, etc.  

 

The only concerns I have is are the long acting benzos as good for social anxiety, and how to make sure I get the correct dosage equivalent.  (1mg ativan is barely effective so I don't want a lower equivalence). 

 

Any thoughts please? 

I would stay with the ativan personally but if you take it every day you will become dependant no matter what. If you say take ativan say once a week or Valium once a week you should certainly stick with the ativan as the extremely long half life of valium will have a higher chance of getting you chemically dependant where the ativan wont.

 

It sounds like all the benzos act very similarly really...........  IDK.  I think I will stick with the ativan but try taking it more regularly rather than 'as required'.   One thing I do like about the ativan is it does not make me sleepy or doped up at all.  I hear Diazepam can do that. 

I think how doped up you feel is a function of your dose and not so much the benzo. I will say that the benzos with the longer half lives do make living a little more easy because they stick around in your system longer. You just get smoother and longer lasting relief. The downside to them is that they tend to have a longer onset of action than, say, Xanax.

 

Valum kicks in super quick in about 15 min.

[jt07]

As per the thread title really.  

About 5 months ago I was given ativan to help with general and social anxiety.  1mg three times per day as required but I don't use the full dose daily and some days I take none.  

 

It does work well but I have to double up dose if I'm entering a particularly stressful situation as 1mg isn't enough, my doctor is OK with this.  The downside is 2mg definitely gives some inhibition and euphoria so I have to be careful about how I behave on the rare occasions I take 2mg.

 

My problem is I'm going through a very stressful patch at the moment that will last for at least another month.  I think I would benefit from sustained relief from anxiety rather than the peaks and troughs ativan gives.   I'm wondering if asking my doctor to switch me to a long acting Benzo (diazepam, clonazepam, etc) is the way to go?  Or if long acting meds just  increases the risk of dependence?  

 

I do not want to change my antidepressant at this time and I have never had any anxiety relief from antidepressants anyway.  Strangely enough my mood is quite good at the moment I just have that sick feeling in my stomach and constant worries, racing thoughts, rumination, etc.  

 

The only concerns I have is are the long acting benzos as good for social anxiety, and how to make sure I get the correct dosage equivalent.  (1mg ativan is barely effective so I don't want a lower equivalence). 

 

Any thoughts please?

I would stay with the ativan personally but if you take it every day you will become dependant no matter what. If you say take ativan say once a week or Valium once a week you should certainly stick with the ativan as the extremely long half life of valium will have a higher chance of getting you chemically dependant where the ativan wont.

This flies in the face of everything I've been told and what is generally accepted, that is, the shorter the half-life, the greater the chance of abuse and addiction.

[quiet storm]

Yeah, that doesnt make a whole lot of sense. If anything I would say a shorter acting benzo is likely to cause more dependence because the come down is much more abrupt, causing the person to take another dose much sooner than they would on a longer acting benzo.  But it really doesnt matter, you will become dependent on any benzo depending on frequency you take it. Whether its clonazepam once a day, ativan twice day, or xanax three times a day........take it often enough and you will become dependent.

[peacelizard]

Longer-acting benzodiazepines should have less likelihood of dependence because you're not dosing as often. That's where you get into so much trouble with ones like Xanax because it makes you euphoric and it also has a very short half-life, especially compared to Klonopin, and make it much more likely to be abused.

 

If you get the dosage right, I would think a long-acting benzo would be more beneficial for you with social anxiety as social anxiety tends to be more chronic and long-lasting in nature as opposed to situational anxiety, which you probably don't need a long-acting benzo for anyway.

 

As for dosage, you'd have to talk to your doctor but I believe Klonopin is quite a bit stronger than Ativan -- somewhere 4:1 range, i.e. 4 times as much Ativan as Klonopin for the same effect. I'd also talk to your doctor about alternative PRNs so you can cycle them in with the benzo and you'll worry about dependence less.

Edited May 12, 2014 by peacelizard