Ativan: A Couple Of Questions

[LindaJoy]

Hi, everyone.

I know this topic has been addressed here, but I guess I need some reassurance. My doctor put me on Ativan, 1 mg up to three times a day (haven't always needed that much), in the hospital three weeks ago, and I've been using it every day since, but like I said, not always that much. I'm now down to once a day, .5 mg or less.

I'm concerned, though, because I am having anxiety / POTS episodes every day now, (at least one episode a day) and I think they may be triggered by needing the Ativan. Is it possible to be addicted to Ativan already?

I'm also concerned because I read that people can die from Ativan withdrawal. How many of you have experience with Ativan? Do you seem to be addicted? Are you concerned?

I know I sound panicky. Well, it's because I am! I seem to be having the POTS episodes at the same time each day, when I usually take the Ativan for the episode the day before.

What do you think? What's the safest way to get off of this med?

Thank you.

Linda

[morgan617]

As you know if you've read the threads, this is a very sticky subject that no one really wants to talk about.

People seem to either be pro or fanatically con. There's not much middle ground.

I have been on valium everyday since 1994 or 5. I have never developed a tolerance, in that i have never had to raise my dose. I have in fact cut it in half without problems. It varies on my symptoms, how much I take. I have never taken more than 8 mgs in a day. It is not dosed like ativan, so trust me when I say that is a small dose. Average doses of valium are around 5-10 mg 4-5 times a day.

I don't think of myself as addicted to valium, but I am dependent on it in regards to my meneires symptoms, much as a diabetic is dependent on insulin.

Taking valium is way down there on my list of things to worry about. As I have stated in the past, I'd rather be dependent on a drug and feel better, than feel like crap because of a stigma generated by how others who don't have my symptoms feel about it.

This is only my opinion. I believe there are a great deal of people with POTS that take benzos. Some will admit to it and many won't. I could care less what or how people feel about my taking it. I would tell anyone, if something actually helps, why wouldn't you take it? When so few things do help, why do we fight it when one does?

It's a personal decision whether you want to stay on it or not. As far as addiction, I would be incredibly surprised if you were addicted already. Especially at the dose you take. If you want to stop, you need to call and ask your doctor whether you need to taper or not at this point. Going off any benzo abruptly after long term use at med or high doses can be dangerous. You can have significant withdrawal symptoms. But .5 once a day is not a significant amount by any stretch of the imagination.

There may be a flood of input now, pro and con, but it will all boil down to whether it helps you enough that it's worth taking it, or the stigma is worse than your symptoms, or you just don't want to take it. For any reason.

Only you and your doctor can make this decision. My experience with benzos has not been negative, it has provided me with a lot of help with symptoms. That is not the case for others. All I can do is tell you about my experience. Good luck. morgan

[Guest sonotech]

I agree with Morgan! There are so many OHTER stressors in your life, this shouldnt have to be one of them.

If the medicine is helping you then that is great! You should never feel guilty or ashamed for taking a medication that your doc has prescribed for you especially if it helps.

I have read so many articles on different meds and "addiction" and most of the more recent studies say that if you are "taking a medication for the reason it was prescribed, AND you are taking it as prescribed (meaning the appropriate # of pills and TIMES PER DAY as directed) then addiction is not a concern".

Now of course "dependence" is another story. Of course your body can become dependent on it but if the time comes that you no longer need the med, then your doc will help you wean off of them so that you dont go through withdrawal symptoms.

The people that become "addicted" to meds are the ones that take them for OTHER reasons...... like to numb the feelings of depression, or abuse the meds by taking them just for a "high" feeling, or take more than the prescribed amount.

So.....my opinion is......if the med is helping you then take it and dont listen to what others say.

If your doctor thought there was a problem, then I am sure he/she would tell you.

Laura

[futurehope]

Linda,

I have experience taking benzos (in the past before POTS). Only YOU can decide if the medication is "triggering" an anxiety response before the next dose.

I had the same problem. I stopped taking the med because of it. I had anxiety right before the next dose and I needed more and more meds to calm me down as time went on.

Again, I cannot say for certain what is happening in your case. But that is what happened to me.

Apparently, we all react differently as you can see by the responses here.

[JacobyD]

Hi Linda.

Yes, this is a very touchy subject - but one you should have all the information you could possibly gather at your disposal to determine if your problems are medication-related. This is a long-winded post, but my health problems ending up being centered around Ativan. Since choosing to slowly taper off this medication, I am feeling 110% better and know that my original autonomic problems have faded and were replaced by the adverse effects of the long-term use of Ativan. My problems began with extreme tachycardia, orthostatic intolerance, slow gut motility, and dysphagia (swallowing problems). When I began having serious throat spasms, I was prescribed Ativan. I never abused it or took more than I was prescribed. I most certainly never experienced a "high" from Ativan, nor was I looking for one.

Ativan is a very short-acting drug. Unlike Valium (which has a half-life of about 30-200 hours), Ativan has a half life of about 8-24 hours. This can often lead to a phenomenon known as "interdose withdrawals". The word "addiction" can also be extremely misleading. This class of medications (benzodiazepines) works by "blocking" nerve receptors that accept "stimulation". As the medication wears off, the rebound effect can actually cause intense anxiety or even magnify the reason it was prescribed for in the first place. This type of withdrawal can occur in as little as 14 days. I was prescribed Ativan for muscle spasms in my throat. It worked great for a few weeks, but unlike a "constant" medication like insulin (not something you can become "addicted" to or whose effect wears off, but more like something your body needs like food, water, and oxygen!), your brain will try harder and harder to overcome a benzodiazepine's "blocking" effect. This means you either need to take more of the medication, or stop using it all together and let your brain re-train itself to function normally. True, some people don't ever develop this problem, or don't realize they have a problem because they write off any current symptoms as being a part of their original diagnosis.

The FDA recommends that benzodiazepines not be prescribed for more than a 2-3 week period. I wish I had this information when my doctor gave them to me without any indication that there is a very high likelihood problems with long-term use. I drank like a fish in college. I stopped the day I graduated. No problems. I smoked occasionally in my early 20s. I stopped cold turkey without a single tremor or urge for another. I don't have a single alcoholic, drug addict, or smoker on either side of my family. Its not the chemistry of the body that puts you at a greater risk of problems with these medications, but the chemistry of the medications.

I have always taken less medication than I was ever prescribed. I even stopped taking my beta blocker cold turkey after 2 years (more bad advice from a doctor) without any effect. My case has been followed closely by one of the best neurologists at Johns Hopkins. After repeated tests and a review of my case history, it has become very clear that the majority of my symptoms for almost 4 out of the last 5 years of my illness were actually being caused by my medications and not my original dysautonomia, which even according to Dr. Grubb was most likely of viral origin.

To feel shame or be looked upon as a "drug addict" because of what this medication has done to me is as ignorant as any of our friends, relatives, doctors, or loved ones telling us our POTS or dysautonomia problems are "all in our heads" and we should just "toughen up and move on with our lives". I made the decision to cross over from Ativan to Valium and slowly taper off the medication. The withdrawal process is slow and I have had some rough times as my benzo-receptors fight to re-train themselves. The tolerance and withdrawal symptoms so closely resemble autonomic failure in that there can be many unexpected episodes of adrenaline rushes, anxiety, severe problems with gut motility, blood pressure fluctuations, and all sorts of other "fight or flight" malfunctions.

Does this mean this medication doesn't work for some people? No. I am totally convinced it should be used in moderation. If you feel like you're developing new symptoms as a result of being on Ativan for more than two weeks, most likely you should consider an alternative that is designed for long-term use. There as absolutely nothing wrong with taking Ativan, Valium, Xanax, or Klonopin every so often if you're having trouble sleeping, need to chill for an MRI, or have occasional panic attacks. Is it the "insulin" of autonomic medications? Not a chance. One thing I have learned is that most doctors don?t like complicated cases or conditions they can't diagnose. Throwing a med like Ativan or Valium at us is an easy "out" for them. Nothing like a tranquilizer to keep you from buggin' em!

I'm not debating whether some people who use this class of drug long term don't have any problems or not. I'm just trying to share my experience, which is just as real as those who defend its daily long-term use. I've met many people who have come out of their illness after discontinuing long-term benzo use, but have yet to come across anyone who has said "I've been talking Ativan for 10 years and I just keep getting healthier and healthier!".

There is only one long-term clinical study on the effects, use, and withdrawal of benzodiazepines that wasn't performed by the pharm companies themselves. More information on this study, along with some great news articles and other information can be found at www.Benzo.org.uk.

Bottom line... find something that really does make you healthy, functional, and happy. If that means popping a benzodiazepine, more power to ya! Maybe simply taking a dose when you feel your POTS symptoms are really hitting hard might be a good idea? It has already been said here that if the drug is helping you, take it. If you think its making things worse, better stop taking it sooner rather than later. Above everything else, I hope you find something that makes you feel great. Feel better soon, Linda.

Cheers.

[avais1]

Hello!

Last year, I needed some good advice on Xanax. This thread is really good, because people were very honest, and non-judgemental. Here is the URL:

http://dinet.ipbhost.com/index.php?showtopic=1993&hl=

If the link doesn't work, just search under my name, and look for the title "Xanax".

Dan pretty much covered all of the advice I would give to you. For me, personally, I needed to take Klonopin when I first found out I had POTS. My hyperadrenergic nerves were just too sensitive to not have it. I took it daily for 4 weeks. When I did wean back down, I did suffer a few panic attacks, because as Dan explained, the receptors had been blunted for three weeks, so now they were very sensitive to more stimulation. That lasted for about 3 weeks, but they did gradually subside. I now take Klonopin on an as needed basis. A full 30 day Rx will last me more than a year (I usually take it when I fly). I was lucky, I never had a problem with addiction.

Good luck to you!

[kmpower]

Good question and I am thankful for everyone's honest replies.

When I started running to ER for the tachy episodes I was given enough Ativan to fall asleep and when I woke up I was sent home. Two days later I was back, worse. After this happened 4 times, I "got" that the withdrawal made the next episode stronger, so I became frightened to take it again -- not because of addiction or withdrawal, but fear of worse tachy and another trip to ER. The next time it happened, the ER doc and I decided not to Ativan it and it slowed down by itself.

After eventually getting into therapy to discuss my fears of ER, doctors, drugs, being told the problems were only anxiety and not physical, I resumed my courage to return to doctors, but it took 1/4 mg. Ativan to get me out my door and sometimes another 1/4 mg. to get me in the doctor's door. After I got a diagnosis that was real, I relaxed enough to not need that Ativan anymore. But it is ALWAYS in my purse!

I have a lot of respect for benzos. They are addicting as has been explained and as you know. I had read all of Breggin's books and knew that their place in my life would be limited to need and stay under my control, if possible. I think Breggin tells the truth and if you wanted to understand how to go up and down your dose and stay in control of the process, read Your Drug May Be Your Problem.

Don't let the judgments by others or your fears interfere with your decisions if possible. There are physiologic facts to know. But because our body chemistries are mysteries to us and our doctors, only we can assess if the experience is beneficial for us.

Good luck in your decision-making.

OLL

[LindaJoy]

Hi, everyone, and thank you for your input on this topic. I had to go to the ER today because my anxiety was just toooo much to handle. I felt like I couldn't breathe, I was tachy, my blood pressure was high, etc. They said I was having withdrawal from Ativan because I was trying to go down off of it too quickly, so they gave me a safer withdrawal schedule. I still feel lousy, but better than I did earlier. I'm actually back on .5 three times a day for three days, then cut back to two times a day, etc., for two weeks, until I'm off the medicine. I was only on it for two and a half weeks to begin with. My body really reacted to it. I guess maybe because my POTS is so out of control right now.

Again, thank you for your posts. I know I'm not alone in this. That does make it easier.

I'm off to stay with my mom for awhile. Yes, I'm still panicky, and she lives closer to our hospital. My husband's not too happy, but right now, I really need to do what's best for me to feel safe until I get through this. I hate doing that to him, but it'll be better soon. I hope.

Take care, everyone.

LindaJoy

[BuddyLeesWife]

Before being correctly diagnosed, my husband was prescribed Xanax and when his symptoms continued, the dr. kept increasing the prescription. We didn't know any better and he was taking way, way too much. In fact, the Xanax was bringing on the same symptoms we were trying to diminish. Once diagnosed with NCS and depression, he was started on different medications but first he had to wean off of the high dose of Xanax. His body had become dependent and it took about 6 months to wean down to an appropriate level of the drug. He has continued with a low dose of Xanax for the past year and has not felt any need to increase.

So, is/was he addicted? I don't know that answer but I do know he was definately on too high of a dosage before and that his current low dose seems to help. As long as it continues to help then he will stay on it - we both are alert for any "need" to increase the dosage and if that happens, we will reconsider.

[Clairefmartin]

I'm glad this came up, I was perscibed ativan a few months ago when my doctors didn't know what to do with me, and I vary my doage based on need. Some days its nothing, but most days its .5 to 1mg, and never has been any more than that. I have been concerned with the possibility of withdrawl issues, but figured i felt so crappy that if it helped right then i'd deal with it later. I find myself taking it most nights before bed to calm my pounding heart down, but hopefully i'll be starting a beta blocker soon which should take care of my tachy symptoms.

I don't like taking any meds, but i agree that everyone is different, and is it helps me/you feel better, than so be it. I think its good to hear others opinions on all these various drugs we are all perscribed, but it can sometimes make it scarier to take meds after hearing other peoples bad side effects, when they may not be an issue for you. I went thru this with florinef, i almost didn't take it because i read all the horrible side effects people talked about, but i actually have not had any and it seems to work for me.

Good luck!

[AJVDK]

I agree this is one thing no one want to talk about. I am been clean ( drug free) for 2 1/2 years now. I had to start taking pain pills two months ago because I can't handle the pain anymore, from the headaches to the pain in my legs from not being able to do much anymore. I been working with my doctor. We have an open relationship when it comes to this subjuct, what we do is I get small amounts, and I call, or go in and see him when I need more. this why we are wroking together to make sure I am not taking too much, and try everything not for me to have problems again, all though it was other drugs and pain meds, it is too easy to have problems.

I use to not talk about the fact I went to rehab, and now I don't care I am who I am, and the only thing I know now it to live one dat at a time, and to be honest with your doctor. If you think you are having problems please talk to you doctor! I know its hard, but you don't want to end up where I did. I lost everything, and had to start over. I am not trying to scare you I just wanted to share what happen to me. Maybe it will help.

Amy

[Guest Julia59]

I remember when my POTs first hit me hard in Dec. 2000. They gave my Ativan---but would only give me about 10 ot them at a time. My adrenaline surges were so bad at the time--I had to do something to get throguh work. But I found that my symptoms got worse also---IN OTHER WAYS. I was spaced, and felt like I was going insane at time. Taking Ativan was not a good experience for me at all. I wasn't on it long. I only took a partial dose---and only when I felt I couldn't make it. I would live on the edge a lot, and avoid taking it when ever I could.

I used extreme caution, but I was lucky---so did the Docs that prescribed it. Some Docs just prescribe it loosely, and if the patient is not aware of the (catch-22) of the drug---they can sometimes run into dependence problems. I have taken phenobarbitol for around 6 months in the early 80s, and xanax for about 6 months also. I always remained on a low dose, but as soon as my body slowed down some, I would start to wean myself off the drug. And if I felt jittery, I would try to work it out myself---I usually did just fine.

These spells---(adrengic spells) tend to come in cycles---I am on Klonopin now due to a very rough adrengic period. I was prescribed .50 once a day, but I only take 1/4 with dinner, and 1/4 in late evening. My sympathetic nervous system is very irritated----which means-----(very jittery). This is due to compression on my cervical spinal cord. I have lived this way for a long long time----no fun, but I manage most of the time without benzos. I never get used to the real bad panic attacks, and that is when I may take them for a short period until my body settles down again.

Dan, I can't tell you enough how happy I am to see that you are doing so much better. I knew you would make it. I never cared for how ativan made me feel----very, very odd----and also made me feel very weak.

I have nothing against giving your body a rest---and getting help from Benzos from time to time, but only with great caution---and avoid building a tolerance. If you find yourself needing more---that is a tell tale sign of a growing dependence--- try to taper off the drug. Sometimes they can even make you feel worse------rebound effect...............

Julie :0)