How to properly take Ativan for anxiety?

Hi all

I have GAD (diagnosed) and maybe a touch OCD (not diagnosed). In the past my anxiety has been mostly episodic- I'll go through a period of a few bad weeks, then months that are okay can go by until the next episode. the ruminating worrying about the future is the worst of it for me, and I become irritable, distracted, generally unhappy. It sucks for me and for my family, who need a better mum

My doc (family doc, not a psychiatrist) recommended a benzo (ativan) as well as zopiclone to help me sleep. I am pretty sure my insomnia is connected to the anxiety in some way. funny thing is I fall asleep fine usually, but I wake up at different points throughout the night...and then the anxiety sets in and the next day after a night like this is usually BAD.

I last saw this doc in early summer, when we came up with this plan. thing is, since then my anxiety has not been really 'episodic'- it's been pretty much non stop, with a few days of good happy respite here and there. the bad days have definitely outnumbered the good for about 4 months now. there have been some external stressors that have added to this (like dd being diagnosed as adhd/gifted at the end of the last school year), but the root of this has always been in me, for sure.

anyhow, my question is, am I taking ativan properly? He prescribed 1 mg twice a day, "as needed". I presumed he meant when I am feeling acute anxiety, and not as a daily maintenance thing. so far, if I wake up and feel "okay", I try not to take it, then if the day gets worse I have this ongoing conversation with myself if I should be taking it...bah. also, does twice daily mean one in the morning and one at night, i.e. every 12 hours to cover the 24 hour clock, or, 2 doses spread over my *awake* hours, which would be closer than every 12 hours.

I also wonder about the zopiclone and how it relates to the ativan- if I have taken 2 doses of ativan during the day, do I still need the bedtime dose of zopiclone to get me to sleep? is it even okay to do that?

anyhow, my timing is good because I have a follow up appt. next week. I am wondering also if it's time to try an SSRI again since this in not really 'episodic' anymore.

any input, advice, experience is muchly appreciated- thanks!

Help? Anyone????

I used to take Ativan and had it prescribed "as needed". My instructions were to take 1-2 mg every 4 hours as needed. Generally I needed to once a day every couple of days.

If you're taking it multiple times during the day I'd just spread it out so it'll be even for the time when you're awake.

It's probably ok to take it with the sleeping med. If it wasn't the Dr. or pharmacist most likely would have said something 1 mg isn't very much. But if you're really worried check with your pharmacist.

Ativan is good because it's really fast acting - you usually feel the effect within 30 min., but it also doesn't stay in your system all that long, so you can get sudden spikes in anxiety when it wears off.

I'm now on clonazapam, another benzo that's slower but longer acting. I'm supposed to be taking 1 mg 3 times daily - so I just take it with meals, and another 2 mg at night, but 3/4 of the time I forget to take it after breakfast, so I'm probably going to be telling my Dr. to officially reduce it soon.

--splitimage

Thank you splitimage for your reply...it was very helpful. I had a super bad day yesterday, and I ended up taking 1 mg at 11 in the morning, and another 1mg at around 6:30...the evening would have been brutal without it. And, as crazy as it sounds, I start to get anxious about whether or not I should be taking it...am I feeling anxious enough, or do I try to ride it out? *sigh*

Noticed you are in ON also. I'm wondering how long it will take to get referred to a psychiatrist here in Ottawa. Waiting lists, bah humbug...

i took xanax "as needed" for several years. i found that it was easier to take it before i got REALLY anxious. as long as i took it when i was feeling just a little bit anxious i never really got bad. however, if yours is getting worse, try to see a pdoc asap. the sooner they catch problems like this the easier they are to treat. i kept pushing till i had a breakdown, and i am now agoraphobic.

lost

If you have to take more than 5mg of Atvian per week talk to your PMD. You will develop a dependency on Ativan if you take it too often.

Betosca, I'm glad you posted this question because it is something I wondered about. It was suggested that I start taking Ativan, but like you I knew I'd have a really hard time knowing when to take it. I knew I'd constantly 2nd quess myself about whether I was "anxious enough".

So at my most recent pdoc appointment I talked about this with her. I told her I wanted an anti-anxiety med to go with Lexapro, but didn't want to have to make the day to day decision whether to take it. She said I could take .5mg of ativan twice a day. I didn't have to make a decision on which day to take it. So that's what I've been doing. Maybe you could try this as well (check with pdoc of course). See if you can take it twice a day at the times you typically become most anxious for a couple weeks and see if that helps at all.

Personally, I'm trying out 9am (after I get to work) and then again in the mid-afternoon.

Wow, Lemon, that's an excellent suggestion! I swear some days half of my anxiety is about anticipating how anxious I'll feel if I don't take some Ativan. I will definitely ask my doc about your suggestion. I am really feeling now like I need to go back on an SSRI (maybe not Lexapro- when I took it in the past it did alleviate the anxiety but it made me so...flat. and utterly unmotivated- in short, it didn't exactly lick the depression). And I know I will need to take the ativan to take those sharp edges off until the SSRI kicks in.

"anyhow, my question is, am I taking ativan properly? He prescribed 1 mg twice a day, "as needed". I presumed he meant when I am feeling acute anxiety, and not as a daily maintenance thing. so far, if I wake up and feel "okay", I try not to take it, then if the day gets worse I have this ongoing conversation with myself if I should be taking it...bah. also, does twice daily mean one in the morning and one at night, i.e. every 12 hours to cover the 24 hour clock, or, 2 doses spread over my *awake* hours, which would be closer than every 12 hours."---From BETosca on 9/4/08 (partial quote)

Boy can I relate to this. Like you I always second guess myself, on whether I'm "anxious enough" to take Ativan. I take 1/2 mg or 1mg "as needed". So I try not to take it like you, because I'm afraid of getting addicted. Or, what's worse is a tolerance in a way, because it stops working at your current dose. Then you "have to" up the dosage to get the same effect.

I also have Klonopin, which takes about an hour to kick in. Ativan takes about 20 minutes. Of course I only take either one, not both!

I can kind of tell whether or not I'll be "climbing the walls" at bedtime by how I feel a few hours before.

I believe my insomnia is multi-faceted in causes. Also, I have noisy upstairs neighbors which doesn't help. Pathetically thin walls/ceilings make for an unsettling night. Music, footsteps over my head, toilet flushing, shower going, stuff dropped on the floor, yada yada yada. Even with earplugs I still hear it. If I'm awake it's harder to fall asleep with that racket. If I am asleep by some miracle, I can be awakened by it. Manager is an asshole so no sense in complaining to him.

I also get apprehensive about what sounds I MIGHT hear, whether from upstairs or elsewhere. Should I drift off? Is is "safe" to go to bed? Is it quiet now or will someone turn on music or decide to move in/out at that moment?

I don't know what I'm going to do to make this better without taking drugs too much. I've tried herbal stuff called MidNite, but it isn't strong enough. It will take the edge off, but it does NOT make me drowsy at all. I could even drive after taking it, if I had to.

I went to a sleep workshop where they talk about things like getting into a bedtime "routine", don't look at the clock, don't stimulate your brain too close to bedtime, like answering e-mail (or going into PsychCentral LOL), etc. Some of these work for me, but not every night. I haven't slept through the night in YEARS. I only sleep pretty well (without meds) maybe 1 or 2 days a week!

Hello to all. I have been prescribed Ativan 1 mg po qid prn to treat my anxiety for the better part of two years. There are the occasional days when I don't have to take them and days when all four doses are not required. But then my symptoms seem to return bigger and badder than they were to begin with. Has this happened to anyone else?

For basic GAD and OCD, Luvox CR is my first choice of SSRI, it will also help you sleep! For Zimovane, all that I know is it helps put you to sleep but not keep you asleep. Now for taking Ativan...I only take it when I'm really nervous or know I'm going to be anxious. Like taking one for performance anxiety before a speech! It works most rapidly if you let it dissolve under your tongue and sometimes you'll need .5mg or even 2mg. Just play with it and you'll figure it out! Best of luck!!

Ativan should be PRN in most cases, I would understand those instructions as you are allowed to have 1mg up to 2 times a day if you need it, none if you dont. Not that you need to take it daily. Be aware that it should be at least moderate anxiety before you turn to medication, if you learn to live without mild anxiety you are going to have a hard time.

Taking it every day is what leads to addiction. It can happen all too quickly on benzos.

I -2MG EVERY 4 HOURS your doc must be a little out of touch , thats 12 mg in 24 hours if you have never taken them before you would be asleep all day and night , the half life is 6 -10hours

I am the ATIVAN MAN 35YEARS on Ativan , started on take has needed , could take has many has I liked in them days given in bucket full nobody new any research . I have at one time been on 12mg a day now 4mg a day. I take mine if I feel ok or not has a preventive . 2mg 6 am with 10mg lexapro - 2 mg 7pm so I can chill the night away. don't take them to late at night you will have the worst nightmares ever. Has for addiction I laugh at that tolerance yes, but if addiction I would be on 2000 mg a day by now. I will spend my life on 4mg a day and it suits me fine and dandy .

I ended up having a total meltdown at work when my GP took me off both HRT & Paxil cold turkey. I could not reach GP or T at the time so ended up in the ER. From ER I was transported to Psych hosp. On of the conditions of my release was to have a pdoc manage my MH meds. It was the best thing that came out of the whole thing. What I learned is that pdoc's are more aware of what works together and how to work with the MH issues much better than a GP. I strongly suggest that anyone having problems with MH meds work with a pdoc.

Of course , your GP is not trained in mental health he is for physical problems , and a p doc for Mental you would not ask a p doc to look at your boil on your bum. But the long waiting list to see a shrink forces them to give ADs has they don't like there patients suffering .

Zopiclone is a great sleeping pill but super addictive.