Benzo-effectiveness

[aberke]

ive been givin a prescription for lorazepam(Ativan) for panic attacks. my panic attacks normally last abou a 30 minutes, i take the ativan as soon as i feel one come on, but it doesnt do anything, not until at atleast after the panic attack subsides, maybe its too low dose (.5mg), or is there something else that acts more quickly?

[Bridgie]

Hi Aberke! You just may need a stronger dosage. I use a benzo called Clonazipam and take before I have to go into a situation, because it usually takes at least 20 minutes to take effect. So, once you are already experiencing a panic attack, I'm not sure how affective it would be at that low of a dose. Talk to you doctor if you feel it is not working for you!

[aberke]

i have read that diazepam works much quicker than lorazepam, is it likely that my doctor may prescribe this instead, is it worth mentioning?

[shoe]

aberke, from things I've read online, it does seem that Valium (diazepam) is one of the quicker acting and longer lasting benzodiazepines out there. You might want to make sure the dose you are taking of Ativan is appropriate though, like Bridgie mentioned. For me, Ativan (lorazepam) didn't work well. I've also tried Xanax (alprazolam) and currently use Klonopin (clonazepam).

here's some Benzo charts which show comparative doses, half lifes, and time to take effect:

Benzodiazepine Equivalence Charts (benzo.org.uk):
http://www.benzo.org.uk/bzequiv.htm
Benzodiazepine Equivalence Charts (Dr-Bob):
http://www.dr-bob.org/tips/bzd.html

good luck

[Maggie May]

Shoe, what a great list! Thank you for that, I have been wanting one of those for reference. (I'm a psych grad student.)

In my humble experience, which may be different from anyones, Ativan works faster for me if I let it dissolve in my mouth. I did a temp job at a hospice care center and I noticed that the nurses orders on some of the charts said that for patients that can't swallow very well or can't keep anything down, they just put the Ativan under the patient's tongue and let it dissolve. The drug can pass into the bloodstream through the soft tissues in the mouth. This is faster than swallowing it whole and letting it dissolve in the stomach. I don't usually chew it up with my molars, because, being a perfectionistic anxious person, I wouldn't want it to get stuck in my teeth and not get into my bloodstream. :) So I kind of nibble it into pieces between my front teeth as it's dissolving so it dissolves as fast as possible.

I _SO_ understand wanting something that will work right the hell now. I have spent some of the longest half hours of my life in bed, crying, praying, bargaining with God or whoever might be out there to help me not lose my mind until the Ativan starts working. So I really sympathize.

Another side benefit to letting it dissolve in your mouth is that you will start to associate the taste of it with feeling more calm. So even though its not exactly a delicious taste, you may come to feel more calm simply by the taste of the med, which might tide you over until it starts working.

I heard from one doctor that Ativan takes 30 minutes to take effect, and Xanax takes 20 minutes, but in the ER (my sister is an ER doc) they always give Ativan. That might be because Ativan works longer than Xanax, my sister didn't even have a good answer as to why they don't use Xanax. :) Sometimes doctors just use what they've learned, or following the standard operating procedure without knowing why.

Also, when I am having a big gnarly hellish panic attack, I need a whole milligram to realy calm down, .5 won't do so well. So as others have said, you might ask your doc about trying 2 (.5mg) pills. It doesn't mean you're a drug addict, it just may be that your body is pumping a whole hell of a lot of adrenaline into your body when you panic.

Keep us posted!

Maggie



A secondary benefit of

[shahram72]

Is Ativan more expensive than Xanax? I'll bet it is. Xanax also has generic equivalents that make it even cheaper. These companies are constantly making improved products and renaming them to charge $60 a bottle instead of improving what they have. Also, drug reps leave samples of the expensive stuff behind for docs to give out. They give it out, with good intentions cause it's free and helps the patient out, but then the patient has to continue with the expensive stuff. So if your doc gives you a free example, most of the time you can bet it will be expensive. I think alprazolam(xanax) is about the cheapest stuff out there right now, isn't it?


I heard from one doctor that Ativan takes 30 minutes to take effect, and Xanax takes 20 minutes, but in the ER (my sister is an ER doc) they always give Ativan. That might be because Ativan works longer than Xanax, my sister didn't even have a good answer as to why they don't use Xanax. :) Sometimes doctors just use what they've learned, or following the standard operating procedure without knowing why.

[shoe]

In my experience, and also one other person I talked to who had taken Xanax, it has a very noticeable dropoff.. I mean, you can almost feel when it loses its effect in your body. Clonazepam has a more smooth and gradual dimishing effect.. I don't get the same feeling as I do with Xanax's more abrupt loss of efficacy. Might be the same for Ativan and some other benzos, I don't know. But could also be an individual thing.

shahram, I believe nearly every benzo out there has generic versions. I'm pretty sure I got a prescription for a generic form of ativan.

shoe

[Bridgie]

When I was taking Zoloft, it was $75.00 for a month's supply. Forget that! But the clonazapam was under $10.00 last I bought it, and it works far better than any SSRI!

[aberke]

Thanks for all the feedback guys, really appreciate it, and will put all teh input to good use. Im going to have a talk with my doctor and see what he thinks. I never hear much about diazepam, is it that it is used for different reasons than 30 minute panic attacks? or is it more readily abused, or what, im curious

[Maggie May]

Is Ativan more expensive than Xanax? I'll bet it is. Xanax also has generic equivalents that make it even cheaper. These companies are constantly making improved products and renaming them to charge $60 a bottle instead of improving what they have. Also, drug reps leave samples of the expensive stuff behind for docs to give out. They give it out, with good intentions cause it's free and helps the patient out, but then the patient has to continue with the expensive stuff. So if your doc gives you a free example, most of the time you can bet it will be expensive. I think alprazolam(xanax) is about the cheapest stuff out there right now, isn't it?

Hey Shahram,

I only know parts of the answers to the points you brought up, but I think it's really important for people to compare and contrast what they hear from doctors (even sisters who are doctors!) and drug companies and magazines and clinical trials and all the rest. We should keep it up! :)

I believe the FDA, or the patent office, or whoever, gives a drug company only a certain amount of years to have the exclusive rights to a new drug. After that, generics are allowed to be made. Luckily, benzodiazepines like Xanax, Ativan, Valium and the rest were introduced back in the fifties, so their patents have long run out, and that's why we can get cheap generics like Alprazolam, Lorazepam and Diazepam, which are the generics for Xanax, Ativan and Valium.

Since the SSRIs were introduced in the 90s, their patents haven't run out yet, so you can't get generics yet. The drug companies are pretty wicked though. As you said, they re-introduce the same drugs, but with CR after the name, meaning Continuous Release, meaning they coat the pill so that it takes much longer to dissolve , and gives you a more steady stream of the med. And I *think* that they file a new patent for each incarnation of the drug. I dunno, I wouldn't even mind that so much if the damn things worked better than they do, or with fewer hard-to-tolerate side effects.

The side effects that kill me are the sexual side effects. I don't know about the rest of you, but for me, orgasms have extremely powerful anti-anxiety effects. Not to mention all the calming endorphins you release when you are physcially intimate with someone. And how much better you sleep afterwards, etc. I tried Paxil for 6 months because it was supposed to be the wonder drug for anxiety, but all it did was not work and make me unable to have an orgasm! Come on, you can't take one of the sweetest joys in life away from a person! ;)

Anyway, back on track. I believe the benzodiazepines are pretty much equal in price, dose for dose. But I hear you about the free samples from doctors. I think if doctors know you don't have insurance, they'd better be repared to keep you in samples indefinitely. There are also *some* programs out there that will help you pay for your meds that are still under patent, I'll have to find a list one of my doctors gave me, or do some internet research on it. I believe they help you if your income is below a certain amount, which doesn't help the people who are able to hold down some kind of job, but are still suffering.

Aberke, I believe the benzodiapepines fall onto a spectrum. Among the most commonly prescribed, Xanax works the fastest and leaves the body the fastest, hence the "drop off" Shoe mentioned. Klonopin, or Clonazepam takes the longest to take effect and stays in the body for the longest time, something like 12 hours. The rest fall somewhere in between.

Sometimes docs will prescribe a short acting benzo for people who don't have a lot of general anxiety most of the time, only short panic attacks like you described. They use the longer lasting ones for people who have gnarly anxiety most of the day/night.

Addiction is a whole other can of worms. The medical and psychological community still know so little about why it happens to some people right away and never happens to others. I have been in contact with hundreds of anxiety sufferers through my work in an anxiety-management class, and they all say the same thing. "I'd rather die than get addicted to anything, so I only take the smallest effective dose and never take it to get high." Some people with a family history of addiction avoid benzodiazepines, and that's fine, no one should take anything they're not comfortable with. Others would rather be dependent (not the same as addicted) on a med rather than live through hell. It's up to the individual.

For me, when the anxiety disorders got so bad that I was unable to eat, sleep or go to work with any regularity, that was when I broke down and started taking benzodiazepines. It's been about five years and I haven't had to take much higher doses or started holding up pharmacies to get more yet, so I think I'm okay. ;) I made a deal with myself that I would allow myself to take the benzos as long as I was doing everything else I could to find equally effective methods of fighting anxiety. That's where my journey has lead me, it's not necessarily righ for anyone else, I'm just sharing.

That's the beauty of anxiety forums. :)

Maggie

[shoe]

For Medication Assistance programs, check my post 'Medications' in the Resources section.. or here's a direct link:

http://www.anxietyforum.net/forum/about114.html
(under heading 'Medication Assistance Programs')

btw, in my experience clonazepam works pretty much as fast as alprazolam, but does last a little longer. It seems to run out of 'steam' about 4-6 hours after taking it for me. OF course, these are all just how it works for me (others have different results). I personally have wanted to take diazepam for a while now since I've read about it lasting so long, but I haven't had luck getting that benzo yet.