How much Ativan is too much?

[JimmyJazz41]

Hi all!! First post. I've been suffering from pretty nasty anxiety for about 4 months now (butterflies in the stomach, racing heart, difficult to sleep,muscle twitching).

I went to see the psychiatrist and he gave me some Ativan to take PRN (as needed) 0.5mg 3 times a day as needed. He also gave me some propranalol which doesn't seem to do much tbh.

It's really difficult to know how much Ativan I should be taking. He said just take it when things get bad. I've read so much about the problems of physical dependancy and addiction with Ativan. Generally I only take it 3 or 4 times a week, usually 0.75 mg a day (0.5mg doesn't really cut it). The most I've taken is 1.5mg. I've been doing this for about 3 months. Do you think this is too much or should I relax about it? If I go 48 or even 72 hours without I don't seem to get withdrawal symptoms (except it's really difficult to sleep). I'm scared of benzos but I'm wary of SSRIs and hope to be starting CBT within the next couple of weeks.

Many thanks in advance fellow anxiety sufferers!

[acetone]

Wikipedia states rebound insomnia is a symptom of ativan withdrawal-
http://en.wikipedia.org/wiki/Lorazepam

[alankay]

Withdrawal can't happen unless you take it daily for as period. Don't buy into all the fear mongering when talking about "as needed" use(but of course be cautious an sensible). I used to take up to 2 mgs or more for specific classes and then no more for days and never had any issues. 1 mg was a more common dose. The doc wants you to hold off as much as you can and learn calming skills. If you need .75 mg to 1 mg just a couple times a week you're OK. If you really are worried about it.................just don't take it.
I will just say the for some(myself included) truly judicious use of a benzo allows me to live normally when taken for specific situations only(flights, dental appts, interviews, tense meetings) where I have severe anxiety. Simply try and use the minimum. Alankay

[JimmyJazz41]

Thanks a lot for the advice, I really appreciate it. I'm taking it about 4 days a week (on my most stressful days) and can't seem to get it down much lower than that. It's ironic that worry about anxiety medications actually makes me anxious. I'm living and working in Japan at the mo. and they seem pretty pill happy here....I had to do my own research to find out that I shouldn't be taking it everyday.

BTW do you know anything about the interaction between beta blockers and ativan? Sometimes I've taken them around the same time and haven't noticed any adverse effects but don't know if this is really the done thing. The combination seems to work but not the propranalol (inderal) on it's own. Thanks.

[alankay]

It's ok to take propranolol and Ativan. I used to take atenolol and Ativan but now take valium and propranolol for racing heart/tremor/shaking(social anxiety) when anxious as well.
Some do take it(ativan) daily it's just not best long term. A very anxious patient may take it Daily just to get calmed down at first then learn to use it more spariingly. This keeps tolerance down. You are lucky you are not in the UK where they seem to like to let you suffer as the fear mongering on benzos is very bad there. Here in the good ole US you can get them if needed but you'll be told to try to use the minimum, add a daily Ssri to help lower anxiety and get psychotherapy if possible for a while and learn about anxiety in general. A better approach.
Trust me .75 mg is not a giant dose. Rather low to medium but that med is quite effective. I'd use it again if offered it as again it's effective and commonly used for high anxiety.
If needed I can email as well as I know it helps to have some help, etc.
Again, best policy is usevas little as needed onlynwhn needed and you'll be fine. Alankay

[JimmyJazz41]

Thanks a lot for your thoughtful and kind response. I have an additional problem with dealing with this anxiety as I'm in a foreign country and it's not so easy to get the same support network around me.
Sounds like benzos started to get demonized in the 80s in the U.K after a BBC "expose" when they just took the worst case scenarios where people had taken too much for long periods and then their experiences were presented as the norm. So I will be cautious about my use and stop worrying. I'm starting skype CBT and if I don't see improvements I'll start on a SSRI after a while.
I appreciate any advice about medications as I'm new to all this. I guess I had mild social anxiety for years but was in denial about it and far too often self-medicated with alcohol. After getting sick in April (which thankfully turned out not to be too serious) I got bad health anxiety. Now I have no idea what I'm worried or fearful about anymore! It sems like my central nervous system has just gone into overdrive and I can't switch it off. I keep waking up with a racing heart (when I finally get some sleep) and have this regular knotted feeling in my stomach. Get the shakes too. I feel like I'm od-ing on adrenaline a lot of the time.
Anyway thanks again Alan.

[Dahila]

I was on Ativan for years and somehow I did not get addicted. it was helpin with my insomnia. When the zoplicone showed itself on market i made a swift switch. I forgot about ativan. Of course before the airplane flight i had to take it, to calm down my paranoia of dying, or before the driving test and other stressful situations. In my opinion Benzos are necessary for people in our situation. I chose meds, instead of going crazy and ruining my life and my family. I take Ativan maybe 3 times a months. I do not think it is dangerous in this amount. In good Canada doctors will prescribe SSRI but not benzos. I can not tolerate SSRI, so my GP adviced to calm myself somehow, not offering any other option. She did not care that I was considering suicide, somehow believing that older people do not do it. Finally I got help when I tricked the idiot family doctor for referral to psychiatrist. Psychiatrist does not have the problem to deal with my anxiety using meds. She is trying to help me to enjoy life and feel safe. Thanks to her I had the last panic attack like 3 moths ago,

[alankay]

Wow didn't realize the Canadian docs bought into the benzo fear mongering. Sad.
Anyway Jimmy you might have your thyroid checked but it seems like anxiety. Often something is bothering us somewhere to cause it. That's why meeting with a therapist is often a best first step but at least you have a doc that will ok Ativan to help and you seem to get how to use it.
You are 100% correct. I do not know how the genius Dr. Heather Ashton managed to convince a whole UK govt and medical community benzos somehow "caused" anxiety. It was docs over prescribing for years that caused the problem not prudent prescribing. It is important to investigate the psychological aspect when and if you can. Not always but often there is a cause, current or past life issues/experiences that needs to be found for anxiety and addressed but not always. Glad to help if I can. Are you from the US originally? Just wondering. Alan.

[JimmyJazz41]

No. I'm originally from England but haven't spent much time there over the last 15 years. I've moved around a lot. When my health anxiety was bad a couple of months back I was checked out for lots of things and it would appear that there's nothing wrong with me physically. So it is "just" anxiety. It's frustrating that I can't pinpoint what's causing it anymore, hopefully the CBT will help. I have good days and bad days...today is a bad day unforunately. I hadn't touched the Ativan (it's called Wypax here in Japan btw) since Monday afternoon but just had to reach for it a short while ago (it's Thurday afternoon here). You seem really knowledgeable about medications Alan...it's a big help.

Dahila, I find Ativan helps a lot with my insomnia too. But I've been prescribed something called Brotizolam (also known as Lendormin) for this which I take occasionally and I find this works brilliantly for sleep. If you can get hold of this I'd definitely recommend it for when things get really bad. It gives me a good six hour sleep (usually) without much morning drowsiness.The problem is I'm not sure if it's available anyway in North.America.

[alankay]

CBT should be tried.
Yep often(not always) there's something bothering/worrying us at some level that causes anxiety. Sometimes folks just develop anxiety. If your interested do an "inventory" of important aspects of your life, like work pressures, status of parents and siblings, intimate relationships, children, significant upcoming event/changes, etc. Write it out and see if there's a conflict or worry your psychological defense mechanisms may be holding down and that may be causing or contributing to your anxiety. Sometimes nothing really can be found including the all important past.
Just some additional thoughts. Alankay

[JimmyJazz41]

Yep. We shall see. I'm hoping counselling will help to draw out whatever really is sustaining the anxiety. I've got my first session coming up tomorrow. If you've had CBT yourself did you find it beneficial and worthwhile?

[alankay]

No back when i was diagnosed they didn't call it that. I think it was part of the psychotherapy but there was no formal name to it to separate it. I've read about it have tried to see the essence of it and in how it helps. it should be tried. Alankay

[jessy]

I take 5 mg every day of lorazapam :-/ this must be a high does then

[JimmyJazz41]

Hi Jessy. You do mean 5mg right? Not 0.5 mg? If you mean 5mg that does seem high. How long have you been on it at that dose?

[Dahila]

is the ativan aka lorazepam in different doses. The one under the tongue is 1 mg I think, I had the lorazepam to swallow and it was much bigger dose.

[alankay]

Ativan=lorazepam exactly. 5 mg is a dose that a pdoc would only manage after many other things failed(unless it's 2.5mg twice daily). .5 mg would be a low to normal dose. Alankay

[Dahila]

mine is 1 mg, I went to check. and the pdoc said to take two if I have the panic attack, i usually take just one to take the edge off :)

[alankay]

That sounds about right. I bet 1 and 1/2 tabs would also help a panic attack. Might take 2 also. It is a potent benzo. Alankay

[SunnyHours]

I'm in the same boat as you, I'm new to panic attacks and been benzos more than id like...for example, this morning to get on my way to work, I almost had a panic attack.
I guess I feel ok to go to work...I don't have much choice I'm on the verge of losing everything...

[jessy]

I take 1mg five times a day of lorazapam . This is what's pescribed by my physiatrist along with Cymbalta now

[JimmyJazz41]

I feel your pain Sunny Hours. Some days I really feel like I can't work because of my anxiety but I just have to....I have no choice. I teach adults and it's really hard to hide when you're ruminating and panicking inside. Good luck. I'm slowly finding some ways to deal with it.....contact me any time and I'll try to help.

[jessy]

So is 5 mg a day to much ???? Why have I been advised to take between 5-6mg per day ?????

[acetone]

So is 5 mg a day to much ???? Why have I been advised to take between 5-6mg per day ?????

The usual dose for anxiety is 2-3 mg/day for anxiety. If you want to come off from 5-6 mg/day definitely taper.

[JimmyJazz41]

Hi Alan. Thanks for the advice you gave me the other day by pm. I was fine. BTW I think your pm inbox is full cos I couldn't send a message there.