![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by krisdance83 on October 15, 2004, at 22:25:05
Hi there,
My anxiety has been bad lately because I have not been feeling well and it is still unclear if my anxiety IS what is making me feel unwell in the first place! Anyhow, I am going for some stomach tests in November so my primary care physician doesn't want me to start Lexapro until after we find out what's wrong with my tummmy. Until then she has given me .5mg of Ativan to take as needed. I've taken it once per day for about 30 days now. I have half the bottle left...The thing is this: when I take the Ativan it is because I am anxious or feel that I will have a panic. BUT it does make me feel much better almost right away. I would really like to get thru this rough patch without going on a daily medication and just taking the Ativan as I need it. Now, my question is: how long can I go on taking this dose before I will develop a tolerance. And, more importantly, how long can I go on taking Ativan before becoming dependant. Now I know that everyone is different when it comes to these things but roughly I mean, will I become dependant on it after 60 days? Or is it more like months, years? What is the average with these things. I'm wondering if I can get thru 4 or 5 months taking it as needed and not become physically dependant on it. If anyone has any input I would really appreciate it. Like I said, I know everyone is different but I have NO idea what they mean when they say that one can become "dependant" on this med after "prolonged use." What exactly is this prolonged? Days, weeks, years???Thanks so much.
And one other question, does use of Ativan, after a while, cause sexual side effects?
Posted by tai daluna on October 17, 2004, at 4:27:45
In reply to Ativan questions, posted by krisdance83 on October 15, 2004, at 22:25:05
hi,
i have used ativan as needed for two years without serious incident. it is important to remain aware of how much you are using and discuss this with your doc. explain how you are worried about physical dependance. my doc and i talk about it a lot re: my own use. i do notice that if i take 1mg or more for a few days running i will have a sore stomach when i try to stop: abdominal cramps are a common withdrawal effect. i also get headaches.
overall, i find this drug less addictive than alcohol, as long as i do not take it every day in *excess*. i have not developed a tolerancy to it that could not be overcome by giving it a break for a few days. if you find yourself using too much, back off for awhile. you can control your own body!
for this reason: i suggest you save ativan for when you really need it. it is my emergency med. i think of it the same way i think of asthma (steroids to help heal the prob/rescue inhaler to save me the terror of an attack= AD for anxiety disorder/ativan for panic)...
good luck,
tai
Posted by Kon on October 17, 2004, at 10:41:40
In reply to Ativan questions, posted by krisdance83 on October 15, 2004, at 22:25:05
Most of the material I've read suggests that tolerance to anti-anxiety effects usually does not occur with benzos. What does "usually" mean...have no clue. Anecdotal reports, however, do suggest a greater potential of tolerance with xanax and ativan in comparison to longer acting benzos like clonazepam, but I've never come across any hard evidence for this claim. Wrt dependency (which is basically withdrawal) based on material I looked at (see one such article below) slightly less than 50% of users will develop noticeable withdrawal after months to perhaps years of use. From Tyrer's research (see below), he does mention years in one article I read in Ashton's UK benzo site. Dependency/wthdrawal may be higher, however, in individuals with passive-dependent personalities.
Thus, you likely have over 50% chance of not becoming physically dependent even if you use it for months to perhaps years. Probably well over 50% if you take it as-needed. Personally, I've used different benzos as-needed including ativan for over 2 years and never had any problems with dependency...(i.e. withdrawal). I normally take a month off drug use during summers. Even if you did become dependent, just do a taper and slowly come off the drug.
>I have NO idea what they mean when they say that one can become "dependant" on this med after "prolonged use." What exactly is this prolonged? Days, weeks, years???
For most people it means months to years. Only rarely do individuals become dependent on benzos within the course of a few weeks (especially if taken as-needed).
> And one other question, does use of Ativan, after a while, cause sexual side effects?
I had none but sexual side-effects have been reported to occur occassionally with benzo use. Far less than SSRIs, however. Occassionally, sex drive is even increased.
------------------------------------------------
Biochem Soc Symp. 1993;59:107-19.Benzodiazepine dependence: a shadowy diagnosis.
Tyrer P.When benzodiazepines were introduced into clinical practice in the 1950s they were hailed as efficacious minor tranquillizers, largely devoid of unwanted side effects, in contrast to the barbiturates and similar drugs that they largely superseded. It was 30 years before the phenomenon of low-dose dependence on benzodiazepines was recognized. Benzodiazepine dependence differs from other psychotropic drug addictions because the benzodiazepines do not produce either euphoria or drug-seeking behaviour (except in those who are already addicted to other drugs). However, benzodiazepine use is associated in some individuals with a marked withdrawal (abstinence) syndrome that provides the best evidence of dependence. Just over half the people prescribed long-term benzodiazepines do not develop any sign of a withdrawal reaction (Fig. 1): this reflects factors including the type of benzodiazepine prescribed, the dosage and duration of treatment, as well as characteristics of the patient. Individuals with passive-dependent personalities appear to be more likely to experience withdrawal symptoms than other patients, although this remains a controversial issue. Therefore benzodiazepine use should follow certain guidelines, and if these are adhered to the benzodiazepines will continue to be valuable drugs in clinical practice.
Posted by Kon on October 17, 2004, at 15:01:20
In reply to Re: Ativan questions, posted by Kon on October 17, 2004, at 10:41:40
I managed to locate a few papers on the incidence of dependency/withdrawal following long-term benzo use.
Rickels (1983) calculated the incidence of withdrawal after > 8 month (average 3 years)of daily benzo use to be about 43%. The incidence of withdrawal with < 8 months of daily benzo use was found to be 5%.
Noyes(1988)looked at 9 controlled long-term studies (mean 3 years, range 1-16 years) and found that abrupt benzo discontinuation resulted in withdrawal symptoms in about 45% of the patients.
Generally, reports that suggest very high incidence of benzo withdrawal (>80%)tend to include patients who have previously had difficulty discontinuing benzos (Ashton's study, for example). The high rates of withdrawal/dependency are then not surprising.
Thus, discontinuation of a benzo taken daily for < 8 months and at not too high doses, generally carries a small risk of producing withdrawal.
See:
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.