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ativan for panic disorder
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MedHelp Member's Question

ativan for panic disorder

by jocer, Sep 24, 2001 12:00AM
I have been on Zoloft 50mg for about 1 1/2 months. I also was prescribed Ativan 0.5mg at bedtime to help with panic attacks at night that still continued despite taking Zoloft. My family dr wanted me to stop taking Ativan and switch to Klonopin 0.5mg at bedtime. The Ativan was working perfectly (no more waking up in the night with panic attacks and woke up refreshed). Since taking the Klonopin I am waking up again in the night. Is it possible to take Ativan 0.5mg at bedtime on a long-term basis for panic attacks? I know it is addictive but if Klonopin doesn't help what is the other alternative? The panic attacks only occur in the night. During the day I function without any problems. Thank you for your advice.
Doctor's Answer

by Forum-M.D.-DT, Sep 25, 2001 12:00AM
Thank you for your question and for visiting the Family Practice Forum.

Anxiety and Panic attacks can be treated in several ways. I want to begin by discussing your Zoloft. Zoloft is a type of anti-depressant which is also used in patients with anxiety and/or panic attacks. One consideration you may wish to discuss with your doctor is to possibly increase the dose of Zoloft. If a patient of mine continues to have problems with anxiety/panic attacks and is on 50mg of Zoloft, I increase the dose. The most effective dose of Zoloft is, in fact 100-150 mg daily. Increasing the dose of Zoloft may indeed improve the panic attacks you are experiencing, without the risk of addiction present with medications such as Ativan and Klonopin.

I am unsure of the reasons your doctor had to change from Ativan to Klonopin. Klonopin and Ativan are both of the same class of medication (benzodiazepines) and therefore there is no reduced risk of addiction with Klonopin. If you and your doctor are not comfortable increasing the dose of Zoloft and want to stay with taking the Ativan at bedtime, I see no problem with this, provided that you do not see a decreased effectiveness of the medication (or need for a higher dose) after taking it for several months/years.

My approach if you came to my office with this history would be to first increase the Zoloft to 100mg and see if there is not a reduction of the nighttime panic attacks. If they persisted despite the increased dose, I would go back to taking Ativan 0.5mg at bedtime and monitor you closely for signs of increased tolerance (addiction) to the medication.

My very best to you !

Dean M. Tomasello, M.D.

Member Comments (9)

by Anitra, Sep 25, 2001 12:00AM
I started taking this drug called Buspirone, not alot of people know about it apparently.  It works awesome!!!! especially at bedtime for those panic attacks and anxiety, and it is not addicting!!! you should ask your MD!!

by monalynn, Feb 01, 2002 12:00AM
Just a topic of concern. I am a full-time psychology student in university, currently in my second year. I'm aware that panic disorder only affects (from stats I've researched) 3-4% of the population. My main concern is with prescription medication, Ativan. I was diagnosed with panic disorder at the age of 14. I had severe panic attacks, at first, especially waking up during the night, I would wake up with merely all the symptoms. I remember sitting in a class and my teaching talking about how addictive ativan is, and how it should only be used if the panic is interfering in daily life. For 3 months, @ the age of 14 I was on prozac and another on Herbal St. John's Wort. Personally, they did nothing for me. I finally went back to the doctor, and he refuses to put me on Ativan, like many other doctors I have heard of. I don't understand why. I have at one point, had an ativan in my purse for 9 months and not used it, because for me, while I'm having a panic attack, just knowing the Ativan there (in case things get underbearable, to the point where I pass out), makes me feel better. I'm not a medication person, but one moring when I had to wake up for a final exam, I was very relaxed, but all of a sudden at school, 10 minutes before I final, I had a full-blown uncued panic attack. I don't know how I made it through. For those of you who know, what panic attacks are like, do you know what I'm talking about? I just need something like Ativan in these severe situations.I can handle panic disorders, but when it interferes suddenly, in such a circumstance, what is there to do if breathing and relaxtion techniques do not work. I work out regularly and that mellows me out alot, so I highly recommend it, although I would like your advice on my situation, if you have the time to reply.

by monalynn, Feb 01, 2002 12:00AM
Just a topic of concern. I am a full-time psychology student in university, currently in my second year. I'm aware that panic disorder only affects (from stats I've researched) 3-4% of the population. My main concern is with prescription medication, Ativan. I was diagnosed with panic disorder at the age of 14. I had severe panic attacks, at first, especially waking up during the night, I would wake up with merely all the symptoms. I remember sitting in a class and my teaching talking about how addictive ativan is, and how it should only be used if the panic is interfering in daily life. For 3 months, @ the age of 14 I was on prozac and another on Herbal St. John's Wort. Personally, they did nothing for me. I finally went back to the doctor, and he refuses to put me on Ativan, like many other doctors I have heard of. I don't understand why. I have at one point, had an ativan in my purse for 9 months and not used it, because for me, while I'm having a panic attack, just knowing the Ativan there (in case things get underbearable, to the point where I pass out), makes me feel better. I'm not a medication person, but one moring when I had to wake up for a final exam, I was very relaxed, but all of a sudden at school, 10 minutes before I final, I had a full-blown uncued panic attack. I don't know how I made it through. For those of you who know, what panic attacks are like, do you know what I'm talking about? I just need something like Ativan in these severe situations.I can handle panic disorders, but when it interferes suddenly, in such a circumstance, what is there to do if breathing and relaxtion techniques do not work. I work out regularly and that mellows me out alot, so I highly recommend it, although I would like your advice on my situation, if you have the time to reply.

by monalynn, Feb 01, 2002 12:00AM
Just a topic of concern. I am a full-time psychology student in university, currently in my second year. I'm aware that panic disorder only affects (from stats I've researched) 3-4% of the population. My main concern is with prescription medication, Ativan. I was diagnosed with panic disorder at the age of 14. I had severe panic attacks, at first, especially waking up during the night, I would wake up with merely all the symptoms. I remember sitting in a class and my teaching talking about how addictive ativan is, and how it should only be used if the panic is interfering in daily life. For 3 months, @ the age of 14 I was on prozac and another on Herbal St. John's Wort. Personally, they did nothing for me. I finally went back to the doctor, and he refuses to put me on Ativan, like many other doctors I have heard of. I don't understand why. I have at one point, had an ativan in my purse for 9 months and not used it, because for me, while I'm having a panic attack, just knowing the Ativan there (in case things get underbearable, to the point where I pass out), makes me feel better. I'm not a medication person, but one moring when I had to wake up for a final exam, I was very relaxed, but all of a sudden at school, 10 minutes before I final, I had a full-blown uncued panic attack. I don't know how I made it through. For those of you who know, what panic attacks are like, do you know what I'm talking about I just need something like Ativan in these severe situations.I can handle panic disorders, but when it interferes suddenly, in such a circumstance, what is there to do if breathing and relaxtion techniques do not work. I work out regularly and that mellows me out alot, so I highly recommend it, although I would like your advice on my situation, if you have the time to reply.

by Tomasello_MD, Feb 05, 2002 12:00AM
To: Monalynn
Chronic Anxiety and Panic Attacks are treated either through medications to prevent Panic Attacks and control anxiety (i.e. Effexor, Buspar, Zoloft) or for TREATMENT of the actual panic attack itself. True, deep breathing exercises are good but if these fail and you are indeed having a "panic attack", I see know reason why a doctor would not give you a medication such as Ativan or Xanax to control these attacks. It certainly doesn't sound like you are abusing the medication. It is ignorance on the part of the physician to not prescribe this medication for you. Glad to hear you are exercising. Without a doubt exercise helps control symptoms of both anxiety and depression as well as reduce the frequency of panic attacks.

by taleisyn7, Feb 19, 2002 12:00AM


      GREETINGS ALL!

      Ativan does work well for Panic Disorder.

      I've had terrible bouts of Panic Disorder since the late 1980's. In fact, my First attack was so scary- I really thought that I was dying....or something, that I vivdly remeber almost every detail to this day (!!).

      Actually, ANY benzodiazepine can squash a Panic Attack - provided the right dose is given (examples; 25-50 mg Librium will stop an Attack dead within 20-30 minutes; 1 to 1 1/2 mg Xanax would be an equalegsic to do the same thing).

     Now, for Long Term treatment, Klonopin has been the Dr's favourite. Klonopin has always worked well for me, but just like Librium, Klonopin can (and usually does) some degree of Mental Depression. ATIVAN and Xanax, on the other hand seem to actually 'uplift' the Mood; sort of an Anti-Depressant quality.

     HOWEVER, on the other side of the coin is the fact that both Klonopin and Librium's beneficial effects last a LONG time. Therefore, there is no 'break-thru' Attacks in between doses. (Xanax is Notorious for in-between-dose Attacks; even seizures have been reported.

     Ativan lasts abit longer than Xanax, and in the right dosage, does just a good, or even better job on calming Panic Attacks. I, so far, am very happy with Ativan; not only prevents me from Panic Attacks, but also makes my overall, extreme nervousness go away completly!

     IN CLOSING, for long-term Therapy of Panic Disorder