Ativan tolerance?

[Retired]

What wonderful news, Arose! The fact is you really do have the ability to do the task, but it's just your thoughts that are getting in the way.

After you have done the task a few times, with the help of your medication, you may want to try cutting back when your confidence increases, ultimately weaning yourself off the meds.

Thank you for sharing your success with us. We'll be looking forward to hearing about your progress. :clap:

 

[David Baxter PhD]

Long term use most definitely creates dependence and subsequent withdrawal symptoms. The severity of the withdrawal is directly related to dosage and length of time using.

There are no serious withdrawal symptoms if the individual tapers off gradually, in the vast majority of cases. And even if you choose to discontinue abruptly, which no doctor would recommend, the worst you're looking at is a spike in anxiety and insomnia for a period of time. We're not talking about a scene from a movie on heroin withdrawal.

And at commonly prescribed doses (i.e., below 2 mg per day), there really are no downsides other than the potential for tolerance that Steve (TSOW) mentioned above. If an individual does develop tolerance (i.e., a need to increase the dose in order to continue to derive benefits from the medication), s/he is not a candidate for this type of medication and would be advised to look for alternatives.

 

[ThatLady]

Wow! Congratulations, Arose! It sounds like you did great! :yahoo:

 

[Peanut]

Thank you both so much! I am really extra happy today too because I got a chance to talk with someone that was present in the group (as a member) and she said that she had no idea that I was nervous or felt insecure at all! She said that she never would have guessed, so that made me feel really good!

Regarding the Ativan issue, I really like it because I can count on it to work reliably so I feel like I am capable of doing a lot more. I don't have to worry about siutations that are coming up because I know they won't get too scary. Plus, my anxiety can have a tendency to build on itself, and the Ativan can kind of break that cycle. With that being said, it is just now that I have finally found a doctor that is willing to prescribe it, many don't believe in it as a long term treatment or will only let you have very, very little. But I am really grateful because life is a lot less scary with it.

Thank you so much everyone for helping me get the timing right and offering moral support!

 

[David Baxter PhD]

my anxiety can have a tendency to build on itself, and the Ativan can kind of break that cycle.

Precisely. And for that reason, it is still the most effective treatment for certain anxiety disorders.

There was a recent article on this topic in one of the psychiatric journals. I'll try to dig it up.

 

[David Baxter PhD]

See Some Concerns About Abuse of Benzodiazepines Unwarranted.

 

[Retired]

Thanks for pointing to this article.

Based on the reading I've done, much of the concern about long term use of benzodiazepines stems from the long held misunderstanding about the various compounds within the class of benzodiazepines. Not all benzo's are the same.

The shorter acting and metabolocally cleaner compounds are much safer for most people and less likely to result in some of the problems associated with the long acting compounds which produce active metabolites that add to the effect of the parent compound, plus often cause drug/drug interactions to produce additional unwanted adverse reactions.

 

[David Baxter PhD]

Thank you, Steve. I wasn't aware of the "active metabolites" you mention but that certainly fits with my clinical experience regarding the newer benzodiazepines.

 

[Peanut]

Haha, thanks, looks like I already liked that article the first time! That is so funny!

But particularly this part has some extremely valid points:

Serotonergic antidepressants commonly produce sexual dysfunction and blunted affect, and are associated with withdrawal symptoms when abruptly discontinued, said Dr. Salzman, also a professor of psychiatry at Harvard University in Boston.

Overall, benzodiazepines are safer than antidepressants. They do not impair cardiac function, alter hepatic enzymes, or lower seizure threshold. Thus, Dr. Salzman believes benzodiazepines should still be first-line treatment for anxiety. For patients who must choose between mild dependence vs. loss or reduced sexual function, benzodiazepines trump antidepressants.

It reminds me of being presented with the arsenal of "safer" options which include the warning of "well you have to aware that this one has caused liver failure in a few people","this one causes weight gain","this one can cause increased anxiety"(what???) or "pretty much all of these are going to cause sexual dysfunction to some degree". It's frustrating when you feel like they potentially have something that would work a lot better but won't use it because they just don't use it for anyone.

But, on another note, I actually did email my doctor and ask her for her opinion on if I could take in a way to maintain constant serum levels as we discussed here. That seems preferable to the up-down-up-down until things calm down with life. Anyway, I liked that idea and I'll be interested to hear what she says about it. Thanks guys.

 

[Peanut]

I heard back from the doctor. She said, something like, Yes you're using it the right way, and it sounds like you've gotten creative for your speeches, that's great. Maybe eventually you won't need it. Be careful driving but if it works for you, so be it.

So, thanks guys for your specific input. I'm not sure that I could have figured out as succinct of a plan without you all.

 

[Retired]

Arose,

It's very satisfying to know you found a plan that works for you. Ah yes speeches...there's always the old rule: imagine everyone in the audience with no clothes on...but that can be distracting :mrgreen:

From my working experience, I found that a shift in focus was what worked for me. It's not easy, and takes some practice, and your present strategy will eventually bring you there.

I recall when I had high anxiety when speaking to a group, I was focused on what I perceived as individuals in the audience who might want to be laughing at me.

Eventually I changed my focus to the individuals in the audience I perceived were truly interested in what I had to say.

There may still have been people laughing at me, but I was intent on delivering my message to those who were interested and paying attention.

Please continue giving us feedback on your progress...it sounds very interesting!

 

[Peanut]

Thank you so much for your continued caring messages Steve! Also, thanks for this tip:

Eventually I changed my focus to the individuals in the audience I perceived were truly interested in what I had to say.

There may still have been people laughing at me, but I was intent on delivering my message to those who were interested and paying attention.

I really appreciate helpful tips like that. Incorporating things that you and other people have learned along the way really helps me since I'm just starting out. I tried that today and I think there is really a lot of value speaking to the person who wants to learn. It's very rewarding for both people!

I also wanted to come back and tell you guys that I had the second group today and it went really well again (and I am saying this relative to the fact that I am new--it would probably not be really good for someone that was really experienced)!!! There were less people there this time so it wasn't as large of a group to speak in front of. Although it had less of a public speaking feel, in some ways it ended up being more work to get them interacting and figure out what to work on. I was way less scared this week and next week I think (I hope) I will be even less scared. Plus, I think some of the skills that I teach in the group are actually rubbing off on me and I'm learning a lot too besides just group facilitation--also how not to rake myself over the coals for mistakes or set myself up with unrealistic expectations.

I really think there is a silver lining to every cloud, and I think it ended up being such a good thing to step outside my comfort zone. I've never been so scared in my life but it turns out that I lived through it and it totally rocked!

 

[David Baxter PhD]

That reminds me of my first ever course. I was still a pre-Ph.D. graduate student and this was an introductory psychology course with like 250-300 students - in a lecture hall that just went up in a steep incline of about 35-40 degrees. I walked out at the bottom of the lecture hall and felt like a bug at the bottom of a bucket.

Like Steve, I learned to focus on one or two people at a time in the first two or three rows - people who seemed to be interested in actually listening to what I had to say.

Throw in a little physical comedy like tripping over chairs and getting tangled up in the microphone cord, and it actually went pretty well after that.

 

[Peanut]

Too funny!! Can we get a collective Amen for those few people at each of our gatherings that actually want to hear what we have to say!?! Thank you people!!! We love you!