BeeBee

Does anyone know why a doctor may prescribe, oh let's say, Ativan over Xanax or any other benzo over another? Besides half life, I'm trying to figure out why one benzo may be prescribed over another.

QU31

I am wondering the same thing. I am going to ask my dr. the next time I am there. I think it mostly has to do with how long-acting they are and that some have higher risk of dependency than others. My old dr. used to always prescribe Ativan, which I loved--I would go right to sleep and not wake up groggy. My new dr. presrcibed klonopin, which is longer acting. He said it has less risk of dependency. But I wake up feeling very groggy, not like with the ativan. It seems like for generalized anxiety disorder, they all seem to favor klonopin these days.....

weatherfreak

I personally found ativan useless, klonopin depressing and put me in la la land, xanax extremely addictive and valium fantastic. It's funny how everyone reacts differently. I don't know what I'd do without valium when I have a panic attack, which isn't very often these days.

BeeBee

Do you think that Xanax is more addictive than Valium? What would make Xanax more addictive than any of the others. I thought a benzo was a benzo was a benzo. Anyone have any idea?

ccgirl

If you go over to the substance abuse section, there's loads of information and threads on benzos. Just beware, some of it is very heated conversation!!!

pedagogue

*not medical advice*

In action a benzo is a benzo is a benzo, though they can very in other ways such as potency (.25mg vs 2mg vs. 7.5mg, etc), half-life, administration (injectable, pill, etc), binding affinity, etc.

People tend to find Xanax more addicting because of the high potency + short half life....which results in a quick in / quick out. Think of it like a peak and valley instead of a more flowing wave like you'd see in something longer lasting like Valium. The lowest pill dose of Xanax is .25mg, with a 12-15 hour half-life, compared to Valium's 2mg and 20-50 hours. In simple terms this means that Xanax is far more potent (amount needed for something to happen) than Valium. It is important to note that this doesn't inherently make one more 'addictive' than the other, though it is an important factor when considering dosing.

One of the problems with Xanax is that it does it's job VERY well, but once someone goes Xanax, they tend to not want anything else. Then there is the addiction risk, problems tapering off, etc.

-p

Live

My p-doc told me that Xanax was the Muhammed Ali for anxiety. I have been on it for several years. I am dependent upon it for sure. But I believe there is a difference between dependence and addiction. I would have withdrawals from my anti-depressants as well. I have tapered myself off xanax at least 4 times before as the situation I was in, I no longer needed it. But this is the longest I have ever been on it before and when I decided to taper and threw away some 180 1 mg tablets....it was pure hell....and then when I had tapered off and was given a low dose valium from a gp, I quickly learned that I had suffered needlessly, that the xanax works for me and I do need it. My p-doc was very upset with me about it....I was working out of state when I did this...and had gone to a gp. And made this decision on my own....because some of the abuse threads scared me so badly. From now on, I work with the p-doc I know and trust and who has been seeing me for 4 years. We have discussed klonopin at the last two visits, because of I was complaining of the lethargy produced by xanax. I was also quite depressed last time and she changed the AD meds to more activating ones....so far so good!

weatherfreak

What pedagogue said!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!

weatherfreak

Not all people, but people with mental illness suffering from depression find klonopin very depressing. If you find xanax lethargic then klonopin will knock you on your butt. Maybe ativan might be a better choice for you. It is by far the least sedating benzo I have ever had. I would also choose valium over klonopin anyday

BeeBee

Ok, this is the deal. I have been taking 0.25 to 0.50 Xanax off and on for two years. On an as needed basis. Some days I just take 0.25 once and some days I may need an 0.50. Some times I need to take it daily for several days or maybe even as long as two weeks. I never take it for longer than two weeks at a time. I can go weeks and sometimes months without needing it and then suddenly something will happen in my personal life and then I'm fighting anxiety again. Two years ago when I saw the doctor for Xanax it was a med I had requested and I forget just now why I requested that particular one. Undoubtedly it was some comparisons I made based on internet research I'd done. The Xanax tends to cause depression for me and it also makes me very sleepy, even at the 0.25 dose. I'm going to be seeing my doctor again soon and I want to request something else. My sister gave me a couple of her 0.50 Ativan and I cut it in half and it seemed to work reasonably well and I didn't feel too sleepy or get depressed and so I'll probably ask the doctor about Ativan when I go in, but I have wanted to better understand the differences between the benzos so I could be sure I was requesting the best product for myself. The doctor will be someone I've never seen before at a state run clinic so he has no medical chart on me unless he sends from one from my old clinic.

I do understand the difference between addicted and dependant and I don't think I'm either in regards to the Xanax so I don't feel that's a problem for me. As I said, I have been very careful how I've taken it. What I'm still not understanding is what would make an 0.5 Xanax different than an 0.50 Atavan? This is really troubling me. Pedagogue is it the half life of the med? Both come in tablet form and yet one makes me too sleepy and the other not so much.

pedagogue

Here is a somewhat simplified explanation:

The potency for Xanax is more than Ativan, so if both are given at the same mg dosing, Xanax should create more of a reaction. Both bind to the same receptor, though I don't know off the top of my head the binding affinity %'s (how likely it is going to bind to a free receptor of the same type), the avg. bound time (how long it stays bound), typical plasma levels (amount of actual drug in plasma), etc. There are a number of other things at play too, but in short.....Xanax at 1mg, compared to most other benzos at 1mg, will be 'stronger'. (not counting Halcion/Triazolam)

-p

BeeBee

Pedagogue, I know it must seem that I'm being difficult here, but I promise you that I'm not. I am only trying really hard to understand. So then all benzo's are not created equal. A benzo is not a benzo is not a benzo then? If 1mg of one brand is stronger than 1 mg of another brand, then what makes one so? What makes ones half life longer than another. I guess this is a real source of confusion for me. There must be another chemical combined here to make a 1mg dose of one stronger than a 1mg dose of another, right? What is going on here that makes it so?

PS. and by the way, you are a fabulous source of information. Don't ever stop being so smart or so helpful. I for one appreciate your knowledge. Thank you.

pedagogue

No problemo! This helps me review the information also, so don't worry about asking questions (at least in regard to information, I can't give any medical advice nor speak to personal situations).

Here is another way to think of it. (I'm hungry, so my example involves food). There are a lot of different kinds of sandwiches out there. If you were to describe a sandwich to someone, they'd have similar characteristics and they do the same function (provide nutrition, etc), but they aren't made of the exact same thing. You can have a ham sandwich and a turkey sandwich. Both are sandwiches, contain meat, and are used to provide nutrition, but the actual contents are a bit different. Benzos are like that!

Here is the chemical structures of each:

Xanax


Valium


As you can see, they are structured similarly (the bottom part), but like the sandwiches, they may act in a similar way, and may serve the same function, they are slightly different. This difference can effect how long it stays in your system, how strong it reacts to things, etc.

-p

ps. I should have used the sandwich example earlier...the stuff I put up top is correct, but kind of obtuse. I remember when I learned the stuff I asked a thousand questions, so don't feel bad about asking questions.

weatherfreak

Bee Bee, check out a benzo equalivency chart, google it, it will show you how different benzos relate to their strength. For example

Benzodiazepine Equivalence Chart


BENZODIAZEPINE
COMPARATIVE DOSE

Alprazolam .5mg Xanax
Bromazepam 3.0mg
Chlordiazepoxide 25mg Librium
Clonazepam .25 Klonopin
Clorazepate 10mg
Diazepam 5 Valium
Estazolam 1mg
Flurazepam 15mg
Halazepam 40mg
Ketazolam 7.5mg
Lorazepam 1mg Ativan
Nitrazepam 2.5mg Mogadon
Oxazepam 15mg Serax
Prazepam 10mg
Quazepam 7.5mg
Temazepam 10mg Restoril
Triazolam .25mg Halcion

Now all these different benzos last for different periods of time in your system, refered to as half life, so check out a proper chart so you can see the brand names too. Good luck

http://www.mental-health-today.com/rx/benzo.htm

BeeBee

Pedagogue, I want to be sure I'm understanding this right.....So the chemical structure of the benzo is changed to make it more long lasting, have a longer half life? It's not that anythng else is added, more that the chemical structure has been changed. Did I understand that right? So science is messing with the chemical structure and that in turn determines half life and strength?

BeeBee

Weatherfreak, so this equivelancy chart shows me how the differences of mg in these listed meds actually do the same thing, actually are the same strength but because of the changed chemical structure the mg dosage is different. Did I understand that correctly? I must have missed something. It wouldn't make sense to me to make or sell benzos this way. It would make more sense to just adjust the dosage of one chemical structure rather than twiddle with the the structures. I'm sure I've missed something here.

Thanks for the link. I'm going to check it out now.

BeeBee

Ummmmm.......so the chemical structure is changed to determine half life and strength. I think I said that somewhere above, didn't I. That what I'm getting from that link above.

Can it be said that one benzo is more addictive or creates stronger dependancy issues than another? Is there a benzo that is more safe than another?

And.....how is it determined which benzo is best for any given patient? Doctors seem to be prescribing this stuff like candy so how is it determinded what's the best med for a situation. My sister recently had high blood pressure that she thought was brought about by work related stress. Rather than prescribe a bp med, the doctor gave her Ativan and told her to keep an eye on her bp. This makes no sense to me. Does it make sense to ya'll? My sister is a smoker, a drinker and smokes pot. This med regimine makes no sense to me.

pedagogue

There are a lot of factors that contribute to half-life. Much like cooking, every little thing you add/change can effect other things...and often not a one to one cause/effect. Whether you tweak a ring on the structure, or add a few things, each thing can do something different.

It isn't quite that easy because the structures go through a process (or multiple processes) before they can do what they need to do, and it is a delicate balance. Many times meds are developed by different companies and they only vary by a little bit, though that little difference can make a big difference in how they work, side effects, etc. One company may add something to one side, and take something else off. This can change how it is broken down....and sometimes it helps, and other times it makes it less effective. So in a sense they do try and add more of the 'good' part, but it isn't always 'more' that they want....sometimes they want it to last longer, etc.

Yes and no. People will react differently to different meds. In general, the 'stronger' and 'quicker' meds are more problematic, but not always. Sorry that isn't more specific, but people can get addicted to a number of different things for different reasons. Benzos in general aren't a great choice for many, but that doesn't mean they don't get prescribed. They are very good at what they do, but that doesn't mean they should be given out as easily as they typically seem to be.

It is up to the prescriber to consider all of the factors involved (medical history, symptoms, side effect profile, etc), and it often is not cut and dry. There can be reasons why s/he thought that would be the best course, and it very well could be. If she is concerned or has questions, she should let them know.

-p

BeeBee

So basically it's trial and error with benzo's. There really is nothing I have to go on that may help me decide if one benzo may work for me better than another? Since I don't have much faith in the medical industry to begin with, I just don't really feel that I can trust a doctor who's never seen me before to make an educated decision about a benzo for me, especially considering it's so hit and miss with these meds. Are there any factors I should take into consideration when talking with a new doctor about changing from Xanax to something else that would better help in the decision to try one over another? What specific information should I give the doctor?

pedagogue

Deciding which will work best for you is part of the prescriber's responsibility. They go through a plethora of training and thousands of face to face hours. Unfortunately many prescribers get a bad/unfair view because of the limited time they have with their patients. I mentioned earlier that people can't be everything to everyone, which is what often happens with general practitioners, family practitioners, NPs, PAs, etc. I'd probably look to someone like a psychiatrist or prescribing psychologist to help you; both of those groups specialize in psychotropics.

I'd share with them your concerns, your previous meds, and any side effects that you experienced while on those meds. All of this information can help inform them of what med/meds may be best for you. They may decide that benzos aren't even the way to go! Certain benzos have certain side effect profiles that are better fits for people. While it isn't an exact science, it is still a science. I look at prescribing as half science and half art....since it takes some outside the box thinking to be a truly effective prescriber.

Don't lose all hope in prescribers, there really are some great ones out there.

-p