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Q: Ativan as an Anti-manic Drug?
Dear mr.Phelps, I am curious about the bentzo Ativan being used as an anti-manic
drug. I found mania as an indication for it at whatmeds.com. This is weird,
since no other bentzo is indicadet for mania. Do you have experience with it
among bipolars? If used for mania, does it have to be used daily (addiction
being the threat, in that case). I understand it has somewhat longer half-life
than Xanax. Any information appreciated,
A.J
Dear AJ --
Benzo's are not generally regarded as mood stabilizers. But they do help
diminish agitation, help people sleep, and seem to add some "oomph" to
the effect of other mood stabilizers sometimes. Clonazepam (Klonopin,
e.g.) may have a little better effectiveness in this role, in some
psychiatrists' view. Ativan is not recognized as being any better in this
respect, but as you point out, it has about the right "lifetime" in
the bloodstream: Xanax is much too short, and some people don't like the
"hangover" feeling from Klonopin, but instead prefer Ativan for less
daytime sedation.
However, none of these is to be relied upon for
prevention of cycling. They can add on, somewhat; perhaps mostly by
helping people sleep at appropriate times, or decreasing daytime stress which is
now thought to be one of the factors that promotes cycling.
Daily use of any benzodiazepine does have
"addictive potential". Your body will become used to it within
2-3 weeks and often the initial benefit is decreased quite a bit, sometimes
gone, by that time. But many people, perhaps especially with clonazepam,
see continued benefit, perhaps at a lower level than at first. In these
people, there may be a role for ongoing benzodiazepine. Many psychiatrists
use these medications that way. One simply has to watch closely to see
that the dose is not allowed to creep up over time, as that is generally an
endless attempt to get back the initial level of benefit, and can lead to large
doses (anything over 3 mg for Xanax, Ativan, or Klonopin) that have the risk of
serious withdrawal symptoms when that dose is no longer taken for one reason or
another (most commonly, in my experience, some new doctor in the picture who
refuses to continue those doses...).
Hope that helps some.
Dr. Phelps
Published March, 2003
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