Question about timing of doses

[[Ri...]]

Hi!

I was prescribed Ativan (.5mg) to be taken up to 3 times per day for anxiety while waiting for my SSRI to kick in. 
As I feel the anxiety is worse in the morning, I’ve been taking 1mg upon waking around (7pm) and then another .5mg at around 3pm.
I’m recently wondering whether that may be too long a lapse between the afternoon dose and the next dose almost 16 hours later…given Ativan’s short half life, could I be doing myself a disservice and maybe I should spread the .5mg out morning, afternoon and before bed?

I love my Dr but she’s never been on Benzos and she doesn’t always ‘know’ the answer.

I’d love to hear other experiences…thank you!

[[Cr...]]

That sounds like a reasonable idea. Three doses (.5 mg) all 8 hours apart correct?

It is only too long of a lapse if you are actually feeling interdose withdrawal. You said you are starting up an ssri right? When you wake up in the morning the Ativan has likely worn off so your anxious feeling could also be ssri start-up effects or normal anxiety (if that is why you got on the ssri).

The only benefit I can think of for 2 doses over 3 is that it is one less dose to remember every day. Midday doses are more often forgot about than morning/night doses.

[[Ri...]]

8 minutes ago, [[C...] said:

That sounds like a reasonable idea. Three doses (.5 mg) all 8 hours apart correct?

Yes.

8 minutes ago, [[C...] said:

It is only too long of a lapse if you are actually feeling interdose withdrawal. You said you are starting up an ssri right? When you wake up in the morning the Ativan has likely worn off so your anxious feeling could also be ssri start-up effects or normal anxiety (if that is why you got on the ssri).

“Yes, the SSRI is for anxiety and I’m wondering if I’d perhaps not feel as much anxiety in the morning if I took a dose before bed.”

The only benefit I can think of for 2 doses over 3 is that it is one less dose to remember every day. Midday doses are more often forgot about than morning/night doses.

[[Cr...]]

6 minutes ago, [[R...] said:

Yes, the SSRI is for anxiety and I’m wondering if I’d perhaps not feel as much anxiety in the morning if I took a dose before bed.”

What one is it if you don't mind sharing? I found certain ssris were better taken at night. When I was on sertraline back in 2012, I found a split dose (half morning, half at bed) worked best for me. It also felt less stimulating since, although my daily amount was the same, I was taking less of a dose all at once.

[[Ri...]]

4 minutes ago, [[C...] said:

What one is it if you don't mind sharing? I found certain ssris were better taken at night. When I was on sertraline back in 2012, I found a split dose (half morning, half at bed) worked best for me. It also felt less stimulating since, although my daily amount was the same, I was taking less of a dose all at once.

Ecitalopram is what I’m taking…

[[Cr...]]

7 minutes ago, [[R...] said:

Ecitalopram is what I’m taking…

Once fully acclimated, I found escitalopram to work the same in either day or night. I guess it depends on what type of side effects it gives you. I think I even used to do two doses with that as well but went to one due to always forgetting my morning dose.

For those with severe anxiety, it is always best to avoid making it worse by starting at the lowest dose possible and slowly work your way up to a therapeutic dose over several weeks.

Often times doctors start patients out at doses that are difficult to adjust to right off the bat and when the patient has a bad reaction they immediately assume it was the wrong ssri when it may have just been the wrong starting dose.

[[Ri...]]

1 minute ago, [[C...] said:

Once fully acclimated, I found escitalopram to work the same in either day or night. I guess it depends on what type of side effects it gives you. I think I even used to do two doses with that as well but went to one due to always forgetting my morning dose.

For those with severe anxiety, it is always best to avoid making it worse by starting at the lowest dose possible and slowly work your way up to a therapeutic dose over several weeks.

Often times doctors start patients out at doses that are difficult to adjust to right off the bat and when the patient has a bad reaction they immediately assume it was the wrong ssri when that may not be the case.

Yes…I had that experience unfortunately- too high a dose too quickly - had to backtrack! Thanks for your input - much appreciated. 

[[Ri...]]

On 06/07/2024 at 20:06, [[C...] said:

That sounds like a reasonable idea. Three doses (.5 mg) all 8 hours apart correct?

It is only too long of a lapse if you are actually feeling interdose withdrawal. You said you are starting up an ssri right? When you wake up in the morning the Ativan has likely worn off so your anxious feeling could also be ssri start-up effects or normal anxiety (if that is why you got on the ssri).

The only benefit I can think of for 2 doses over 3 is that it is one less dose to remember every day. Midday doses are more often forgot about than morning/night doses.

I’m new here and don’t know how to post properly, but I have another question. The reason that I asked about switching to 3 equal doses is because last Wednesday at around 3pm, I  found myself experiencing a full-blown withdrawal episode (sweating, anxiety, heart palpitations, nausea - you name it!) I had no idea what was happening until I realized that I had forgotten to take my 1mg Ativan dose that morning at 7am. Since I was only taking .5mg at 3pm and 1mg at 7am…that meant that I was 24 hrs since last dose! I’m very sensitive so obviously my system was quite destabilized as I’m still not settled! I did switch to .5mg every 8 hours when we last spoke. Have you knowledge of one’s nervous system taking a bit to ‘recover’? 

[[Cr...]]

2 hours ago, [[R...] said:

had no idea what was happening until I realized that I had forgotten to take my 1mg Ativan dose that morning at 7am. Since I was only taking .5mg at 3pm and 1mg at 7am…that meant that I was 24 hrs since last dose! I’m very sensitive so obviously my system was quite destabilized as I’m still not settled! I did switch to .5mg every 8 hours when we last spoke. Have you knowledge of one’s nervous system taking a bit to ‘recover’? 

That is not necessarily a situation of a destabilized nervous system. Missing a dose (1mg or 2/3rds of your daily dose), going without a benzo for 24 hours, and having massive panic with withdrawal symptoms is a strong sign of physical dependence. Those symptoms probably didn't happen because you have not stabilized on your current Ativan dose. Whether stable or not, it is a very fast acting benzo with a short half-life, it would cause the reaction you had in almost anyone that has become dependent.

And yes, the nervous system does take quite long to recover in terms relative to the rate of healing for other areas/systems of the body. I am not an expert, but some of the recovery will happen while you are tapering.

[[Ri...]]

34 minutes ago, [[C...] said:

That is not necessarily a situation of a destabilized nervous system. Missing a dose (1mg or 2/3rds of your daily dose), going without a benzo for 24 hours, and having massive panic with withdrawal symptoms is a strong sign of physical dependence. Those symptoms probably didn't happen because you have not stabilized on your current Ativan dose. Whether stable or not, it is a very fast acting benzo with a short half-life, it wo7od cause the reaction you had in almost anyone that has become dependent.

And yes the nervous system does take quite long to recover in terms relative to the rate of healing for other areas/systems of the body. I am not expert, but some of the recovery will happen while you are tapering.

Yes, I know for sure I’m dependent. I’m just surprised that after missing that dose almost a week ago, I still feel anxious and unsettled even though I’ve reinstated the 1.5mg per day. Although it was just yesterday that I started taking 3 equal doses instead of front loading the day. 

[[Cr...]]

24 minutes ago, [[R...] said:

Yes, I know for sure I’m dependent. I’m just surprised that after missing that dose almost a week ago, I still feel anxious and unsettled even though I’ve reinstated the 1.5mg per day. Although it was just yesterday that I started taking 3 equal doses instead of front loading the day. 

You may just be very sensitive to these types of meds. I have come to notice that whenever panic attacks or severe anxiety is involved, it often takes awhile for the body to return to the state it was before they occurred.

This is a common phenomenon even in people that have never touched benzos or other psychotropic meds. I recall having a severe anxiety attack in my teens that left me feeling shaken and nervous for weeks to follow. You might still be experiencing the aftershocks of your reaction. As long as you keep your dose stable and allow more time to pass things should return to a more tolerable, familiar state

[[Ri...]]

2 minutes ago, [[C...] said:

You may just be very sensitive to these types of meds. I have come to notice that whenever panic attacks or severe anxiety is involved, it often takes awhile for the body to return to the state it was before they occurred.

This is a common phenomenon even in people that have never touched benzos or other psychotropic meds. I recall having a severe anxiety in my teens attack that left me feeling shaken and nervous for weeks to follow. You might still be experiencing the aftershocks of your reaction. As long as you keep your dose stable and allow more time to pass th ings should return to a more tolerable, familiar state

Thank you. That’s exactly how it feels - aftershocks - I’m trying not to freak out as this won’t help anything, but I’m also a bit angry for myself as this could have been prevented by my not missing that dose. I feel so lousy - your kind words make me feel better. ❤️‍🩹 

[[Cr...]]

You are welcome. Please forgive my grammar mistakes that are immortalized in your quotes. I am using a touch screen phone to type and didn't have time to proofread at the time. 

[[Ri...]]

16 minutes ago, [[C...] said:

You are welcome. Please forgive my grammar mistakes that are immortalized in your quotes. I am using a touch screen phone to type and didn't have time to proofread at the time. 

[[Pl...]]

Yeah definitely do 3 doses that's way too long without dosing. I actually do like 4-5 tiny doses spread throughout the day to keep it steady in my brain, it's tedious but worth it