Ativan as an Anti-manic Drug?
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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 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,

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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