Xanax and Ativan are both members of the benzodiazepine family and are used for the treatment of anxiety related disorders.  They can also be used for muscle relaxant and anti-convulsive effect.

For a list of ways to fight anxiety in general, see The Top 25 Anxiety Tips.

How does Xanax vs Ativan compare?

First, they are both high potency.  This means that they are relatively strong among their class of medication.

Xanax has a half life of 6-20 hours while Ativan has a half life of 10-20 hours.  This means that your body gets rid of both of these medications relatively quickly.  By comparison, Valium, another popular benzodiazepine, has a half life of 20-100 hours.

This is both good and bad.  It’s good in that you clear the drug out of your system quickly.  It’s bad in that it means that drug delivery is relatively quite rapid.  When you stop taking the medication, it quickly clears from your body, which can result in horrible withdrawal.

Both are fairly addictive when used for long periods of time.

In a survey of 31 clinicians with detox experience, 84% said that Xanax is “especially problematic” for withdrawal.  Ativan is also highly addictive and has similar withdrawal incidences, but has somewhat less of a bad reputation.

Efficacy

Both Ativan and Xanax are highly effective for the short term treatment of anxiety and neither has been indicated for the long term treatment of anxiety.  Both work at fairly high rates to treat panic symptoms.

One study of 74 patients showed that the two have similar efficacy for treating of anxiety at around two weeks.

Remember, both have very similar chemical activity and similar half-lives.

Side effects

Both have similar side effects.

Xanax and Ativan both cause some degree of memory impairment.  One study showed that Ativan was among the “most frequently associated with amnestic effects” in the benzodiazepine class.

The way that memory impairment is tested for is as follows.  Participants are told to memorize a set list of numbers or words then are given the medication and asked to recall them.  This, or some variant, is used to show if memory impairment happens.

It’s somewhat artificial and does not replicate the more realistic use of the medications over several weeks.  It has been shown that the memory impairment side effect may be attenuated to some degree over time.  On the other hand, other studies have shown that long term use of Xanax or Ativan can cause memory and attentional problems.

Both Xanax and Ativan are also both associated with sedation.  One study showed that Xanax was among the least sedating of the benzodiazepines while Ativan was among the most sedating.

Another study showed that Ativan has slower onset of sedative and memory effects, but that they lasted longer than with Xanax.

Note

There are very few studies that directly compare Ativan vs Xanax.  This is likely because drug companies have no reason to run comparison studies when there is the chance that their medication may come off in a bad light.

Xanax: an anxiety medication

Xanax is one of the stronger benzodiazpines (BZD), a class of drugs that slows down the nervous system, inducing calm and relaxation.

And it works quickly, and seems to have limited side effects. No wonder that it’s extremely popular, used even by those who appear to be the most successful and least need it.

Unfortunately, use of Xanax may have gone too far because long term use can cause serious problems. Benzodiazepines like it are best used for short term relief of anxiety, and generally as support for treating anxiety and panic disorders.

The American Psychological Association released guidelines to that effect, emphasizing the preferred use of SSRI medications for anxiety disorders.

What should Xanax be used for, for how long, and what are its potential side effects?

Use

Xanax is very good at fighting anxiety. As such it makes sense to use it in the short term for insomnia caused by worrying, and for short term control of anxiety. On the other hand, other drugs are preferred for certain types of short term anxiety, like stage-fright.

Xanax can be used for panic and anxiety disorders and has shown some ability to work for those conditions – but there may be better options that just take longer to work. The SSRIs may perform better and with less risk, and as such have been recommended for typical treatment of anxiety and panic disorders.

And you can’t forget the importance of therapy and exercise for anxiety/panic conditions, which have no side effects.

Use of Xanax after a traumatic event might be a bad idea.

Xanax’s side effects

Xanax can cause excessive sedation, memory problems, and cause or make depression worse. It can interact dangerously with alcohol as both are depressants. And it is addictive.

Long term use has been associated by some with cognitive damage. This means a potential decline in intelligence, ability to pay attention and concentrate, and decreased memory. Stopping Xanax does not always reverse these changes.

Use of Xanax after a traumatic event to help control anxiety may highly increase risk of developing Post Traumatic stress disorder. It is isn’t entirely clear how – or if – this happens.

In terms of physical side effects, Xanax has less side effects than earlier drugs, but can still cause serious physical problems either in overdosing or through interactions with other medications.

Most common side effects: drowsiness, increase salivation, weight gain and constipation.

Use of Xanax can cause difficulties with memory formation and some form of memory impairment in anywhere from 7-33% of those who use it.  It may also be associated with difficulty falling asleep, headache, and some form of cognitive impairment.

Menstrual irregularities have been reported in up to 10% of women using Xanax over an extended period of time.

Addiction and Withdrawal

We know Xanax is about as addictive as cigarettes; we just aren’t fully clear on how long dependence takes.

One study showed that 1/3 of people who used any BZD for just a month became dependent to some degree. Another showed a similar rate of addiction over a two months span, and another study put the time-line at 3-6 months.

Use of Xanax over an extended period of time may lead to serious problems upon stopping. The milder problems include anxiety, unpleasant thoughts, and disorientation. Rarer but more serious discontinuation issues include extreme sense-sensitivity, seizures and psychosis.

Do you have any thoughts on Xanax?