Over 300 million people worldwide suffer from anxiety disorders—making it the most common mental health disorder. While treatment can greatly vary, anxiolytics (anti-anxiety medications) are often prescribed for anxiety and related disorders.
Two of the most common types of prescribed benzodiazepines for anxiety include Ativan and Xanax. Both of these drugs work by enhancing the actions of gamma-aminobutyric acid (GABA)—a neurotransmitter that promotes calmness and relaxation in the brain. However, in specific situations, one might be more suitable than the other.
Below, we explore Ativan vs Xanax, ensuring optimal treatment outcomes and the minimization of potential risks associated with their use.
Mechanism of Action
Ativan and Xanax are both categorized as benzodiazepines. This means they share a similar mechanism of action. As mentioned, they both increase GABA levels, helping calm the nervous system and, thus, reduce anxiety. So, how does this work exactly?
Both Ativan and Xanax bind to specific GABA receptor sites in the brain. This activates a chemical reaction that reduces overall brain activity. In turn, this can decrease anxiety or panic attacks, reduce muscle tension, prevent or stop seizures, and even cause sedative effects.
However, it’s worth noting that these two benzodiazepines aren’t as likely to cause sleepiness or sedative effects, especially when compared to other benzodiazepines like diazepam or temazepam.
While they work similarly, the duration of onset of Xanax vs Ativan can vary slightly. So, let’s take a closer look.
Onset and Duration of Effects
Xanax has a slightly faster onset of 15 to 30 minutes. Yet, it lasts a shorter duration—typically only four to six hours. This makes it ideal for acute anxiety episodes or panic attacks.
On the other hand, Ativan has a slower onset; it typically takes about 30 minutes to one hour for noticeable effects to occur. However, its effects last longer, around six to eight hours. This means it’s often prescribed for extended anxiety relief, such as those diagnosed with anxiety disorders. This also means that Ativan can be taken less frequently than Xanax.
Key Differences
When comparing Ativan vs Xanax, the side effects are very similar due to them both being benzodiazepines. Side effects of Ativan and Xanax may include:
- Drowsiness
- Dizziness
- Confusion
- Fatigue
- Decreased sex drive
- Constipation
- Appetite changes
- Impaired learning
- Reduce coordination
- Memory loss
However, Xanax is more likely to cause mood changes and appetite shifts when compared to Ativan.
Additionally, both Ativan and Xanax have a high potential for addiction and dependence, particularly when used long-term or at higher doses. However, Xanax is generally considered to have a higher risk profile than Ativan.
Withdrawal from Xanax can be more severe and potentially dangerous—often manifesting with more intense rebound anxiety and, in some cases, seizures. The shorter half-life of Xanax contributes to this increased withdrawal risk, as the body experiences more rapid fluctuations in drug levels.
Withdrawal from Xanax can also lead to post-acute withdrawal syndrome (PAWS), which can impact your mood and cognition for months after discontinuing the use of Xanax. Other symptoms of PAWS may also include:
- Depression
- Anxiety
- Drug cravings
- Irritability
- Memory lapses
- Learning difficulties
- Obsessive-compulsive behaviors
Most often, halting the use of Xanax is done slowly and gradually. This tapering off, involving lowering the dosage and medical supervision, can help prevent withdrawal symptoms or negative health consequences, like seizures. Thus, it’s important to listen to the advice or recommendations of your health care team or doctor; halting either medication suddenly isn’t advised.
Lastly, while both are prescribed for anxiety, Ativan is also used pre-surgery and for longer sedation. In contrast, Xanax is preferred for immediate relief during panic attacks.
Comparative Safety
When used correctly and as instructed, Xanax and Ativan can be safe and effective. However, with long-term use, there can be an increased risk of addiction.
Prolonged exposure to benzodiazepines can also lead to a higher tolerance, where higher doses are required to achieve the same effect. This can increase the risk of dependence and make it more challenging to discontinue the medication when it’s no longer needed.
In turn, regular check-ins with your doctor are recommended when taking either medication. This can help your doctor monitor for signs of addiction, dependence, or any other adverse effects. From there, if needed, they can also provide alternative (and potentially safer) treatment options. However, exact therapies or treatments depend on each individual and their specific situation.
Ultimately, while Xanax may have a higher potential for addiction, this doesn’t always mean Ativan is the safer choice. The best option for you, again, will depend on several factors, such as your diagnosis, medical history, and more.
Conclusion
When comparing Ativan vs Xanax, these two benzodiazepines have similar mechanisms of action, enhancing the function of GABA and producing calming effects. They also may have similar side effects, with Xanax more likely to lead to mood or appetite changes. Xanax may also be more likely to cause withdrawal symptoms, especially when used for long durations. However, both medications can cause dependency issues.
As with any prescribed medication, it’s essential to follow the instructions given to you by your doctor. If you’re experiencing side effects or withdrawal symptoms, seek out medical advice from healthcare professionals who know you and your situation the best.
