# Any one else hate travel? Or avoid it?



## bigben70 (Jul 15, 2011)

I am taking a week off - and my wife wants to go out of town for a few days. The last time we "vacationed" out of town was 2005, and I had such terrible anxiety attacks on the road, I needed more medication than what would allow me to drive safely. (Wife got us the rest of the way there). I travelled again in 2009 for a medical consult in a nearby town - made it okay with ativan and two travel companions. I guess I travel so rarely for work and holiday that when I do travel it's still a very very disorientating and anxiety provoking situation for me.

I'm really not looking forward to this week off. I'm stressed out and tired from a 3 month stint of stress and overtime. I want to rest - I don't want to take all that anxiety medication so I can have a dozen of the typical photo album "This is me at the...." pictures. I really don't mind at all not having any of those pictures. I find travel enthusiasts to be much like sports fans - people I avoid at parties.

I know I'm supposed to look at this as a challenge and that the "wonders of travel" will open their doors to me once I get over the anxiety. Truth be told, I was never into travel as a child or young adult. The parents were not travel bugs and they took us once per year to the next province to visit relatives on summer vacation. Aside from mother making it a stressful tension filled event, I can't recall having issues being a passenger with parents on the highway. I did have panic attacks frequently when  I slept over at the homes of friends and family. Hmmmmm.... some sort of abandonment fear? Separation anxiety? When I was a boy, I used to dream I was lost on the other side of the city and I was nervously trying to make my way home. In the dream, I struggled to remember landmarks but the dream version of the city was all disorganized - so I kept wandering deeper into new and unfamiliar territory. As I got older, I actually enjoyed the dreams - because they were sort of like a fantasy adventure. I would dwell on the distorted places I would visit and recall which places in real life were the theme for that particular fantasy district or area. When I travelled as a young man with friends in my 20's, I began having the attacks regularly and my avoidance of travel began. The attacks cost me a job doing "field work" requiring extensive travel. Truth be told, I can live without a job that requires extensive travel anyways!

So how do I look forward to this trip, be a "good sport" and not ruin things for my wife if I am sitting here dreading the entire experience? I can't stop thinking about it - and this feeling I anticipate having of being "stuck there" with nothing I really care to do... Most people "count the sleeps" before time off. This is ridiculous!

I wish I could change my outlook on this. 

Thanks,
-Big Ben


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## Always Changing (Jul 15, 2011)

Is there anyone else that your wife would go with? leaving you to rest at home?


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## Daniel (Jul 15, 2011)

Or maybe a staycation that allows you both to enjoy the wonders of your own town/city or a nearby town that is maybe just a half hour or hour away. Or maybe seeing a play in a nearby city and spending a night there.

In other words, it doesn't have to be all-or-nothing with these trips ("baby steps," "take one day at a time," etc.)



> Any one else hate travel? Or avoid it?


I used to avoid traveling even to the grocery store when I was hungry -- I would rather eat oatmeal than go shopping     Part of the problem was that the more time I spent away from certain places, the more anxiety-provoking they seemed.

Even going to a yoga class can make people want to run back home.  Both the problem and solution mostly concerns habituation -- i.e. habits start as threads that eventually become cables that tie people down.


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## Retired (Jul 15, 2011)

Hello Ben!

Do you have anxiety with any other situation or does it manifest itself mainly around travel?

I have found that if I experienced anxiety in connection with travel, it was usually because of concerns about something unexpected happening over which I had little or no control.  Reality is that in day to day life, we are constantly exposed to uncertainly, but when we are doing routine activites, such as going to and coming from work, going out for errands etc, the familiarity of the task and of the trip relieves most of the anxiety.

Some strategies that might help relieve travel anxiety could be:

Make sure the family car (if being used for the trip) is in tip top shape and has been recently verified for safety and updated maintenance.  Also purchase road hazard/towing service in the unlikely event the car breaks down along the road. Check the air in your spare tire and carry an extra quart of oil.

Plan your trip in advance, and make reservations before starting out, so you don't have to hunt for a place to stay.

Allow plenty of time for travel to each destination, so you are never rushed even if you encounter traffic delays.

Use a GPS in your car for routing, to avoid taking the wrong road, and carry a cell phone for emergency.

Make sure you have some cash in addition to your credit cards, in case of emergency.

Keep the number of destination places to a minimum so you can relax.

View your trip as an adventure, to see new things.

If you have to fly, reduce your expectations to th elowest possible level, and expect inconvenience and delay....sometimes you willbe pleasantly surprised at how well it can go, as it did for me during a recent trip that involved flying
In short, being prepared, eliminating as many possible surprises and keeping expectations low might be a few things that might help.

What do you think?


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## bigben70 (Jul 15, 2011)

Thanks guys - for the quick replies!

@ Daniel:

_"I used to avoid traveling even to the grocery store when I was hungry -- I would rather eat oatmeal than go shopping  Part of the problem was that the more time I spent away from certain places, the more anxiety-provoking they seemed."

_This is key I think - more avoidance = more fear = more anxiety when you eventually need to do it. I've read (and believe) exposure just might be the only way to go.

@ Always:

Well, she *could* travel with others (like girlfriends) but being her husband, and having kids, I fear they will all look back and be sad (or plain resentful) that they didn't get to enjoy travel. This was actually a big concern for me when I found out I was going to be a dad - it was like "Oh no - I don't do so many things that dad's need to DO!" Like travel, go to amusement parks, this sort of thing. I really lived a sheltered life before getting married and having kids - wow - it's been quite a struggle! My fear, Always, is that she might end up wanting to travel with someone else... like a DIFFERENT HUSBAND for instance!! 

@Steve:

Thanks Steve. I appreciate your post. I always check the fluid levels. Tires. Take maps. Tools. Fire extinguisher. Money. Knife in the console (in case I need to cut safety belts...). First aid kit. I tell people where we are going and when we will get there. Cell phones. Chargers. I even took an epi-pen with me on my kids first camping trip (forgot to mention that one) last year. How do I know if they're allergic to bee stings? They've never been stung yet and the campground is 45 mins from the nearest hospital = dead kid if they're allergic. People snickered at my "paranoia". Near-tornado like storms on the way to the campground and three ativan later, we made it - but stayed in a hotel because I wouldn't let my 2 and 3 year old kids stay in a tent during weather warnings and funnel clouds. (I was the only one who thought the weather was reason to cancel the trip apparently.) I truly hate it when people disregard warnings and excuse their ignorance as if it were "positivity". Oh be positive! What are the chances! Don't worry! Sigh. I was raised to be the cautious and worried one and it's so hard to change.
*
I just realized I forgot one little thing: I have this strange pervasive fear of having a heart attack and being too far away from a hospital or medical help.
*
I guess when I panic I always think I am having a heart attack, so it stands to reason that I have this deep down fear that being further (or far far) away from medical help is a serious serious risk. When I panic in town, my first thought is "how far away am I from the nearest hospital." Wow. Now I know my I get nervous in a traffic jam. This would delay my travel time to the hospital. It also explains my fear of being in an airplane - can't hop of the plane and skydive to the nearest hospital! And they need to fly to the next city at LEAST - then land, then get you off the plane. 

I avoid rigorous exercise too. I roller-bladed up until about 2006 (stopped after panicking two times in a row). I managed to do lots of stair climbing in 2007 and got my heart just POUNDING. I lifted some weights in 2009 but got dizzy spells - I was probably doing too much too fast, or just getting adrenaline dumps from anxiety. But since 2009 I have been largely sedentary - which ironically the single worst thing for my heart. I think I should get a stress test to reassure myself but the thought of someone pushing me to some extreme limit on a treadmill with tubes and wires attached to me and this makes me so anxious I don't think I could get my HR to 120 without having a full blown panic attack. Then I fear the adrenaline dump will throw the test results and they'll tell me I have heart disease anyways. It's really making my life kind of unhappy and full of fear and avoidance. My dad almost died from a heart attack at 64 (in 2000) and had heart surgery last year. High choelsterol and being "wired for stress" is an unfortunate reality in my family.

I always worry that I carry too much weight, have high blood pressure, get too much salt and am under WAY too much stress all the time. Exercise avoidance is so ironic - I am afraid of the same thing I need to do to prevent serious health problems. I am dieting carefully and have cut my salt, junk food and greasy food WAY WAY back. I am losing weight, but I know I need to exercise as well, and I also may need cholesterol lowering meds in addition to my blood pressure meds.

Sorry guys. I just needed to vent a bit about this. I want to make my wife happy, I just wish she didn't have that darned travel bug!!

Thanks again.
-Big Ben


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## Daniel (Jul 15, 2011)

> this feeling I anticipate having of being "stuck there" with nothing I really care to do...



One of the tips by Rick Steves (the American-TV travel guru on European vacations) is that there should be some time set aside in each trip for each travel partner to go their separate way and do whatever they wish.



> I've read (and believe) exposure just might be the only way to go.



Yeah, exposure therapy, a.k.a. systematic desensitization, a gradual approach which is aided by cognitive therapy (addressing cognitive pitfalls like emotional reasoning, catastrophizing, etc.).
In other words, CBT, with the "C" part being the cognitive therapy and the "B" part being exposure therapy.


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## bigben70 (Jul 15, 2011)

Thanks, as always, for the informative links Daniel!

Yes, I have stumbled "systematic desensitization" before on the net. I will revisit this concept.

And yes, I DO tend to CATASTROPHIZE!! I have tried to work on this with a number of different therapists over the years. I grew up in a home where the mother was at a loss if she had nothing to catastrophize or exaggerate or fly off the handle about.

Sadly, this environment is where I grew up so a lot of this thinking got programmed into me. It seems so important not to program our own children with our maladaptive thinking during their formative years! But, aside from totaly isolation, our kids WILL pick up a certain amount of behaviour (and thought processes) from their parents.

Something to think about - my kids are 2 and 3..... am I "programming" them better than my mom programmed me?

Who am I kidding. Of course I am!

Thanks Daniel.

-Big Ben


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## H011yHawkJ311yBean (Jul 15, 2011)

Is this going to be a road trip, airplane, train or bus?

If your wife is willing, why don't you ask your wife if she could drive in the parts that are scary for you (I found when David and I traveled that I hated driving in 8-lane freeways around the cities but I was fine driving on the highway)...  You don't have to be in control _all_ the time, that's half the problem, right? *wink*  You can't be in control of everything all the time which, if I understand correctly, is part of the reason one panics.   I do know what you mean about racing heart and such, as I have had a bit of those.   I remember listening to my heart pound in my ears at night when I was a kid and getting more and more afraid that I was dying until I would start to cry and then call my mom.  And it's happened a few times in my adulthood, only not so bad...

When you aren't driving, can you focus on calming music (wearing headphones and closing your eyes and breathing slowly listening to relaxing music or breathing meditation instructions)...? 

Other than that, I kind of like the idea Daniel had of not traveling hundreds and hundreds of miles, but even to just outside of town or to a neighbouring City or Town.   Even a small change where everyone can just throw bedding and towels around and not clean up dishes and do ironing and housework is a nice change.  Maybe if you know someone in the same town as you're traveling to, you could all go swimming or to a cheap movie or some other form of entertainment so you would still be with people you know and not surrounded by unfamiliar faces.

One summer for when David's mom came to Regina, we planned a little 20 min trip to the valley, so we could enjoy a bed and breakfast, the farmer's market and a scenic drive in the country out by the lake.  Then we were going to go to a city a couple of hours away and check out steamboat charters and a zoo as well as a nice hotel and a restaurant that is open seasonally (for the Saskatoon Berry season)...  It wasn't like we drove all the way to Edmonton, but it was nice.  I had also planned some "just in case" locations, like Southwest of us there is a place where they dig up T-Rex bones and such and you can join them excavating, or you can go on nature hikes, tours, etc...  Watrous has a natural hot spring, but we didn't end up going there...  There are also museums and art galleries and so forth, and sometimes they have kids' programs.  

Get a travel brochure or check with their Chamber of Commerce or their City's Tourism or website and see what you can come up with.


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## bigben70 (Jul 15, 2011)

JollyGreen:

Ha ha - the internet makes people seem so far away but you brought up some interesting places, for sure!

I am from Edmonton and I have family in Saskatoon, Regina and small towns from Lloydminister to Yorkton!! I've been to Watrous three or four times and we met family there... what a neat little place in the middle of the prairies! You drive down in, and drive up back out... and the whole town is built on a hillside. You can literally "roll" down to the beach. Apparently, the old wood construction swimming pool burned down due to arson (many years ago) and now they have a new facility built there. I think it's the only salt water lake in Saskatchewan if I'm not mistaken.

My wife wants to go to Banff. That's where we went 6 years ago in 2005, and that was the last time I have travelled for a "vacation". I made it as far as Nordeg and there I stopped and had a complete meltdown. I wanted to limp back to Rocky Mountain House and then home, but the look of sheer disappointment made me go on. Since then, I travelled in 2009 to Westakiwin for a sleep study and last year to the "camping trip from h*ll". Actually it was beautiful there (just before Red Deer about 45 mins north of Stettler). But getting there was h*ll on wheels for me because we needed to drive through a storm that was (no kidding) as bad as the storm the day we had the tornado here (Black Friday, July 31, 1987). I took 2 ativan while leading a convoy of 2 other vehicles out of the storm. I used my wife's Iphone to get on the weatheroffice website and track the storm on radar. The way the storm was tracking (right towards our destination) I estimated we needed to travel straight south. 20 mins later, after driving through what seemed like a combination of a carwash and an earthquake, we landed in Stettler - and got a HOTEL ROOM!!! But we went back for the day the next day and the kids had a total blast.

_Hmmmm... I always wait until I am very very anxious before I take Ativan. Maaaaaaaaaaaaybe....
_
Maybe I should medicate before I go INTO an anxiety provoking situation and then the anxiety might not build at all... Paramedics (anxiety attack sufferers often end up calling 911 or going to hospital) always seem to ask "Did you take your Ativan?" and I say "Well, yes, just now I did..."

_"Why didn't you take it as soon as you felt your anxiety going up?" 
_
"I try to avoid taking it as much as possible to avoid getting addicted or using it to much..." 

_"But that's what it's for..."_ :huh:

"Hmmmmmm...." :blush:

"_Yeah -_ _Hmmmmmm - next time maybe take it sooner..." :huh:
_
"DOH!" :facepalm:


Yes, that was an actual conversation I've had... more than once! Thanks for chiming in here JollyGreen! You somehow made me have a realization!!! And thanks for bringing back those warm fuzzies about places I've been. You know, if I had never travelled, I would not have any of those warm fuzzy memories!

Thanks for the perspective! 

Cheers,
-Big Ben


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## Retired (Jul 15, 2011)

> "I try to avoid taking it as much as possible to avoid getting addicted or using it to much...



You have a condition that requires treatment and intervention, so use the medication your doctor prescribed for these situations. If you were a diabetic you would not be waiting to lapse into a diabetic coma before taking your insulin and if you had angina, you would not wait to take your nitroglcerin until you had a heart attack, would you? Same rationale here, if your doctor prescribed Ativan for panic and anxiety, it should be used as the doctor indicated.

In case you do not already have it, you might ask if your doctor would prescribe Ativan Sublingual (available only in Canada). Ativan has been shown to be absorbed under the tongue for quicker onset of action..not immediate but quicker than swallowing an oral tablet. Ask your doctor if this form of the medication would be right for you.

Correct way to take it: place the sublingual tablet under the deepest pocket of your tongue, and refrain from swallowing or drinking water for two minutes. The sblingual form will completely dissolve during that time and the onset of action should become apparent quicker than you probaly experienced with oral tablets.

Oral tablets can also be taken sublingually, if your don'tmind a very slight gritty residue under your tongue from the binding ingredients used in oral tablets.....but it will be absorbed just the same.

Ask your doctor about it!


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## JennyS (Jul 15, 2011)

I hate travel and I am amazed at the people around me that love it. But it's the set up the coordination that I don't like. But I have to admit I am not fascinated by other cities in the US because they look a like. Nature on the other hand is a different story. The ocean and the forests do something for me. But again I don't like the idea of packing to go there.


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## Daniel (Jul 15, 2011)

> "I try to avoid taking it as much as possible to avoid getting addicted or using it to much...


To add to what Steve said, most people who drink alcohol do not become alcoholics.  Similarly, most people who take benzos do not become addicted to benzos.   It's not like you are already considering doctor shopping for more pills, and your concern would seem to indicate that would not be something you would do.


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## bigben70 (Jul 16, 2011)

Hi Steve:

Thanks for the information - I appreciate it! Actually, I've been using ativan for a number of years now - I keep it with me pretty much all time. I don't use it when I get anxious, else I'd be using it pretty much all the time. I do use it when I have the feeling the anxiety will get the better of me. So knowing when I need to take it can become a bit of a tricky business. Once I panic, I need to take considerably more of it than if I were to dose before hand, but there is the trick. If I take 2 or even three ativan to stop a panic attack, I am still taking less than if I take 1 every time I get anxious and only suspect a panic attack. Sometimes, I can feel extremely anxious and I won't panic. Other times, I feel hardly any anxiety at all and BAM - there I am. Many things make it worse - fatigue, issues with work or family, use of sleep aids, travel (huge for me)...

My doctors seem to very reluctant to give Ativan out for longer periods of time - they now want to put people on anit-depressants for longer term / chronic anxiety treatment. I can say for me, they don't work. And Anti-D's have very nasty side effects; my last one celexa and then lexapro are very bad for weight gain and cholesterol increase. (Two very significant causes of heart disease). 

Thankfully, I stopped relying on MDs for psych meds and found a great psychiatrist. She has me on lamotrigine (anti-seizure as an off-label mood stabilizer), imipramine (low off-label dose tricyclic anti-d for anti-anxiety effect), and gabapentin (for general anxiety). I take ativan from time to time and always keep it with me. I sort of try to keep a stockpile of about 15 - 20 tablets on hand because I can go through that many quite quickly if I start having regular attacks. My psychiatrist never once questioned my usage of this drug, but maybe I AM taking it too sheepishly.

Yeah, Steve. You might be right here. I'm trying to avoid taking the drug I need to take. I associate using it with addiction (and possibly failure). Some people put it in my head (a long time ago) that people who quit drinking have to be very careful with these drugs. Others said that any use of these drugs at all is a no-no. Neither group were medical doctors. Just a bunch of sober drunks who knew even more than the doctors did. Some folks, too, just don't trust doctors or pharmaceuticals for any reason. You get all kinds.

Anyways, I am NATURALLY tired now and I am going to fall asleep sans medications two days running now. I had a good day at work with no "Nytol hangover" but wow was I wound up and fighting a steady stream of distractions. OCD? ADHD? I want to focus on work so badly... Some days it seems impossible. Today was one of those days. I need to go in tomorrow and play "catch up".

Cheers,
-Big Ben


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## Always Changing (Jul 16, 2011)

> Yeah, Steve. You might be right here. I'm trying to avoid taking the drug I need to take.


 I would agree with this. 
When I was experiencing panic attacks a while back... the panic would start (just like yours has) long before the actual "event", in your case (at the min) its the thoughts of travelling, and all that you have outlined and *this is before you even set out*.  My doctor advised me to start taking the med the day before and on the morning of "going ???".  
and so I am thinking that in your case, You could in my humble opinion, maybe start to take your ativan daily (at this time given that the trip is imminent) to help calm your thinking and slow the panic process down some.   Ring your psychiatrist for advice on this as I am no doctor ok, (and no two people are the exact same as regards panic attacks, what works for me, may not work for you)  and also ask her if it might be okay to up the dose if necessary to help while on your vacation.  You can taper back down and come off it again after your trip so the risk\fear of you becoming addicted to it is taken away. 

my 2cents worth.


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## bigben70 (Jul 17, 2011)

Thanks for chiming in Jenny! I know what it's like to be the only one at a party who's not into travel! I don't get it either, but then again when I was a kid we would be quite excited to travel. Even then, however, we travelled only to one place (with two stops on the way) to visit relatives. We never (now that I think about it) travelled for the sake of travel very much except for two or three trips to the mountains. I like the mountains, but since I don't ski anymore I have little reason to go. Although I've done some "hiking" in town along the river valley, I'm just not that adventurous to go hiking or mounting biking or hill climbing etc. So, not really being a "mountain sports" person, I feel that having seen the mountains a number of times is sort of.... good enough. So yes, I do have an appreciation for nature as well, but the older I get the more I am just fine with experiencing nature on the Discover Channel!! Some people like to make those programs, and others just like to watch them I guess.

Cheers,
-Big Ben

---------- Post added at 12:24 PM ---------- Previous post was at 12:06 PM ----------

Ooops. The editor said my time was up. That's a new one! 

@Daniel:

_"Similarly, most people who take benzos do not become addicted to benzos. It's not like you are already considering doctor shopping for more pills, and your concern would seem to indicate that would not be something you would do."
_
Yes Daniel - I've often thought this myself. I've used Ativan with great care over the years and my use of it has never come into question. I don't "ask around" in the twelve step community because there will always be zealots and "born agains" who don't even take aspirin. (I got out of the 12-step community for a number of reasons but being "told" about my medications, therapy and psychiatry and how only "the program" was needed... well, for me that kind of control and dependency on JUST THEM had a eerie cult-like feel.)

@Always Changing:

Nobody has EVER told me this but it makes sense! I have been told by every doctor that gave me Ativan to "take it when you start feeling anxious"! Incredible. How many times I would be awake, sleepless, the night before a trip and then get up on 4 hours sleep to face my biggest fear - being shuttled off to some tiny airport to get onto a small plane. No wonder I was so anxious. All the anticipation to boot. People who don't anticipate (build up fear) just can't appreciate how anxiety provoking ordinary situations can be! This makes good sense. But now that I think about it there is a "circle" of professionals in the anxiety treatment community who actually believe that ativan (and benzo) use actually makes long-term anxiety worse because it is somehow involved in the avoidance cycle. 
*
Anyways, thanks to all of you for chiming in here.* I think I will revist this issue with my psychiatrist and talk to her about the ativan. She seems "anti-ativan" as many other Canadian doctors are these days - now family doctors are handing out SSRI anti-d's for anxiety treatment (questionable) and psychiatrists are using gaba-pentin or off-label anti-psychotics like risperdal and seroquel. In my heart, I think that the problem is that I have a phobia of something I do INFREQUENTLY!! I have heard many people with highway driving and travel anxiety overcome this by simply getting a job that required daily travel. They often say things like "It was very bad at first and I needed meds. Then, slowly, the fear of travel got lower and lower and now I drive all the time now."

I'd like to be able to drive to neat-o places for my kids. Because for kids, ANYWHERE new you take them is a new neat-o place. My kids are going to have fun and do things - I won't have it any other way, even if it means having them join family and friends on trips. I'd like it better to show them things myself, and be there to witness their awe and wonderment.

My wife told me that she'd be happy to get  a hotel room in town as long as it had a hot tub. I actually want to try and surprise her and book the hotel - 4 hours away - and just hit the highway and surprise her. She's been so patient with me all these years.... it could end badly, but still showing her I care enough to try and go outside my comfort zone would be a very nice gesture considering the other problems we're having these days...

Thanks again gang!
Cheers,
-Big Ben


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## bigben70 (Jul 24, 2011)

Hi Gang:

Me and my wife got back from our trip on Friday. We left in the afternoon on Wednesday. We were supposed to leave around 11:00 am Wednesday but I went to the hospital Wednesday around 2:30am because I could not sleep, my heart was pounding, my BP was 150/110 and I had heart burn. I knew I was having an anxiety attack but the nurse on the phone said with a high BP and the heart burn I should go in. So I took a 1mg ativan and went in. I was still very anxious in the waiting room 2 hours later so I took another. I got home, still shaky, took another and finally got to sleep at 7am. I got up at 1:30 and said to my wife "Okay! Let's finish packing and go!"

We drove to our destination 4.5 hours away and I did not have very much trouble at all. It was already 10:00pm when we arrived instead of 4:00pm like we had planned so we ate and went to bed.

In the morning, I suddenly felt very aware that I was not at home. I was very anxious and took 1mg of Ativan. I was thinking about the activities my wife wanted to do that day and I just felt anxious about the whole thing and I was not looking forward to anything. I took another 0.5mg about an hour later and the rest of the day didn't go so bad. The next day, we checked out and toured around one last time. I was anxious on the road I was on (new road) and despite the nice scenery I wanted to turn back. The road finally led us to the main road so we headed out. My anxiety got worse and worse as we drove. I took 2 or 3 mg of Ativan just to get to the main highway - about 1 hour into our 3.5 hour trip back home. Once I got on the main highway I felt better and better the closer we got to home.

Today is Sunday and since returning Friday afternoon I've been miserable. I still feel zonked and tired from the stress and medication. Yesterday I could feel my "world" collapsing down again and I was so avoidant I could not believe it. I didn't want to be around anyone, or do anything. I went to dinner with the kids, the wife, and her parents and brother. We went in their van and my wife asked if we should take our car (because she knows I don't like being "stuck" in someone elses vehicle) but I said no, and drove everyone there. Dinner was quite nice actually and my boy impressed me with how he ate new things and was so well behaved. My daughter was being cute for the waitress and generally cooperated too. Without my wife's family being so supportive I'd be at a loss. My own family is not really able to help me much, they have their own issues. Yesterday everything seemed to bother me. Noises or sounds and especially TV or radio commercials just drove me nuts. I just wanted to stay in bed. Today I am trying to think about positive things to do but I have zero motivation to do anything. I suppose I will do the grocery shopping and perhaps mow the lawn.

My wife wanted to plan the same trip but with her parents, siblings, and the kids. (Actually she mentioned this as we headed home which did not help my anxiety on the drive back). I told her NO WAY. I barely made it through this trip and I did not want to be taking ativan on the highway with my kids in the back. And for me, doing things with the kids is anxiety provoking enough but if I add the anxiety of travel in, I don't think I could handle it. So I asked her if we could perhaps go to a closer destination (lake or something) where I don't have to deal with 4.5 hours of being on the road before even getting there.

My last trip with just the two of us was 2004. My wife said this one (2011) was better and she had more fun. But she says after trips I "make her pay for it" but I think it's more of a case of this "post trip mental crash' I seem to have. I don't feel renewed and rested and "more experienced" and confident after a trip. I feel exhausted, miserable and LESS confident after a trip. I know "exposure" therapy is supposed to be the best approach, but it seems like I snap back after a rubber band after each trip, and I never look forward to the next one. I know my wife is not going to wait 7 years for another 2-day weekend getaway! This trip had it's moments, but the anxiety always seems to make the trips far more work and effort (for me) than they are worth. You go to the dentist despite anxiety because it's necessary and only a couple of hours. But for me, travelling is extremely anxiety provoking and hardly necessary in my view.

This travel thing is the bane of my existence!!

Thanks for listening.
-Big Ben


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## Daniel (Jul 24, 2011)

> I know "exposure" therapy is supposed to be the best approach, but it  seems like I snap back after a rubber band after each trip, and I never  look forward to the next one.



Given the infrequency of these trips, I wouldn't make too many conclusions.   Personally, I feel much less exhausted than I used to after taking trips.  

Certainly, it may help to ask your therapist for some cognitive therapy to help you re-appraise things and to help you with deciding the right "dose" of the next exposure.

My guess is that overcoming your travel anxiety will help you with your general anxiety as well.   It would be hard to imagine otherwise.


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## bigben70 (Jul 24, 2011)

_"Given the infrequency of these trips..."

_Daniel:

I think you're absolutely right - the problem for me is that I rarely travel and if I want to make progress travelling I think I need to do it more than once per year. I should clarify that although 2004 was the last time I travelled with my wife "as a couple" I have travelled for medical reasons, a funeral, and very occasional work related travel.

I'd like to say I would do it more, but everytime I do travel I am left with this very intense "I am so glad that is over" feeling that it makes sense that I would not want to do it again any time soon.

My therapist wants to do EMDR with me, so perhaps this is the first anxiety trigger we can look at.

Thanks Daniel.
-Big Ben


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## H011yHawkJ311yBean (Jul 24, 2011)

Here are some probably whacky questions you could probably ask your therapist (because I can't relate to the trip anxiety, but I have anxiety, so I can understand how it feels, only I feel it differently, if you get my drift:  same but different)...

-- can you ask your therapist if you can take the medication during a vacation even before you feel anxious?  Can you start taking it one or two days _before_ your trip, and then _while on the trip_ and then _slowly wean yourself off of it _near the end of the trip or after it so you don't have a sort of crash?  (or maybe you just have a crash from the release of all the stress after the trip, I don't know)...

-- maybe you can try once a month just driving yourself somewhere (less stress than you, kids and wife, right?) -- a short distance that will just take a few hours to get to the destination and back again...  Then you are used to that at some point... Maybe in a couple months, maybe in 6 months, maybe in a year...

 Then maybe try driving once a month to a place where it takes a _half day_ to get there, have lunch, then drive back again so you are still home the same day... 

 Then if you get used to that, then drive out to somewhere with your wife once a month where you have to stay overnight at a friend's or hotel overnight and drive back the next day.  

Eventually you might be able to drive once a month out to a place with the kids _and_ your wife, even if it is just to stay overnight in a hotel with an indoor waterslide, no dishes, visiting some destination that will take only a half day or a day's drive to get back and maybe stay on Friday night and Saturday night and drive home on Sunday...  You know?  Slowly build yourself up to it.  

Then by the time a bigger excursion is scheduled it may not be so hard to take, ya?


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## Daniel (Jul 24, 2011)

> but everytime I do travel I am left with this very intense "I am so  glad that is over" feeling that it makes sense that I would not want to  do it again any time soon.



It's easy for me to imagine that these trips will seem less dramatic with enough habituation.  

And, of course, the key is to not let those feelings affect your behavior.   That's partly why people develop these anxieties in the first place.


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## Daniel (Jul 25, 2011)

BTW:  http://forum.psychlinks.ca/positive...hemicals-dip-your-brain-concocts-failure.html


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## bigben70 (Jul 26, 2011)

Daniel:

Thanks for the informative link - it's a good reminder of how there is a natural low after a high. Reminds me of the Latin proverb, “Omne animal post coitum triste.” which translates: _All animals are sad after sex_.  

For me, these days, I can't really tell WHAT is going on. There is so much going on in my life right now and I am on more meds than ever. (Mood stabilizer, Anti-D, Blood pressure med, and Gapapentin for anxiety plus Ativan as needed). On the trip, I took approx 3mg of Ativan in 0.5 or 1.0mg does per day. Not really that much and within normal dosing range. But Friday upon my return I made a point NOT to medicate. Saturday I started feeling queezy - Sunday was worse and Monday I was quite ill. I had cold sweats where my head and hair was soaked with sweat. I had low heat tolerance, and after mowing the grass (45 mins in 26 degree sun) I had to hide in an air conditioned room. My face was red hot and my arms felt hot as well - I put a compress on my head and sat in the dark A/C'd room. After a couple hours I felt better. Last night it was "the night before work again" and again I could not sleep. I took 1/2 of a "Nytol" (diphenhydramine hydrochloride) and it worked since I have abstained from using it for a couple of weeks now. But I don't want to use it regularly again, that's for sure.

I have a therapy appointment here in an hour where we are supposed to start EMDR. Today, I feel more like using that hour for a NAP! I came back to "fires here at work" which have only grown larger since I left. I told my wife this short sabbatical was ill timed but she said that if I waited for a "break in the action" I'd never get a break at all. She's right - most jobs in my line of work (and probably most others) will eat you alive if you don't set firm boundaries with your employer.

For me, at this point, I actually feel tired of my usual self-analysis and internet research (which surprises me). I think my need for so much online data is a symptom of something else: hypochondria. I fear heart attacks and cancer. I fell that I can't expect to live a long and healthy life because of the stress I experience. Between wife, kids and work it feels like I am being torn in three directions. Work / life balance boils down to who is screaming at me loudest at any given moment. ME! no ME! no ME ME ME! They all cry. They seem like infants, or little squeeking chicks in a nest who are never full, never happy and never content. I feel like I just want to tell them all to shut up. But I need my job, and I need my wife to help me with my kids. They're all tightly interdependent and they all pull on me at once. Had I known how difficult parenting was going to be.... oh that thought never ends up in a happy place...

I'm sort of numb today - sort of floating. I am a bit hungover from the Nytol (1/2 pill hangover is manageable).My forehead is warm for a change and not clammy - my hands are cold though. Heart rate is nice and low. I guess after that stressful "vacation" (3 days of travel and 3 days of withdrawal) I am doing quite good.

Compared to my vacation, being back at work is actually quite a relief! Sad, but true...

Sorry if I sound defeated and whiney. It's just that I would have much rather rested for six days - but my wife deserved that break very badly. She said it was better than our 2004 trip but she fears that I would "make her pay for it later". I think I don't intentionally "make her pay", but I get quite stressed when I get back especially when the bills from the trip start coming in. I need to really not comment on the money spent on the trip or she'll get set off like a firework on the 4th of July.

I sometimes think if I were her I would not want to be married to me. I can sympathize with her how hard it must be to live with me. I appreciate her, but I think I keep her at arms length because all of my other relaitonships failed due to my mental health issues. I fear she too will have her breaking point and go. We can't afford marrriage counselling right now and that's not a good thing.

Cheers,
-Big Ben


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## H011yHawkJ311yBean (Jul 26, 2011)

Any reason your why your wife can't keep track of the billing for you so you can keep your mind off things?  She can warn you if you guys are getting low in the funds.  Let go of that stress/control.  One less thing for you to worry about/be responsible for/control.  If she doesn't know how, maybe show her how, or have her take a class...  

Maybe it would help her understand where your stress is coming from as well.  Because maybe she doesn't know that x amount spent will cause y to have to be delayed.  

Anyway, glad to hear you are seeing someone to talk about your progress and your questions...


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## Retired (Jul 26, 2011)

> I took 1/2 of a "Nytol" (diphenhydramine hydrochloride) and it worked since I have abstained from using it for a couple of weeks now.



Why aren't you using your prescribed Ativan as a sleep aid instead of Nytol? In fact if you have difficulty with sleep, your doctor can prescribe much better sleep medications that ensure good quality sleep without the disruptive effects of antihistamines.

BTW in response to the topic of your post, I enjoy travel and therefore travel is an integral part of our current lifestyle. There are strategies necessary to alleviate some common stressors associated with individual forms of travel, but when planned correctly, travel can be relaxing, exciting, educational, enjoyable, challenging and plenty of fun.


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## bigben70 (Jul 26, 2011)

@JollyGreen:

Actually, it's funny you should mention it. Wife wants me to take over family bills and finances because she is more swamped than I am with family business and the bookwork for the biz. But yeah, I need to let go since I resolved to spend the money and definately don't want to spoil any memories by whining about the money part. 

@Steve:

I am very very reluctant to use ativan on a regular basis due it's highly addictive properties. Ativan is known to have both a chemical and psychological dependency component. That said, ANYTHING that helps one sleep is habit forming - aka, chemically addicting or not, your body becomes reliant on the med for sleep. If tolerance is evident, more and more will be needed for sleep as well. If tolerance builds with Ativan, this is dangerous. I use Ativan only for periods when anxiety is more than I can manange. I think this is why it's delicate balance for me - use or not to use. My pysch. gave me Gabapentin and Imipramine for general anxiety which seems to work. Truth be told, I think I have terrible sleep hygene. I get to work too late, stay too late, and somehow expect to wind down too quickly. I think it was Daniel who suggested to simply leave work early, and that going to bed earlier would follow - rather than trying to get up earlier. It's a bit of a paradigm shift about sleep. I think I'll give that a try - but I'll ask my psych about using Ativan for sleep anyways and see what her opinion is about it. She seems very... tight fisted with the Ativan and will not use it (for example) for chronic or general anxiety. She believes it's primary use is for when anxiety shoots up to unmanageable levels, or for subduing a panic attack. Anyways, my goal is to try and get to sleep (like I normally do) med free. 

Thanks to everyone for taking the time to write!

Cheers,
-Big Ben


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## Daniel (Jul 26, 2011)

> but I'll ask my psych about using Ativan for sleep anyways and see what her opinion is about it. She seems very... tight fisted with the Ativan and will not use it (for example) for chronic or general anxiety



There are other drugs that can help with both anxiety and insomnia, like a low dose of Seroquel. Even some antidepressants like Remeron can be sedating.


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## Retired (Jul 26, 2011)

Ben,

I agree the topic of using benzodiazepines is controversial in many circles, and even seems to be the _bad drug du jour_ among some physicians.



> Ativan is known to have both a chemical and psychological dependency component



I don't believe there is evidence to support chemcal addiction potential with Ativan, however there are reports of psychological habituation.



> ANYTHING that helps one sleep is habit forming - aka, chemically addicting or not, your body becomes reliant on the med for sleep.



I don't believe the literature supports that hypothesis either particularly with the more recent specific medications developed and indicated for helpng to sleep, when used as directed.  Probably truer with older narcotic type meds used for sleep, no longer used for that purpose.

As you correctly allude to, however, lifestyle changes may often be required to complement treatment with hypnotic medications.

We have to be careful not to allow the hyperbole and self serving rhetoric on the internet to distort the reality of how many of these medications can help, when used correctly, under the care of a physican.

My understanding from the literature and from the clinical experience of psychiatrists with whom I discussed the subject in connection with my work, the older, longer acting benzodiazepines with complex metabolic pathways (diazepam, chlordiazapoxide) were more likely to result in habituation because of the way their metabolites tend to remain in the bloodstream for days after the medication had been taken.

Additionally when these medications were first introduced in the late sixties, they were the first breakthrough in minor tranquilizers after years of only narcotic drugs being the only available option. The use of the early benzodiazepines was so widespread, in such huge numbers that any problems or idiosyncrasies were exaggerated by virtue of the numbers of people using these drugs. To this day, the reputation of this class of medications is still burdened by the problems of those early years.

Concerns about habituation are real and are usually associated with extended duration of use, unusually high dosages and when used in individuals with a predisposition to dependency behaviours.

Your concerns about tolerance are well taken, and I believe evidence shows that tolerance is also influenced by duration of use and/or excessive dosage.

As I understand it, your doctor has recommended you use Ativan at a relatively low dosage of 1 mg as needed, and the way this particular benzodiazepine is metabolized, it is pretty well out of the system in about 8 hours, with no lingering metabolites to interfere with subsequent doses. Furthermore this medication is considered a _clean metabolizer, _so there is virtually no risk of interaction with other medications.

However, for people with chronic difficulty to fall asleep and or to stay asleep, there are newer, non benzodiazepine "hypnotics" (sleep medications) that produce normal, good quality sleep with virtually no hangover effects or daytime drowsiness. 

You are prudent to be concerned, and your decisions should be made after consulting with your doctors, but I would caution about reaching conclusions about medications based on innuendo and hysterical self serving internet rhetoric that serves only to undermine the benefits many of these medication can deliver by improving the quality of life of millions of people, when used judiciously and according to their prescribing directions.


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## suewatters1 (Jul 26, 2011)

I take the generic version of Ativan to sleep.  I usually take 2x1 mg of Ativan.  Sometimes I take 1mg only of Ativan and 50 mg or 100 mg of Trazadone.  Trazadone alone doesn't help me because 50 mg is not enough and 100 mg gives me nightmares.  I was given Serequel a few years back by another DR I don't see anymore and on 5 mg I woke up stoned.

Sue


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## bigben70 (Jul 26, 2011)

Thanks Steve!

The reason I cite that Ativan having a chemical dependence factor is due to a more commonly accepted phenomenon of "benzodiazpine discontinuation syndrome" - aka withdrawal. I have experienced this myself - anxiety, cold sweats, upset stomach... this to me screams physical (chemical) dependency. This is different from the "I miss the effect" psychological dependency.

As for becoming reliant on sleep aids, it's been my personal experienced that anything that I become accustomed to for falling asleep that is "removed" can increase my difficulty in falling asleep. Example: a person who needs a fan or some white noise or music to sleep will suddenly lie sleepless in a dead-quiet hotel room. So, in that light, it's very possible that a person can become psychologically dependent on a sleep aid (for example) to get to sleep. I.e., when they STOP taking it, it may result in insomnia. I'm no expert here, but the body seems to like to hang on to things that help it get to sleep!!

I am glad to hear they have alternative medicines to benzo's for anxiety and sleep. I quit drinking some 15 years ago and really don't want another addiction! That said, I've used Ativan and other benzo's for almost 20 years now without addiction, so I guess that says something about either how addictive they are or how I've used them.

_"Furthermore this medication is considered a clean metabolizer, so there is virtually no risk of interaction with other medications."


_Interaction as far as chemical interaction, perhaps, but according to my drug interaction checks it can cause additive CNS suppressive effects with a myriad of different drugs from anti-depressants to sleep aids and especially some anti-psychotics and atypical atypical antipsychotics. In general, the doc and the pharmacist should be consulted - and people should always learn the effects for them specifically before driving or operating dangerous machinery (or even watching kids - in case they become so sleepy they might nod off when caring for young kids, for example.)

Yes, I know I make everything with meds seem so complex. I think I do this because I am hypervigilant about side effects - anything unfamiliar makes me panic right away. So I always like to know side effects and interactions real well. I once was getting anxiety attacks, extreme dry mouth, and strangely high frequency of urination. At the ER they looked at my chart and said "anxiety. Go home". But anxiety in the 20 years I've had it has never caused total mouth and throat dryness (dry to touch tongue) and frequent urination. My doc changed me to a different blood pressure med and whamo - no more trips to ER and no more dry mouth episodes. Bad postural hypotension and/or vasovegal syncope (dizziness on standing) was also eliminated - which also would cause me to panic.

Do I sound like a doctor when I write? Trust me - I'm just a hypochondriac with an internet connection. Fear of health problems is something I am currently working on. Hoarding data on meds and psych problems is part of my problem. As you have seen, I can be prone to hanging on to outdated or incorrect information.

I think I need to become a layperson again and focus my energies on how to be a better less-stressed dad rather than an "computer chair physician". Like the "internet doctors" they laugh about on the TV series "House".

Yeah, that's me! 

Thanks again for the great discussion.

Cheers,
-Big Ben


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## H011yHawkJ311yBean (Jul 26, 2011)

I know someone who takes Trazadone/Trazorel, which is not addicting and is sometimes used with other antidepressants or anti-anxiety medication.  He's taken it for a few years to help him sleep.  He has kept it at the same level/dosage for the same amount of time, hasn't tried to take more than prescribed.  Maybe you could check with the doctor about that...


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## bigben70 (Jul 26, 2011)

@ Sue:

Thanks for chiming in Sue!

Yeah, I took Seroquel for a while too. 1/2 of a 25mg tab would knock me cold - but not before it gave me a pounding heart. I am VERY sensitive to this drug! My doc (not psych) at the time liked to dabble in atypical anti-psychotics and off-label uses for regular anti-psychotics. He wanted me on 75mg daily Seroquel in the morning. At 25mg I was stoned by the time I got to work and at 50mg I was sleeping in my desk chair (literally) so I immediately got a 2nd opinion!! I had a refill of 3 x 30 days = 90 tablets of seroquel filled that I used for sleep from time to time (Bad Big Ben, Bad! I know!) but I tossed them when I did my "pharmaceutical kid proofing project" years back - we got rid of old scripts and drugs we were keeping around.

Seroquel works wonders for manic people and for people who are actually psychotic but I've heard similar reports from people who were prescribed it "off label" for anxiety or sleep. The sleep people didn't complain as much as the anxiety people. Anxiety people often say they got too stoned - and could not drive or work or function at all.

Seroquel knocks you out for sleep - but you wake up hungover and if you take it for anxiety during the day, it gets rid of the anxiety. Trouble is, it gets rid of most of  your conscious thought too!! ha ha.

Sort of like cutting off ones head to stop a headache in a way...

Thanks Sue. 

Cheers,
-Big Ben

---------- Post added at 05:20 PM ---------- Previous post was at 05:15 PM ----------

@ Jolly:

I will ask my psych at next appointment about Trazadone. I used to get Zopiclone for sleep, but it tended to interact with my blood pressure med at the time. The result was that it increased the dieuretic effect of the BP med substantially and gave me all kinds of whacky symptoms. I was drinking water until my stomach could hold no more and still I could not quench my thirst. And of course, drinking that much water, I was urinating like.... crazy! Human fire truck ha ha ha. 

Yeah, trazadone maybe. Zopiclone - it works but reacts with my other meds.

I'd try whiskey but side effects include anti-social behaviour, loss of fine motor skills, reduced alertness, dizzyness, dehydration, job loss, imprisonment, and loss of significant other and access to children. 

That drug is, thankfully, no longer an option! 

Cheers,
-Big Ben


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## Daniel (Jul 26, 2011)

> Zopiclone - it works but reacts with my other meds.



So the American version, Lunesta (eszopiclone), is probably out of the question. One perspective: "I'm switching doctors if this guy won't give me Ambien back because the metallic taste in my mouth from one night of Lunesta is so severe."



bigben70 said:


> Truth be told, I think I have terrible sleep hygene. I get to work too late, stay too late, and somehow expect to wind down too quickly. I think it was Daniel who suggested to simply leave work early, and that going to bed earlier would follow - rather than trying to get up earlier.



I do think that with insomnia waking up at the same time each day is more helpful than trying too hard to go to sleep. (Anything is better than _trying_ to go to sleep.) So trying to wake up earlier may be more helpful than trying to go to sleep earlier. 

In other words, people with insomnia tend to be too worried/concerned about getting enough sleep. That's one reason CBT approaches can help with insomnia: http://forum.psychlinks.ca/sleep-dreams-insomnia/4498-cbt-works-better-than-sleeping-pills.html

And, of course, exercising more, such as in the morning, can also help with insomnia, anxiety, and high blood pressure.

---------- Post added at 10:38 PM ---------- Previous post was at 10:19 PM ----------

Incidentally, your blood pressure may be lower than you think:



> *Elevate your arm to heart level.* The blood-pressure guidelines set forth by the National Heart, Lung, and Blood Institute are based on measurements taken from people holding their arms at heart level. *Most doctors and nurses slap the cuff on your arm when it's resting on a desk or chair, which can raise both diastolic and systolic pressure by six to nine points*, according to a study by Dutch researchers.
> 
> http://forum.psychlinks.ca/medical-...ure-numbers-what-do-they-mean.html#post155297



I started checking my blood pressure at home years ago since it's always higher at the doctor's office due to anxiety.


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## Retired (Jul 27, 2011)

> The reason I cite that Ativan having a chemical dependence factor is due to a more commonly accepted phenomenon of "benzodiazpine discontinuation syndrome" - aka withdrawal



Good question, Ben and the answer is that the withdrawl symptoms with this particular medication is not due to a chemical dependency in the way that narcotics modify the need for certain biochemistry for the substance, but rather due to its biologic half life.

Ativan is a short acting benzodiazepine with a half life of about 8 to 12 hours, with no active metabolites; therefore the therapeutic avantage is that steady state is achieved after about three days, when the amount of medication being eliminated equals the amount being ingested.  For the physician the clinical importance is the effect of the medication can be evaluated quickly and any modifications in dose to alleviate the patient's symptoms can be adjusted rapidly.

However, if and when the medication has to be discontinued or dosage reduced, it must be tapered gradually because on discontinuation the effect of rapid steady state works in reverse.  If discontinuation occurs to fast, blood levels drop quickly, resulting in what some people experience as withdrawl symptoms you describe.

The same occurs with some of the short acting SSRI/SNRI medications as well, and the misunderstanding of how these medications work and not following the doctor's instructions on tapering the dose when discontinuing these medications result in misconceptions being propogated on unreliable internet sites.


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## bigben70 (Jul 27, 2011)

@Daniel:

Thanks Daniel! I will experiment with the different arm levels when taking my BP at home! I used to get VERY high readings with the automated BP machines in drug stores - until I learned how to properly situate my arm in the cuff. Then I was able to get the same results as my DR. But... both methods have my arm hanging down or resting.

I can't wait to try this! THanks Daniel!

@Steve:

Hey thanks for the detailed info on Ativan. I think I should clarify that I take the sublingual version and that this is not available everywhere like it is here in Canada. You made excellent points regarding it's use - I used to wait until I was in a near panic state before medicating. By then, an adrenaline dump was already on it's way, and medicating at that point probably just added dizziness to the adrenaline dump! But medicating as I notice anxiety levels increasing seems to work better (and it's what the paramedics have been trying to tell me and I am sure they see their fair share of anxiety patients). For me, the trick is to know when "self soothing" techniques are not going to work. My goal is to no longer need meds for anxiety but learn how to deal with both "acute" stressful situations ('crisis' at work) and more "general long term life stressors" like parenting.

Anyways, I did go to sleep easily last night with no meds at 1:00am. It's not bad because I have flex hours and can sleep in a bit. I got about 7.5 hours with only one or two short awakenings (which is good for someone with sleep apnea I guess).

I was very anxious this morning but I started using my new EMDR techniques and my "CALM" word. I did some breathing exercises and some "self-affirmation" self-talk. I also fed the kids breakfast and talked to them and that always makes me feel better. They're actually a source of strength when they're not stressing me out! The combination worked well, but the tender spot under the left side of my jawbone and the cold sweat on my forehead were a bit worrysome. I do grind my teeth.... but jaw pain is nothing to ignore since I am now in my early 40's... Time to see the doctor! Jaw pain is gone and forehead is warm and dry now - no chest sweating either. And stress is high today... not too bad. Not too bad at all.... I am managing!

I am finally starting to feel "centered" and in my "zone" again after that trip. Travelling is indeed a big upset for me - it's hard to do and it takes days if not a week to get back into my groove after returning. It's really nice to be home. I am quite effective at work here today, and getting complex (and time sensitive) problems done like clockwork. I can admit that I feel a bit of the benefit of the break - in there somewhere. But I do need to lower the over-all stress level of travel. It's very taxing on my mind and body. I am taking my Vitamin B complex (stresstabs) in the morning and they seem to be helping.

Thanks again Steve, for your excellent replies.

Cheers,
-Big Ben


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## Retired (Jul 27, 2011)

> the sublingual version and that this is not available everywhere like it is here in Canada



Yes, the Canadian division of the manufacturer developed and then marketed the sublingual form in Canada, but it was not adopted elsewhere.  Nevertheless, oral tablets of Ativan can be administered sublingually and the molecules will be absorbed; however, there will be a little bit of residue remaining under the tongue from the binding ingredients required in the manufacture of oral tablets, that are not used in the sublingual form.

It is not clear whether generic oral lorazepam is absorbed sublingually, and there is no generic form of sublingual lorazepam in Canada to my knowledge.


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## bigben70 (Jul 28, 2011)

Steve:

You are the psych meds_ guru_! Thanks for the information on this often misunderstood and often feared medication.

I know that there were times that this drug was instrumental in getting me through tough times - especially in work-related situations where to succumb to panic and/or become frantic would have had very negative career consequences - to say the very least!!

For short term relief of anxiety (in my case) it's a wonder drug. I guess the trick is the same as with all drugs - to find the balance between insufficient use and overuse. You're right - there is no point in taking it  if you just carry it along as a security blanket. Then again, sometimes just _knowing_ I had it was all I needed to "push through". Ah, yes. The mind: probably the most poweful "drug dispenser" at our disposal... Now, where is the "Human Brain Manual" hiding.....

Cheers,
-Big Ben


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## bigben70 (Aug 4, 2011)

Update:

My wife and two kids, her mother, her sister & her hubby, and her brother (5 adults and 2 kids) went to the mountains yesterday leaving me and my father-in-law behind (we're both super busy at work). Although I would prefer to be there (to guide my kids, show them things and ultimately protect them should anything arise) they are with the people I trust the most. I know they are having a good time and learning new things - but I have a strong desire to be there the next time. My 3 y.o. boy "wants to climb a mountain" and they wanted to stop and pet the deer they saw along the roadside. I imagine them experiencing this but of course seeing it myself would be a whole lot better... I'm just really glad my wife took them there.

My psychiatrist is going to double my "anti-anxiety" tricyclic anti-d dosage from 20 to 40mg and double my "anti-anxiety" gabapentin dosage from 300 x 3 daily to 600 x 3 daily. I am concerned about this and worry about discontinuation as well as long term health affects including weight and cholesterol - risk factors for me genetically. But I want to try - she really does not want me using ativan for anxiety control. She did not refill my ativan and I don't recall if I failed to ask or if she had no intention! I really would not want to travel - especially long distances or to stressful work related places - without it.

I think I'll try the new med dosages and perhaps go for a trip and see what happens. I have 10 ativan left... kind of scary. I used about 10 for sleep during a rough spot of working too much and 10 more during my last trip. That leaves 10 / 30 left... 20 ativan since my last refill in June... not bad I guess. I wish I would have used only the over-the-counter sleep aid, but it has such a bad hangover quality and, in my estimation, has an even higher tolerance and dependency risk than ativan!!

Cheers,
-Big Ben


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## H011yHawkJ311yBean (Aug 4, 2011)

Whatever happened to traveling small distances first, and then gradually extending the traveling time.... ?   Hmmmm?


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## bigben70 (Aug 4, 2011)

Jollygreen:

There are still plans to do that... my wife was just REALLY insistent on taking the kids to the mountains, 5 hours away. Interestingly, I used to travel (daily) for a number of months to a nearby town (45 minutes out of town) with little trouble. I also used to travel further to a mine site about 1 hour out of town. My worst anxiety level is during snow storms, morning time, in darkness. Next to that would be heavy rain / severe thunderstorms. But panic on the highway for me can come out of the blue in the finest of conditions with the finest destination imaginable waiting for me. Over seas travel seems impossible. I have travelled by air about 6 times now and only a couple of times were horrible, with the other four having about "moderate" anxiety. Then again, I would medicate - often considerably - before boarding. I still recall the itchy skin and cold clammy hands in the boarding areas. Briefcase and site-related protective garb in hand - looking at all the other people who seemed to view air travel as about as necessary and mundane as going to the toilet.

The summer will be over soon - one more month. Then my "pressure to travel" will have diminished considerably. But i fear work related travel is around the bend. I loathe work related travel because for me it involves going to industrial worksites in the middle of nowhere. My career choice is a major source of anxiety and depression for me, and sadly I could have made more as an accountant looking what accountants make 20 years in. This career sucks. High stress, relatively low pay and poor benefits, and an increasing demand for people in my 'area' to travel. I have 20 years experience and the new kid they hired now has 2 years experience and makes 75% of what i make!! I have clearly hit a ceiling in remuneration here. They used to have field service people do the site work and testing - now they want designers, checkers and project managers to do it. Convenient! The latter people make less than "full time field people" in many cases, so it's a REAL BARGAIN to send them to the field! Tradesmen make 1.5x overtime, where 'office people on the road' get banked time overtime - if they're lucky!

Maybe it's not too late for a career change. I really don't think much of what I do anymore. It's just a paycheck. I'd paint walls if I could do it in town for what I make. In fact, I bet many painters do! Pathetic really.

Cheers,
-Big Ben


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