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Anxiety disorders are a category of mental health problems characterized by excessive anxiety and worry. They include generalized anxiety disorder (GAD), social anxiety disorder (SAD), phobias, and panic disorder (PD).[1]
Benzodiazepines are an effective form of treatment for acute anxiety disorders, but they do have associated risks. These drugs increase the activity of gamma-aminobutyric acid (GABA), which has an anxiolytic, calming effect.[2]
Xanax (alprazolam) and Ativan (lorazepam) are two of the most common benzodiazepines offered to individuals with anxiety disorders. While they are similar medications, it’s helpful to understand the differences between them and why one might be more appropriate than the other in certain situations.
- Ativan and Xanax are benzodiazepines used to treat anxiety disorders. Xanax has a faster onset of action and is eliminated more quickly; Ativan is slower to act but lasts slightly longer.
- Benzodiazepines can be addictive, and they can potentially cause side effects, including sedation and confusion.
- Work with a doctor to decide if Ativan or Xanax is the best fit for your situation.
Understanding Ativan and Xanax
Ativan and Xanax are brand names for different types of benzodiazepines. Ativan is the brand name most commonly associated with lorazepam; Xanax is the popular brand name for alprazolam.
Both of these drugs work in approximately the same way. They enhance the effect of an inhibitory neurotransmitter known as GABA, which reduces neural activity and has an anti-anxiety effect.[2]
FDA-approved uses for Ativan and Xanax
Ativan and Xanax are recommended for the treatment of anxiety disorders and panic disorders.[3][4] They can be used for GAD, SAD, and PD.
The American Psychiatric Association recommends initial pharmacological treatment of anxiety with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), rather than benzodiazepines. However, first-line medications may not be appropriate for everyone or may be ineffective.[5]
Key differences between Ativan and Xanax
Although Ativan and Xanax are very similar medications, they are metabolized differently. [3][4] They have similar effects but differ in terms of when those effects start and how long they last.
Xanax is consistently faster to take effect than Ativan, although this difference may only be small. Xanax typically reaches peak concentration in the blood approximately 1-2 hours after taking a tablet. Individuals will usually feel the effects in less than 30 minutes.[6]
For Ativan tablets, a half-life of 2 hours is typical, and the effects are felt slightly longer than Xanax.[7]This is because Ativan takes slightly longer to be metabolized or broken down within the body. This is measured by the time it takes the amount of the drug detectable in the blood to reduce by half. The half-life of Xanax is 11.2 hours, as compared with 12 hours for Ativan.
Some of these differences can be reduced if the slow-release version of Xanax (Xanax XR) or the injectable (faster-acting) version of Ativan is used.
Which medication is better for anxiety?
Ativan and Xanax can be highly effective for treating anxiety. For overall efficacy, neither is consistently better than the other. Doctors and patients should instead discuss which is a better fit for each individual case.
Because Xanax takes effect slightly more quickly than Activan, it can offer rapid relief from symptoms of panic attacks. As a result, it is often recommended for people who have PD or who experience panic attacks as part of their anxiety.
Ativan is slower to take effect, but it offers a more sustained relief from symptoms of anxiety. It may be a better option for patients who experience anxiety symptoms throughout the day.
Because Ativan takes longer to be metabolized and removed from the body, it also leads to fewer withdrawal symptoms than Xanax. This might be a consideration for patients with a history of substance abuse or who expect to be taking benzodiazepines for more than a few days.
Risks and side effects
The side effects of Ativan and Xanax are very similar. [3][4] Both of them have a high possibility for misuse, meaning that they may not be appropriate for patients who have experienced substance use disorders (SUD). Benzodiazepines are rarely prescribed for longer than 4 weeks.
Both drugs also may cause withdrawal symptoms. These include a depressed mood, insomnia, headache, and seizures. Patients can also develop tolerance, meaning that an increased dosage is needed to achieve the same effect. It is essential that any increase in dosage of benzodiazepines be agreed upon with your healthcare professional.
Additionally, benzodiazepines are associated with a risk of suicidal thoughts in people with depression. People at high risk of suicidal thoughts may be offered antidepressants at the same time as Ativan or Xanax.
These are the most common side effects of Ativan and Xanax:
- Drowsiness
- Light-headedness
- Confusion
- Impaired balance and coordination
- Memory impairment
- Constipation
Neither Ativan nor Xanax is recommended for anyone who is pregnant or planning to become pregnant or for anyone who is breastfeeding. There is an increased risk of drowsiness or dizziness in patients over the age of 65.
Ativan and Xanax may each interact with other drugs, including opioids, tricyclic antidepressants, barbiturates, and alcohol. Ensure your healthcare provider is aware of any other drugs you might be taking to ensure they offer you a safe and effective dose.
Addiction potential: Ativan vs. Xanax
Ativan and Xanax have the potential for addiction. Because of the way it is processed by the body, Xanax is often associated with more severe withdrawal effects than Ativan. There is limited evidence that Ativan may be less addictive than Xanax, but both of them still carry significant risks.[10]
Alternatives to benzodiazepines for anxiety
Benzodiazepines aren’t the only form of treatment for anxiety, and they’re rarely appropriate for long periods of time. Xanax and Ativan are each recommended for short-term use, usually under 4 months.[6][7]
Other forms of antidepressants, such as SSRIs or SNRIs, offer an alternative to benzodiazepines for treating anxiety. These have less potential for misuse and are regularly prescribed for longer periods.[5]
Beta-blockers, such as propranolol, can also be used to treat some of the symptoms of panic attacks, including racing heart, sweating, or shaking. These medicines are not approved by the FDA for anxiety-related conditions, but they are prescribed off-label in some situations.[11] Beta-blockers also may be used to treat chronic anxiety.
Over the longer term, psychological support is useful for anxiety disorders. Psychotherapy, cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT) might help.
Consult your doctor: Choosing the right medication
The differences between Ativan and Xanax are slight, but it is still important to try to find the right drug to meet your needs. Before meeting with your doctor, it could be helpful to consider how and when your anxiety impacts your life. Keeping a diary and finding triggers for your anxiety can give your doctor the information they need to give you the right advice.
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