Ativan vs. Xanax: Differences, Uses, and Risks

Side Effects of Ativan and Xanax

Common Side Effects

Both Ativan and Xanax’s side effects⁴ typically include:

• Drowsiness or fatigue
• Dizziness
• Reduced coordination
• Mild memory problems
• Changes in appetite
• Dry mouth

Most people experience mild side effects when they start taking anxiety medications. These usually improve as your body adjusts. If you’re concerned about any effects you’re experiencing, discuss these with your prescribing doctor.

Severe Side Effects

While less common, both medications can potentially cause more serious effects:

• Severe confusion or disorientation
• Significant memory problems
• Mood changes
• Trouble balancing
• Breathing problems, particularly when combined with other substances

People commonly combine benzos with alcohol, either recreationally or to cope with anxiety. This dramatically increases the risk of adverse side effects, addiction, and overdose. Learn more in our article on mixing alcohol and other substances.

Differences in Side Effects 

While both medications share many similar effects, there are some differences in how people typically experience them:

Ativan often causes:

• More pronounced sedation
• Less intense rebound anxiety between doses
• Fewer morning-after effects

Xanax typically involves:

• More noticeable initial effects
• More pronounced rebound anxiety between doses
• Greater likelihood of morning grogginess if you take it at night

Risks of Dependency and Withdrawal

It’s important to have an open conversation about the risks associated with these medications. Both Ativan and Xanax can lead to physical dependence, even if you take them exactly as prescribed. This is simply a result of how these medications work in the brain.

Dependency Risks

When you take benzodiazepines regularly, your brain adjusts to their presence. Over time, you might notice that you need a higher dose to get the same calming effect—this is called tolerance. Some people may become dependent on benzos⁵ within just a few weeks, which is why healthcare providers typically prescribe these medications for short-term use or as needed.

If you’re experiencing any of the following, it could be a sign that you’re developing a dependency:

• Feeling like you need anti-anxiety medication to get through normal situations
• Experiencing increased anxiety about not having your medication available
• Needing higher doses to get the same feeling of relief
• Having trouble sleeping or feeling anxious if you miss a dose

Withdrawal Symptoms

If you’ve been taking Xanax or Ativan regularly, you should not stop taking it suddenly. Always work with your healthcare provider to create a safe tapering plan. Withdrawal symptoms can be uncomfortable—and potentially dangerous—if they’re not managed properly.

Common withdrawal experiences include:

• Return of anxiety symptoms (often stronger than before)
• Restlessness and irritability
• Sleep problems
• Muscle tension
• Difficulty concentrating

Xanax’s shorter half-life⁶ means withdrawal symptoms might appear more quickly and feel more intense. Ativan’s longer-acting nature usually means a more gradual withdrawal experience.

Safe Usage Recommendations

Using these medications safely means taking them exactly as prescribed and avoiding alcohol and other sedating substances while taking them. That said, it’s also crucial to be honest with your healthcare provider about any other substances you’re using. Keep attending your regularly scheduled medication management appointments to monitor your progress. And of course, store your medications securely and never share your prescription with others.

Which Is Better: Ativan or Xanax?

When deciding between Ativan vs. Xanax for anxiety, there’s no one-size-fits-all answer. Think of these medications like different tools in a toolbox—each has its ideal use. Your prescriber will consider several factors to determine which might work better for you.

Factors to Consider

Type of Anxiety

Ativan might be your better option if you have persistent, daily anxiety that needs consistent management. If you deal with panic attacks or sudden anxiety spikes, Xanax could be more suitable.

Lifestyle Considerations

Which anxiety medication is best for you also depends on your:

• Work schedule (including whether you operate machinery or drive frequently)
• Daily responsibilities
• Sleep patterns
• Other medications you take

Personal Factors

Other factors can also affect your treatment plan:

• Your medical history
• Previous experiences with anti-anxiety medications
• Your age and overall health
• Personal preferences about medication scheduling

Doctor’s Recommendation

Your healthcare provider brings valuable expertise to this decision. They’ll consider:

• Your specific symptoms and diagnosis
• Other health conditions you might have
• Potential interactions with other medications
• Your treatment history
• Your lifestyle and daily routine

Keep an open line of communication with your doctor about your concerns and preferences. This will help them make the best recommendation for your situation.

Alternatives to Ativan and Xanax

While benzodiazepines are helpful for a lot of people, they’re not the only option for managing anxiety. There are many effective alternatives, both in terms of other medications and non-medication approaches.

Non-Benzodiazepine Medications

Several other types of medications can help manage anxiety symptoms:

SSRIs and SNRIs

These medications (like Zoloft, Lexapro, or Effexor) work differently from benzodiazepines. Instead of providing immediate relief, they help regulate brain chemistry over time. They’re typically used to treat depression, but many people find them effective for long-term anxiety management without the risk of dependence.

Beta Blockers

These medications primarily help with the physical symptoms of anxiety, like racing heart and trembling. They’re usually used for specific situations like public speaking or performances.

Buspirone

This medication specifically treats anxiety without causing significant sedation or dependency.⁷ It works well for many people, though it typically takes a few weeks to feel the full effects.

Behavioral Therapies and Coping Strategies

Medication isn’t the only way to manage anxiety. Many people find these approaches helpful, either on their own or alongside medication:

Cognitive Behavioral Therapy (CBT) and Other Talk Therapies

CBT helps you understand and change thought patterns that contribute to anxiety. It’s like learning a new language—at first it takes conscious effort, but it becomes more natural with practice. Research shows CBT can be just as effective as medication for anxiety. According to the American Psychological Association, 

For anxiety disorders, cognitive-behavioral therapy, antidepressant medications and anti-anxiety medications have all been shown to be helpful. Research generally shows that psychotherapy is more effective than medications, and that adding medications does not significantly improve outcomes from psychotherapy alone.

Mindfulness and Meditation

Mindfulness is the practice of staying grounded in the present moment. Many people find this helps ease their anxiety, as the brain tends to get caught up in anxiety about the future. Significant scientific evidence supports this. A study of 187 adults seeking treatment for mood and anxiety disorders found that mindfulness helps reduce anxiety by reducing worry.⁸ Even a few minutes of daily mindfulness can make a noticeable difference in managing anxiety symptoms. 

Exercise and Lifestyle Changes

Getting daily physical activity, maintaining good sleep hygiene, and learning techniques for managing stress can help lower your anxiety levels. Some people find that making these changes reduces or even completely eliminates their need for anxiety medication.

Getting Support

Remember, seeking help for anxiety is a sign of strength, not weakness. Whether you’re considering starting one of these medications, currently taking them, or looking for alternatives, your healthcare provider can discuss your options and create a treatment plan that’s personalized to your needs.

Working with your treatment team to find the right approach—whether that includes Ativan, Xanax, other medications, or non-medication alternatives—is an important step in managing anxiety and improving your quality of life. Don’t hesitate to ask questions and share your concerns as you work together to find the best solution for your specific situation.

If you’re looking for a strong start to your anxiety healing journey, anxiety treatment programs offer comprehensive treatment in an immersive, recovery-focused setting. Search for an anxiety treatment center that fits your needs and speak directly with an admissions specialist today.

Frequently Asked Questions About Ativan vs. Xanax

Can you take Ativan and Xanax together?

No, healthcare providers don’t prescribe these medications together because they work in very similar ways. Taking both could increase the risk of side effects without providing additional benefits.

How long can you safely use Ativan or Xanax?

Most healthcare providers recommend using benzodiazepines for short periods (a few weeks to months) or as needed for specific situations. Long-term use should be carefully monitored by your healthcare provider.

Are there non-addictive alternatives to benzodiazepines?

Yes, many alternatives exist, including SSRIs, SNRIs, buspirone, and various non-medication treatments like therapy and mindfulness practices. Work with your healthcare provider to find the best option for your situation.

What should I do if I want to stop taking Ativan or Xanax?

Always work with your healthcare provider to create a tapering plan. Never stop taking these medications suddenly, as this can lead to withdrawal symptoms that can range from uncomfortable to very dangerous.

Is it safe to drive while taking these medications?

Until you know how either medication affects you, avoid driving or operating machinery. Some people experience significant drowsiness or decreased coordination, especially when first starting the medication or after dose changes.