ativan 2mg and darvocet?!

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Darvocet (propoxyphene) is not indicated for anxiety, depression, or any other psychiatric conditions. Darvocet is only approved for mild to moderate pain.

If you are not taking the Darvocet for pain then it is certainly best it is replaced with other medication. Ativan (lorazepam) is a benzodiazepine class anxiolytic (anti-anxiety). You might talk to your doctor about adding an antidepressant which is effective for both anxiety and depression. Without knowing the type of anxiety you have it is hard to say what the best medications are. Commonly used antidepressants include Celexa (citalopram), Lexapro, Cipralex (escitalopram), Paxil (paroxetine), Zoloft (sertraline), and Effexor XR (venlafaxine extended-release). BuSpar (buspirone) is also a potentially good option for generlized anxiety disorder (GAD) however it is not effective for depression. I would recommend either sertraline or escitalopram- sertraline is much cheaper so it may be a better option. For more severe anxiety/depression venlafaxine might be a better option.

You could talk to your doctor about increasing the Ativan. How often are you taking it? 1 mg twice daily? 2 mg once daily? Typically Ativan needs to be taken THREE times daily for continuous use.

Although I would normally never bring it up one option is the opioid tramadol. Tramadol is a unique atypical opioid that has weak opioid actions but it also acts as an antidepressant. Chemically it is almost identical to Effexor (venlafaxine) so tramadol does have some antidepressant effects. It is also NOT a controlled substance and has a very low abuse liability, especially if you have no history of substance abuse and since you have been on Ativan and Darvocet, both of which are schedule IV controlled substances in The United States, for 15 years I doubt addiction is very likely.

The major reason I bring up tramadol is because if you have been taking an opioid for anxiety/depression and it is working and not causing you major side effects or drug seeking behaviour then it might be worth continuing it simply because you have been taking an opioid and have been stable. Tramadol has been occasionally used in patients with highly refractory depression or anxiety and there is some evidence it is effective for OCD.

Talk to your doctor and see what he recommends but in general antidepressants are probably the best way to go.

M.D., C.M. psychiatry, internal medicine (Québec)
Hons. BSc pharmacology