Lorazepam is the generic name for a benzodiazepine that is most often sold as Ativan. This medication is most frequently prescribed for anxiety, including conditions in which anxiety is associated with depression. It is sometimes prescribed to treat insomnia, irritable bowel syndrome (IBS), epilepsy, nausea or vomiting associated with some cancer treatments, and anxiety and panic associated with alcohol withdrawal syndrome.
Lorazepam in the form of Ativan was approved by the Food and Drug Administration (FDA) in 1977, and generic versions became available in 1985. There are several consumable forms of lorazepam, including oral tablets, concentrated solutions, and an injectable form.
Although benzodiazepines were breakthrough drugs in treating anxiety and panic disorders, lorazepam and other, similar substances can be habit-forming. Many people struggle with addiction to benzodiazepines or combine them with other drugs to enhance the high associated with intoxicating substances. This has led to a surge in benzodiazepine-related overdoses in recent years. In 2013, for example, benzodiazepines were involved in 30 percent of overdose deaths, often combined with opioids, alcohol, or both.
What is Lorazepam?
Benzodiazepines like lorazepam act on the gamma-amino butyric acid (GABA) receptors in the brain. GABA is the most common neurotransmitter in the central nervous system (CNS), preventing neurons from becoming excited and firing when there is more of it around. People who have a deficiency of the GABA neurotransmitters may experience anxiety disorders, seizure disorders, insomnia, or panic disorders. Taking a medication like lorazepam causes sedation, acting on the GABA receptors to replicate how the neurotransmitter should calm neurons down. People who struggle with anxiety and take lorazepam will experience a reduction in their symptoms, so they can feel stable. Similarly, people with insomnia who take lorazepam as prescribed should be able to relax enough to sleep.
Typically, lorazepam’s effects will begin within 15 minutes to one hour after the prescription dose is taken. The drug is a medium-acting benzodiazepine, so positive, sedative effects peak within 1-6 hours; after that, the substance is still somewhat present in the body, but it no longer affects the brain.
Many benzodiazepines are prescribed to be taken as-needed for panic attacks or insomnia, or they are prescribed for very short-term regular use – no more than two weeks, in most cases – because the brain can quickly become dependent on them to achieve normal GABA levels. It is important for people with mental health problems to work with a therapist while taking prescription medication, so they can recognize and manage symptoms of the condition. If a person does not take lorazepam as directed or does not get the therapy they need to manage anxiety or panic, they are at risk for abusing these drugs, taking more than needed, and potentially developing an addiction.
Sometimes, people who take potent prescription drugs like lorazepam need help from their physician to safely detox when they want to stop taking the substance. This can occur even in people who take prescription medications as directed, but it is a greater risk for those who struggle with abuse or addiction, including to lorazepam. If a person stops taking lorazepam suddenly, or they do not get help safely detoxing from the substance, they may experience withdrawal symptoms, which can feel intense. Without social and medical support, lorazepam withdrawal symptoms like cravings can cause relapse; some of the withdrawal symptoms, like seizures, are life-threatening.
- Irritability and mood swings
- Rebound anxiety or insomnia
- Other sleep disturbances
- Numbness or tingling in the extremities
- Hypersensitivity to light, noise, or touch
- Involuntary movements
- Diarrhea or stomach upset
- Appetite changes
- Panic attacks
- Anger, or aggressive behaviors toward oneself or others
- Short-term memory loss
- Heart palpitations
- Tachycardia or heart attack
- Seizures or convulsions
Some of these are life-threatening, so it is important to work with a medical professional to taper off lorazepam safely.
How Long Does Withdrawal Take?
There are two forms of benzodiazepine withdrawal, which can be caused by lorazepam: short-term and protracted withdrawal. The first is the more common experience of ending physical dependence on lorazepam, while protracted withdrawal, also sometimes called post-acute withdrawal syndrome (PAWS) or benzodiazepine withdrawal syndrome (BWS), means the individual experiences withdrawal symptoms for longer.
Typically, withdrawal takes between one and two weeks, at the most; however, if a person develops PAWS, they may experience psychological withdrawal symptoms associated with lorazepam withdrawal for several weeks or even months.
- Increased anxiety
These symptoms include:
Tapering off lorazepam slowly can prevent PAWS. Although it will take longer than just quitting lorazepam cold turkey, tapering off the medication with a physician’s oversight is the safest means of withdrawal.
Working with Medical Professionals to Safely Detox
There are no medications designed to treat benzodiazepine withdrawal as there are for other addictive substances like opioids. However, lorazepam and other benzodiazepines are prescription medications, and many people who struggle with addiction to these substances are introduced to them through a prescription from a psychiatrist or physician. Working with a medical professional, especially one who understands addiction treatment, can ease withdrawal via a tapering schedule. A scheduled taper keeps the person focused on treatment because they must return to their physician for checkups about withdrawal symptoms. The doctor can adjust the taper, increasing or decreasing dosage as necessary, until the individual is no longer physically dependent on lorazepam.
Once the person has safely detoxed, follow-up treatment is critical. Detox on its own is not addiction treatment. In an evidence-based rehabilitation program, individuals can learn to understand their addiction and change behaviors toward substances like lorazepam in order to maintain sobriety.
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