Long-Term Effects of Lorazepam (Ativan)
Chronic lorazepam use may lead to issues such as:2,6
- Cognitive impairment*
* Long-term benzodiazepine use has been associated with multiple cognitive deficits, including verbal learning and processing speed. However, some assert that it does not cause chronic problems with cognition. While impairment has been found to improve to a certain degree after stopping benzodiazepines, some level of dysfunction did persist.7
When used as directed, lorazepam, a substance also sold under the brand name Ativan, can be an effective tool in the management of anxiety.1 Lorazepam is a prescription benzodiazepine medication, and, typically, a benzodiazepine should not be regularly used for over a month.1,2 Benzodiazepines help to decrease activity in the brain by increasing the impact of gamma-aminobutyric acid (GABA), an inhibitory chemical messenger.3
Benzodiazepines are central nervous system (CNS) depressants. While the CNS-depressing effects can help relieve anxiety and panic, they can also be dangerous, especially when the drug is taken in high doses.4 Ativan may cause respiratory depression, which could be fatal. Combining Ativan with another CNS depressant can result in even greater CNS depression.5
There have been conflicting findings regarding how benzodiazepines affect dementia risk. However, a meta-analysis found that use of a benzodiazepine is linked to an elevated risk of developing dementia. Using benzodiazepines recently and in the past were each associated with an increased likelihood of dementia compared to no use of benzodiazepines ever.8 Thus, benzodiazepine use may have a lasting impact on dementia risk even after they are stopped.
Lorazepam Abuse and Addictive Potential
- Lorazepam is a drug that can be safely taken under the direction of a trained medical professional if used as instructed.1 Using lorazepam that is not prescribed for that person, using it to get high, using it in ways other than prescribed, or using it with or to offset other substances is considered lorazepam misuse and can be very dangerous.9
- Lorazepam may be misused in attempts to self-medicate anxiety, stress, or depressed moods. Some may misuse Ativan to get high, including combining it with other drugs to enhance their effects. It also may be misused in an attempt to alleviate the undesirable effects of cocaine or the symptoms of alcohol withdrawal.3
- Longer duration of use and larger doses heighten the risk of dependence. Individuals with a history of addiction should be monitored carefully when prescribed lorazepam.5 Misuse of benzodiazepines may result in overdose.9
- Benzodiazepines can be sedating and have high abuse potential.10 Lorazepam is one of the top 5 benzodiazepines found in the illegal drug market. People with polysubstance abuse history may be at an especially high risk of becoming dependent on and abusing benzodiazepines such as Ativan.3
With continued misuse over a period of time, a person may develop a lorazepam use disorder. Symptoms may include:11
- Often using lorazepam more or for more time than intended.
- Spending a lot of time getting, using, and recovering from lorazepam.
- Making attempts to decrease or manage use of lorazepam that are unsuccessful.
- Feeling a strong yearning to use the medication.
- Still using lorazepam even though the person is experiencing social, physical, or mental health issues repeatedly or chronically that the drug probably caused or worsened.
- Being unable to fulfill responsibilities at work, home, or school due to regular use.
- Using the drug repeatedly in dangerous situations.
- Requiring higher doses of the drug to create the same effects.
- Experiencing withdrawal symptoms when cutting back or discontinuing use.
According to a 2018 report, nearly 740,000 people age 12 and older in the U.S. had a tranquilizer use disorder in the prior year. Tranquilizers include benzodiazepine tranquilizers and other prescription tranquilizers.12
Substance use disorders are serious conditions that are associated with severe physical, social, and emotional consequences.
Hazards of Benzodiazepine Addiction
Substance abuse and/or addiction may create interpersonal relationship troubles and may interfere with fulfilling family, work, school, and other life obligations. Everyday life may be negatively impacted as a person with an addiction to Ativan may spend an exorbitant amount of time attempting to secure and use Ativan.11,13
Financial difficulties can arise as well. Individuals may engage in risky behaviors that may harm themselves or others or result in legal problems.13
Side effects from benzodiazepines tend to be worse with larger doses. Side effects from lorazepam use may include:5
- Feeling dizzy/unsteady
- Memory problems
- Thoughts of Suicide
Ativan addiction may result in deadly overdose, which is most likely among those who combine Ativan with other drugs (including alcohol). Combining lorazepam with other substances that depress the central nervous system (CNS) can exacerbate the depression of the CNS.5
Call the National Suicide Prevention Hotline at 1-800-273-8255.
Veterans can also utilize the Veteran Crisis Line via text 838255 or via online chat with a crisis counselor.
Risks of Polysubstance Use
If lorazepam is combined with another substance that depresses the CNS, like another benzodiazepine, alcohol, or an opioid drug, the CNS effects can intensify. For instance, respiratory depression can put an individual’s life in danger.5
The National Institute on Drug Abuse (NIDA) states that over 30 percent of opioid overdoses also included benzodiazepines. In fact, the dangers of combining these drugs are so great that all prescription opioid and benzodiazepine medications now have a warning about the hazards of using these drugs concurrently.14
A lorazepam overdose may be fatal.5 It should be considered a medical emergency that requires immediate attention.
Symptoms of a Lorazepam Overdose
Overdose deaths involving benzodiazepine medications in the U.S. were more than ten times higher in 2017 than they were in 1999. NIDA reports that in 2017 more than 11,500 Americans died from an overdose involving a benzodiazepine drug, usually in combination with opioids.15
Overdose on lorazepam can range from mild to severe. It may produce the following symptoms:5
- Significant drowsiness
- Profound confusion
- Decreased muscle tone, or “floppy” limbs
- Lack of control over body movements
- Low blood pressure
- Cardiovascular depression
- Shallow, slow, and/or difficult breathing
Overdose involving lorazepam can result in death, though fatal outcomes may be more likely when the drug is used in combination with opioids, alcohol, or other drugs.5
Using benzodiazepines for even a week may lead to physical dependence on the drug. Larger doses and/or greater durations of use raise the likelihood of becoming dependent on the drug. Individuals who only use suitable doses for a short time span (as recommended) are at a lower risk of becoming physically dependent.5
Lorazepam withdrawal symptoms may emerge when a person suddenly stops using the drug.5 How much a person uses at a time and how long it has been used may impact how significant the withdrawal symptoms are.3
Since lorazepam acts a CNS depressant, when the drug is stopped after regular use, a sort of “rebound” may occur.6 Stopping a benzodiazepine may result in rebound symptoms of anxiety and insomnia.8 Benzodiazepine withdrawal may be life-threatening in some cases, although this is uncommon, and if a person is experiencing withdrawal symptoms from stopping a CNS depressant, he or she should seek medical assistance right away.6
It is recommended for those who are discontinuing their Ativan use to slowly taper off rather than suddenly stop the medication.5 Anyone considering stopping a CNS-depressing medication should talk with a medical provider first.6
Lorazepam withdrawal symptoms may include:
- Trouble sleeping
- Panic attacks
- Stomach cramps
- Perceptual distortions
- Decreased appetite
- Involuntary movements
- Memory loss
- Sensitivity to light and sound
- Tingling feelings in the arms and legs
- Fast heart rate
- Heart palpitations
Lorazepam withdrawal should not be managed without medical oversight. Lorazepam should generally be tapered slowly. Medical detox can be done in an inpatient or outpatient setting.
Outpatient detox should only be done if the patient is not dependent on multiple substances, has been taking benzodiazepine doses that are generally within therapeutic parameters, and who both are dependable and have dependable loved ones who can help monitor them.16
For patients suffering from benzodiazepine withdrawal (or at risk of suffering from it), assessment should include determining the medication used, amount used, and how long it was used, as well as determining if other substances (such as alcohol, cigarettes, or sleep medications) were also being used and if any co-occurring mental illnesses are present. There should also be a physical evaluation. Throughout detox, especially after a patient’s dose is decreased, professionals should reassess the person’s medical and mental health status.16
Though some people may think detox “cures” someone of their substance use disorder, it only addresses the physical aspects of withdrawal. For those with substance use disorders, it generally is not enough on its own to help them to stay sober long term. If a person has a substance use disorder, they should engage in addiction treatment after detox.17
Behavioral therapies, such as cognitive behavioral therapy, may be beneficial for individuals addicted to benzodiazepines.4 Therapy and/or medications can help to address any underlying anxiety disorders.18 Not everyone will progress through treatment at the same rate, but when patients engage in professional treatment, it may help them avoid relapse and stay in recovery.
- National Alliance on Mental Illness. (2019). Lorazepam (Ativan).
- Johnson, B., & Streltzer, J. (2013). Risks associated with long-term benzodiazepine use. Am Fam Physician, 88(4), 224-226.
- Drug Enforcement Administration. (2013). Benzodiazepines.
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2018). Drug Facts: Prescription CNS Depressants.
- Valeant Pharmaceuticals. (2016). Ativan® C-IV (lorazepam) Tablets RX only.
- National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs.
- Stewart, S. A. (2005). The effects of benzodiazepines on cognition. Journal of clinical psychiatry, 66(suppl 2), 9-13.
- Zhong, G., Wang, Y., Zhang, Y., & Zhao, Y. (2015). Association between Benzodiazepine Use and Dementia: A Meta-Analysis. PloS one, 10(5), e0127836.
- National Institute on Drug Abuse. (2019). Prescription Depressant Medications.
- Center for Substance Abuse Research. (2013).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
- Center for Behavioral Health Statistics and Quality. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- U.S. Department of Health and Human Resources, Indian Health Service. (n.d.). Warning Signs of Drug Abuse and Addiction.
- National Institute on Drug Abuse. (2018). Benzodiazepines and Opioids.
- National Institute on Drug Abuse. (2019). Overdose Death Rates.
- Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment (Treatment Improvement Protocol (TIP) Series, No. 45).
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- National Institute of Mental Health. (2018). Anxiety Disorders.