Sometimes, people experience short-term, situational anxiety, such as after a traumatic event that triggers anxiety and insomnia. Medications like lorazepam (also known by its brand name “Ativan”) can help manage those symptoms for short-term relief.
Before taking lorazepam, it’s good to inform yourself about how it works, what the likely side effects are, and how to safely stop taking the medication when it is time to taper.
Understanding Lorazepam
Lorazepam is a drug used to manage anxiety and treat insomnia caused by temporary situational stress and anxiety. It’s classified as a benzodiazepine, a type of depressant drug used for several conditions.
Benzodiazepines work by slowing down the nervous system. This leads to four effects that make them so effective in managing anxiety:
- Amnestic: Benzodiazepines hinder the brain’s ability to create new memories.
- Anxiolytic: This term essentially means to loosen anxiety’s hold. Benzodiazepines cause the body and mind to settle, assuaging symptoms of anxiety.
- Hypnotic: Benzodiazepines induce sleepiness.
- Sedative: These medications can also settle the nervous system, creating a sense of calmness.
This medication works by boosting the level of a neurotransmitter called gamma-aminobutyric acid (GABA). As the body produces more GABA, it reduces activity in the nervous system and helps people calm down.
Because of its effects and potential to be addictive, lorazepam is highly regulated and cannot be legally obtained without a prescription.
Ativan Uses and Benefits
Formally, the FDA recognizes Ativan as a treatment for short-term (under 4 weeks) treatment of anxiety symptoms in those 12 years and older. It can also be used to manage anxiety-related insomnia.
In some cases, it’s used to alleviate anxiety in patients preparing for anesthesia for surgery, or as a sedative or to induce amnesia during medical treatments. However, it can also be used to treat status epilepticus, a severe type of seizure caused by uncontrolled electrical activity in the brain for five or more minutes that is unlikely to subside on its own.
In some cases, it can be used for off-label purposes. However, it’s important to recognize that health insurance does not always cover off-label use of a medication. Common off-label uses for Ativan include:
- Nausea and vomiting during cancer treatment
- Controlling agitation during alcohol withdrawal
- Panic disorder
- Delerium
- Vertigo
- Psychogenic catatonia
Risks and Side Effects
Taking lorazepam carries risks of addiction and should be managed carefully with your doctor. Use this medication only as prescribed to minimize the risk of addiction and dependency.
Additionally, taking Ativan can potentially result in unpleasant side effects. Most commonly, people report feeling mild side effects such as:
- Dizziness
- Drowsiness
- Impaired coordination
- Nausea, heartburn, and constipation
- Headache
- Blurry vision
- Changes in libido
- Changes in appetite
While these generally aren’t dangerous, they can be uncomfortable. If these side effects linger, speak with your doctor about ways to mitigate them.
More serious side effects are rare, but can occur. Speak to your doctor immediately if you experience any of the following:
- Mood changes such as depression or thoughts of suicide
- Mental changes, such as hallucinations
- Memory problems
- Difficulty speaking
- Vision changes
- Weakness
- Difficulty walking
In very rare cases someone may experience symptoms that warrant immediate emergency medical help. These include:
- Seizures
- Jaundice (yellowing of the skin or eyes)
- Slowed, shallow breathing
Additionally, a very small population of people who are prescribed lorazepam may find that it affects them differently, eliciting agitation instead of calmness. This phenomenon is more common in older adults. Symptoms to look out for include:
- Confusion
- Restlessness
- Rapidly speaking
- Irritability
- Violent behavior
- Excitement
Precautions and Considerations
Before prescribing you lorazepam, your doctor will ask you several questions about your medical history, as well as your family history, to determine whether this medication is right for you. While it can be a life changer for many who need it, it can still be dangerous for some people to take. Your doctor will ask you about the following:
- Allergies to benzodiazepines or other medications
- Kidney disease
- Liver disease
- Glaucoma
- Sleep apnea
- Breathing or lung problems
- Mental health disorders, including anxiety, depression, and psychosis
- Substance use disorder
Additionally, if you take lorazepam, you must take several precautions. Because this medication is a depressant, it’s not recommended that you drive, use heavy machinery, or do anything that requires clear vision or alertness. You should also avoid drinking alcohol and speak with your doctor if you use cannabis while on this medication.
Also tell your doctor if you are pregnant, intend to become pregnant, or are breastfeeding. Lorazepam passes to the unborn baby and into breastmilk when a mother uses it and may cause birth defects. If Ativan is used later in pregnancy, a newborn baby may experience symptoms of withdrawal after birth.
Dosage and Administration
Ativan can be administered either as oral tablets or a solution given through intramuscular or intravenous injection. How you take it and how much you take depends on factors like your age, the condition that is being treated, and other co-occurring medical conditions. Most commonly, doctors prescribe a low dose at first, then adjust the prescription to find the right dose for you.
Oral tablets come in 0.5 mg, 1 mg, and 2 mg forms. The injectable solution comes in 2 mg/mL and 4 mg/mL strengths.
To treat general anxiety, doctors typically prescribe 2 to 3 mg to be taken two or three times per day. However, they may prescribe a 2-4 mg dose at bedtime for those treating anxiety.
The injectable solution is typically only available in medical settings when administered by a medical professional. You aren’t likely to take it in this form on your own.
Older adults often start with lower doses, as they are more at risk of experiencing unusual, adverse side effects.
Treatment Duration and Withdrawal
Lorazepam is typically prescribed for a short period, usually for a few days or up to four weeks for situational anxiety. In some cases, a doctor may prescribe it for longer, but lorazepam is not typically used for long-term management of symptoms.
While physical dependence on Ativan can occur with long-term usage, doctors typically try to avoid this with the shortened prescription period. If you are using the medication daily, they may also taper off the dosage slowly as you stop usage to avoid withdrawal symptoms.
Ativan withdrawal can be dangerous if you attempt to stop using it cold turkey, and it’s not recommended to do so without medical supervision due to the risk of seizures.
Withdrawing from this medication typically occurs in two stages. The first stage, known as the acute stage, happens within 24 hours of the last dose, and on average, they occur within the first three to four days. This stage can cause rebound effects of the symptoms that the medication managed, leading to:
- Increased anxiety or panic attacks
- Increased blood pressure and heart rate
- Insomnia
- Headaches
- Difficulty concentrating
- Confusion
- Tremors
- Sweating
- Nausea or vomiting
- Weight loss
- Irritability
- Mood swings
After the acute stage, a protracted withdrawal stage occurs, typically lasting between 10 and 14 days. This can include:
- Continuing anxiety symptoms
- Craving the medication
- Nausea and vomiting
- Headaches
- General malaise
- Depression
While most people find that these withdrawal symptoms fade with time, others can continue to experience them for months and years. If you were taking lorazepam or Ativan to manage anxiety or a panic disorder, you may need to find alternative treatment options to manage the symptoms.
Conclusion
Ativan certainly has its uses, managing anxiety and insomnia symptoms or stopping severe seizures. However, because this medication can be so dangerous and addictive and can impact your ability to function day-to-day due to its sedative effects, there’s a lot to consider before starting or stopping usage.
Remember, if your doctor is recommending the use of Ativan or its generic form, they have weighed the benefits and the risks and believe that the benefits are worth pursuing. Giving it a chance to work may help you better manage your symptoms.
If you have any questions about starting, continuing use of, or stopping the use of Ativan, consult your doctor or reach out to our mental health professionals at Restore Mental Health. We may be able to answer your questions or refer you to a medical expert who can.
