When used as directed to manage anxiety, lorazepam (Ativan) can be a beneficial pharmacological tool. Lorazepam, a prescription benzodiazepine medication, helps to decrease anxiety by depressing some of the functions of the central nervous system and altering brain chemistry to reduce overactive nerve firings and keep emotions regulated.
As a central nervous system depressant drug, lorazepam minimizes the stress response, which typically involves respiration, body temperature, concentration, energy levels, wakefulness, blood pressure, and heart rate. Lorazepam slows or reduces these functions to enhance relaxation, and it acts as a tranquilizer. The medication guide for Ativan, the brand-name formulation of lorazepam, warns that the medication is designed for the short-term treatment of anxiety disorders, and it is not recommended for long-term use (longer than four months). Taking lorazepam for longer than a few months can cause some serious side effects.
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Physical and Psychological Dangers of Prolonged Lorazepam Use
Lorazepam disrupts brain chemistry. The journal American Family Physician warns that benzodiazepine use may lead to cognitive impairment, an increased rate of hip fractures from falling down due to a lack of motor control and loss of coordination (especially in elderly individuals), and an elevated risk for motor vehicle crashes, as these drugs can impair a person’s reflexes and senses in much the same way that alcohol can. The US National Library of Medicine (NLM) reports that drowsiness, dizziness, fatigue, blurred vision, nausea, constipation, weakness, changes in appetite, disorientation, memory issues, and possible sexual dysfunction are all common side effects of lorazepam use. Lorazepam can impact learning and memory functions, disrupting normal cognitive abilities.
Regular and long-term use of a benzodiazepine such as lorazepam is linked to an elevated risk for developing dementia, especially in the elderly population, the International Journal of Medical Sciences publishes. The journal Neuropathology of Drug Addictions and Substance Misuse warns that benzodiazepine use can cause difficulties with concentration, memory, paying attention, and remaining on task as well as problems related to muscle relaxation and tension. Taking lorazepam long-term can compound these possible issues and side effects.
Lorazepam works by elevating levels of GABA (gamma-aminobutyric acid) in the brain.
GABA is one of the brain’s chemical messengers that calms the “fight-or-flight” response that the body can have to stress, therefore acting like a natural tranquilizer. Continued interaction of lorazepam on levels of GABA in the brain can make it difficult for the brain to regulate itself when the drug isn’t present and active in the bloodstream. Prolonged exposure to high levels of GABA in the brain can damage the circuitry and wiring of parts of the brain responsible for learning and memory, impulse control, emotional regulation, feelings of pleasure and reward processing, and physical movement.
Using lorazepam for even as short as a month can lead to physical dependence on the drug, as the brain can no longer keep up a stable chemical balance without its interaction. Lorazepam withdrawal symptoms can be difficult and even potentially life-threatening when the drug processes out of the bloodstream after a person becomes physically dependent on it. The more lorazepam a person uses at a time and the longer they use it for, the more significant the withdrawal symptoms will be. Benzodiazepine withdrawal is a serious complication and consequence of long-term lorazepam use.
Abuse and Addictive Potential of Lorazepam
Since lorazepam alters brain chemistry and helps to alleviate stress and promote relaxation, it also has a high potential for abuse. When abused, lorazepam can create a “high” that can be euphoric and desirable. Psychiatric News publishes that lorazepam is one of the most commonly abused benzodiazepines along with alprazolam (Xanax), diazepam (Valium), and clonazepam (Klonopin).
Lorazepam may be misused in attempts to self-medicate anxiety, stress, or depressed moods, or as a recreational drug to get high. It may also commonly be mixed with alcohol or other drugs. Combining lorazepam with another central nervous system depressant, such as an opioid, other sedative, or alcohol, can result in a potentially fatal overdose. Regular abuse of lorazepam, with or without other substances, can elevate the risk for drug dependence and addiction.
Lorazepam is considered to be habit-forming even when taken as directed with a valid and necessary prescription. With regular use, a person can become tolerant to certain levels of lorazepam and need more each time in order for the drug to work as desired. This can increase the odds for dependence and withdrawal.
It can be hard to stop taking lorazepam after using it for a length of time, as cravings and withdrawal symptoms encourage a person to keep taking it to avoid feeling bad. Since lorazepam acts a central nervous system depressant, when the drug wears off after regular interaction in the brain, a sort of “rebound” can occur. This happens when GABA levels drop drastically low due to a lack of stimulation by lorazepam and results in some of the functions of the central nervous system being hyperactive to try and compensate. Blood pressure, heart rate, body temperature, and anxiety levels can all spike.
Discomfort related to lorazepam withdrawal can start within 12-24 hours of the last dose. The user may try to avoid these symptoms by taking more of the drug. Compulsive drug use can then become the norm, leading to a loss of control over use and then addiction.
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Hazards of Lorazepam Addiction and Withdrawal
Addiction is a brain disease that has physical, social, emotional, and behavioral consequences. The National Survey on Drug Use and Health (NSDUH) reports that in 2015, just over 6 million American adults misused prescription tranquilizers like lorazepam, and close to 700,000 people suffered from addiction involving a prescription tranquilizer medication.
In the short-term, addiction can create interpersonal relationship troubles related to mood swings, uncharacteristic behaviors, and difficulties consistently fulfilling family, work, school, and other life obligations. Everyday life is negatively impacted as a person battling addiction will likely spend an exorbitant amount of time using lorazepam, trying to figure out how to get it next time, and recovering from the effects of the drug. Social circles can change to only include others engaging in drug use. Secrecy and withdrawal from family and friends is a common side effect of addiction.
Work and/or school production can take a hit, and someone struggling with addiction may lose their job or have a noticeable decline in their grades. Financial difficulties can crop up. Risky behaviors may even include criminal actions, and legal problems can be a consequence of the drug-seeking or inhibited behaviors that accompany substance abuse and addiction.
Unhealthy sleeping and eating habits, as well as appetite changes, can lead to physical decline and health problems as well. Someone battling addiction likely does not put as much effort into personal hygiene, and appearance can suffer. Addiction is also a progressive disease, and the longer a person continues to struggle with addiction involving lorazepam, the more these problems can build up.
Another particularly dangerous side effect of lorazepam addiction and dependence is benzodiazepine withdrawal. Abuse of lorazepam can make withdrawal worse, as can the way in which a person misuses it. For instance, crushing the tablets to inject, snort, or smoke the medication can circumvent the intended way the drug is to be metabolized through the gastrointestinal system; instead, these methods of abuse send the drug directly into the bloodstream and across the barrier between the blood and the brain. This can enhance dependence and therefore worsen withdrawal symptoms.
Taking lorazepam with alcohol, opioids, or other drugs can also make withdrawal more significant as can the presence of any co-occurring mental health or medical issues, a personal or family history of substance abuse and/or addiction, and environmental factors, including external stressors like a chaotic home environment. Physical dependence and withdrawal become more intense the longer a person takes lorazepam.
The journal Psychology Today warns that benzodiazepine withdrawal can be significant and may continue for months, especially in someone who has been using or abusing these medications for a long period of time. The longer lorazepam is used, the more intense withdrawal can be and the longer it may continue on for.
Lorazepam withdrawal symptoms can include:
- High blood pressure
- Troubles breathing
- Stomach cramps
- Trouble feeling pleasure
- Panic attacks
- Sensory distortions
- Loss of appetite
- Involuntary movements
- Short-term memory loss
- Sensitivity to light and sound
- “Tingling” feelings in the arms and legs
- Irregular heart rate and heart palpitations
One of the most serious forms of withdrawal from benzodiazepines is called delirium tremens (DTs), and it occurs most often in people who have been significantly dependent on a central nervous system depressant drug. DTs can be life-threatening and includes significant mental confusion, delirium, high fever, and possible fatal seizures.
Lorazepam withdrawal should be carefully managed through a medical detox program that is followed with an addiction treatment program. In such a program, lorazepam will generally be tapered slowly during detox instead of stopped “cold turkey” in order to smooth out the withdrawal process and dampen the rebound effect of the brain, allowing natural chemistry to be restored and stabilized over a safe period of time.
In general, the majority of the lorazepam withdrawal symptoms will peak in the first few days after stopping the drug and taper off over a week or so. Mood and sleep disturbances, as well as cravings and some cognitive issues like difficulties with memory, concentration, and learning abilities, can continue beyond detox, especially if the drug has been taken for a long period of time. The longer lorazepam is taken, the longer it can take the brain to restore natural order and stable chemical balance.
During rehab, behavioral therapies and medications can be beneficial in managing withdrawal symptoms. A comprehensive approach to treatment can minimize the potential for relapse and support sustained recovery.