What is Ativan?
Ativan is a brand name prescription drug that goes by the generic drug name lorazepam. Ativan belongs to a class of drugs called benzodiazapines, which are prescription drugs that are used to treat anxiety. Other commonly prescribed benzodiazapines include Xanax (alprazolam), Valium (diazepam) and Klonopin (clonazepam). Some prescription sleep aids, like Ambien (Zolpidem), have benzodiazapines added to them as well. What makes Ativan different from other benzodiazapines, like Xanax, is that it is shorter acting. This means it kicks in faster, and also leaves the system faster. The immediate effect is therefore more intense but it doesn’t last as long.
Ativan, like other benzodiazapines, is commonly prescribed to treat anxiety disorders. It is typically used as an in-the-moment medication, for when people are feeling overwhelmed or having a panic attack, although some psychiatrists do prescribe it for daily use in cases when a person’s anxiety has been otherwise difficult to treat. Ativan may be prescribed to treat mental health diagnoses including Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Panic Disorder, Post Traumatic Stress Disorder (PTSD), specific phobias, social anxiety, Bipolar Disorder, psychosis or sleep problems. It can also be used to treat certain medical issues like seizures or alcohol withdrawal, and can be used as a muscle relaxant. The American Psychiatric Association recommends that Ativan and benzodiazapines be used only for short term treatment of intense anxiety, due to the high risk of Ativan addiction and dependence. They also recommend that the lowest effective dose be used.
Like all other benzodiazapines, Ativan works by increasing the effects of a neurotransmitter in the brain called GABA. GABA is what is called an inhibitory neurotransmitter. This means it is responsible for decreasing the brain’s general activity level, leading to a reduction in anxiety, sedation and other effects. Alcohol, while it does a number of other things as well, works on the same neurotransmitter as Ativan. This means that people who are addicted to alcohol have a high potential to become addicted to Ativan, and that mixing alcohol with Ativan can be lethal.
Effects and Side Effects of Ativan
Side effects of Ativan are very similar to those of other benzodiazapines, although what makes Ativan different is that the effects are not as drawn out or extended. Effects of Ativan are more pronounced in higher doses, and include:
- Lowered anxiety
- Muscle weakness
- Blurred vision
- Balance or coordination problems
- Memory problems
- Difficulties concentrating
- Appetite changes
- Nausea or vomiting
- Skin rash (sign of allergy)
- Sleep problems
- Decreased sex drive
More serious side effects include depression, confusion, thoughts of suicide or self-harm, agitation, feeling light headed, seizures, shallow/slow breathing, yellowing of the skin or eyes, fainting or hallucinations. Speak to your doctor immediately if you experience any of these side effects, and call 9-1-1 if you are having a medical emergency.
As you can imagine by this list of side effects, high doses of Ativan can be dangerous or even lethal. This danger is significantly enhanced by use of other substances along with Ativan, including alcohol or opioids.
Long term use of Ativan is Dangerous, and Can Lead to Physical Dependence
The American Psychiatric Association recommends that Ativan (lorazepam) and other benzodiazapines be prescribed only on a short term basis. In the United Kingdom (UK), which has stricter guidelines than the United States, it is recommended that prescriptions typically be limited to 2-4 weeks, and to only use it when a person is in intense short-term distress that significantly impairs functioning. So, what is this all about? Why is everyone so concerned?
Ativan and other benzodiazapines are highly addictive. But even if someone doesn’t have the “more, more, more” feeling that often accompanies addiction, it is easy to become physically dependent. This means that the body adjusts to taking in Ativan on a regular basis. So remember that chemical GABA that Ativan tends to enhance, leading to its calming effects? Well, the body knows it’s getting plenty of it with Ativan, so it produces less of its own, trying to bring the brain back down into a state of balance. This means that if, after physically dependent on Ativan, a person stops using it – they will have really intense anxiety. And they may confuse this for the symptom that they started using the Ativan to medicate in the first place. A person will think: “well, I am super anxious, so I must still need that Ativan!” The problem is, they are anxious because of the Ativan – not in spite of it. It is easy to see how this process, with a highly anxious individual, can lead to dependence and addiction even when following a doctor’s orders.
This process can wreak havoc on issues like Panic Disorder. If a person suffers from frequent panic attacks, and takes Ativan each time they panic, their brain eventually learns that the way out of a panic attack is to take Ativan, and inner resources for coping with anxiety are not developed. Now let’s say that the brain has gotten pretty used to getting Ativan. At this point, the brain can start actually creating anxiety and panic in order to get more Ativan.
A person can easily become more and more anxious, and more and more dependent on Ativan. Just like with alcohol, withdrawal can then become dangerous, with side effects as severe as seizures. At this point, withdrawal from Ativan requires medical intervention. Ativan can also cause pregnancy complications, and can increase symptoms of confusion and clouded thinking in patients who are elderly or suffering from dementia. There is also some research that links Ativan and benzodiazepine use to Alzheimer’s – although this topic is still up for debate.
Ativan is addictive. Most people’s Ativan addiction starts out with a prescription, to address stress or anxiety. Many people, however, also start out by taking other people’s medications, or buy them off the street. So how would you know that you are addicted to Ativan? One major sign is physical dependence, meaning that you feel ill or have very high anxiety when you aren’t taking Ativan. According to WebMD, it can take 1-4 weeks of regular Ativan use to become physically dependent – and this can happen to anyone. Other signs of Ativan addiction include:
- Cravings (desire to take Ativan)
- Feeling you need to take more to achieve the same effect
- Feeling you “need” Ativan to cope with stress or anxiety (psychological dependence)
- Feeling highly anxious when you don’t have Ativan on or near you
- Feeling that psychiatrists aren’t meeting your needs by prescribing you enough
- “Doctor shopping” for someone who will give you Ativan when other doctors won’t
- Regularly taking more than prescribed
- Feeling you need “more and more”
- Often feeling “drugged” to the point where it interferes with your life: i.e. competence at work, your ability to be present in parenting, engaging in activities you used to enjoy or spending time with the people you care about
- Loved ones are concerned you are no longer yourself
- Feeling you need Ativan to help withdraw from another substance (i.e. Alcohol)
- Suffering falls/injuries while under the influence
- Legal or other problems, including due to driving under the influence of Ativan
If you have questions about whether you or your loved one is addicted to Ativan, the best thing you can do is talk to a professional who can assess the situation and help you to develop a treatment plan. Often, recovery from an Ativan or benzodiazapine addiction first involves detoxification and withdrawal.
Cross addiction is also common with Ativan. Many people with a history of addiction to alcohol or other drugs – like opioids/opiates, marijuana or Valium – are at increased risk for Ativan and benzodiazepine addiction. It could be said that taking Ativan is similar to having a few drinks, in its effects on the brain and body. The added problem with this is that mixing Ativan with other drugs, especially alcohol, can be dangerous and lead to overdose. Symptoms of an overdose include very slow or hardly detectable heart rate/pulse, slow and/or shallow breathing, confusion or general non-responsiveness. If anyone you know is having symptoms of an overdose, it is a medical emergency. Please call 9-1-1 immediately.
Detox and Withdrawal from Ativan
When addicted to Ativan or other benzodiazapines, people often pass off their withdrawal symptoms as something else. They might think they are just highly anxious, or not feeling well that day. But if you use Ativan habitually and notice the following symptoms when you haven’t yet had your first dose of the day, you likely are experiencing withdrawal. Following are symptoms of withdrawal from Ativan:
- Mood changes: anxiety, depression, irritability, panic
- Digestive issues: nausea, vomiting, diarrhea, abdominal cramping
- Muscle pains and cramps
- Numbness or tingling in the arms and legs
- Increased heartrate
- Heart palpitations (racing heart)
- Increased blood pressure
- Memory and concentration difficulties
- Increased sensitivity to sound and light
- Severe symptoms: fever, hallucinations (seeing/hearing things that aren’t there), and seizures.
If you have any of these severe symptoms please call 9-1-1 or go to the nearest emergency room.
If you are experiencing these symptoms, a medically assisted detox is often necessary. Withdrawal from an Ativan, like withdrawal from other benzodiazapines, is very similar to alcohol withdrawal. Like with alcohol, stopping cold turkey can be dangerous – especially if it leads to side effects like severe dehydration or seizures. A medically assisted detox can make this process safer and more comfortable. For Ativan, a medical taper is usually prescribed. This means that less and less of the drug is given, in stages, so that the brain and body can slowly adjust to being without it. Since Ativan is in the class of medications called benzodiazepines, usually either Ativan or another benzodiazepine (i.e. Librium) will be prescribed. Other medications can be prescribed to target certain symptoms of withdrawal, including Phenergan (Promethazine) for nausea or Catapres (Clonidine) for high blood pressure and heart rate.
Detoxification is never without symptoms, but medical intervention can help it to be less painful. Being in an inpatient or residential detox facility can also help to increase your chances of a successful recovery. Being away from triggers, temptations, and the normal routine that involved Ativan will help a person recovering from an Ativan addiction to stick it through to the end. Keep in mind, however, that after what is called the “acute detox” stage, which can last anywhere from 5-14 days, there is what is called the “post-acute withdrawal” phase (PAWS). The most common symptoms of post-acute withdrawal from Ativan are anxiety and difficulty sleeping. During this time, many people question why they got off of Ativan since they are so anxious! But it is important to keep in mind that this is the Ativan withdrawal, not your innate anxiety, that is talking. Your brain still needs time to re-adjust. Other symptoms can include difficulties with concentration and short term memory, and feeling more emotional in general. Benzodiazapines tend to have some of the longest post-acute withdrawal periods, but most people recovering from an Ativan addiction notice that their anxiety and other symptoms continue to get better week by week. The medically assisted detox will minimize these symptoms, and ongoing medical care can help people recovering from an Ativan addiction to find non-addictive medications for sleep and anxiety.
Recovery from Ativan addiction, like any other addiction, is a process. Detox is the first step. Residential treatment then provides much more than detox. It offers a safe place away from triggers. Residential treatment also offers an opportunity to learn about addiction, to practice coping skills to manage triggers and anxiety, and to explore any personal underlying issues that may have contributed to the development of the addiction in the first place. Doing some of this work in the beginning stages of recovery can really help increase the chances of success. Additionally, treatment programs will typically work with families, provide for exposure to community support groups, and help people recovering from an Ativan addiction to put together a plan to maintain their recovery long term.
If you or a loved one are suffering from an Ativan addiction, AToN’s alcohol and drug rehabilitation program can help. Call and speak to a professional today!