Ativan (lorazepam) is a benzodiazepine that is commonly prescribed as an anti-anxiety medication. Dependency and addiction are frequently associated with short-term Ativan use, and withdrawal symptoms may be experienced after even a few weeks of use as directed. Misuse of Ativan can cause serious addiction issues and profoundly uncomfortable, even dangerous, withdrawal symptoms. Ativan detox and withdrawal are best addressed in a multidisciplinary drug rehabilitation center that can facilitate a medically assisted detox.
What Causes Ativan Withdrawal?
Drug tolerance refers to the need for increased doses to achieve the same effect over time. Ativan users rapidly develop tolerance, which is why the drug should never be prescribed (or used) for more than a few months. Ativan dependency and addiction develop as tolerance grows. Mechanistically, Ativan acts on gamma aminobutyric acid (GABA) receptors in the brain. GABA receptors are a major class of inhibitory neurotransmitter receptors. When Ativan activates these inhibitory receptors, the result is inhibition of action within the brain. This result is why Ativan is so successful as an anti-seizure medication and why Ativan can reduce anxiety and panic attacks.
GABA inhibition also affects the regulation of dopamine (which controls the “reward circuit”), although the precise mechanism is still an area of study. Activation of the reward circuit is why people struggling with addiction feel euphoric when they take their drug of choice.
Ativan withdrawal is caused when a user reduces or stops taking the drug. The immediate effects of reduced or eliminated Ativan include increased activity in neurons that have GABA receptors. Because GABA dampens neuronal excitability, the net effect of less GABA is more neuronal excitability. Less Ativan leads to more neuronal excitability, which leads to anxiety, restlessness, and insomnia. In extreme cases, seizures and death can occur.
Ativan Withdrawal Symptoms
Once detox is over, Ativan withdrawal generally has two stages: Acute and protracted. Acute symptoms typically last for approximately two to four weeks. Protracted symptoms can persist for months, even years. Symptom duration reflects the length and amount of use.
- Physical Withdrawal Symptoms
Because Ativan withdrawal is associated with increased brain activity, acute withdrawal symptoms are frequently heart palpitations, tremors, numbness, tingling in extremities, muscle aches, cramps, dizziness, hypertension, nausea, vomiting, and loss of appetite. In extreme cases, people in acute withdrawal may have seizures.
- Psychological Withdrawal Symptoms
Psychological withdrawal symptoms include anxiety, panic, paranoia, restlessness, confusion, anhedonia, and depression. Ativan withdrawal has been linked to suicidal ideation or attempts to self-harm.
- Symptoms of Post Acute Withdrawal Syndrome (PAWS)
Many people believe that once the drug is out of their system, their addiction symptoms should be over. Unfortunately, post-acute withdrawal syndrome (PAWS) affects recovery for many people. PAWS symptomology generally has similar physical and psychological effects as acute withdrawal, although the degree to which these symptoms are experienced tends to fluctuate over time. It is important to understand that PAWS can involve cravings and temptation to resume drug use for months, even years after quitting. These uncomfortable physical and psychological symptoms subside as time goes on.
- Protracted Withdrawal Symptoms
PAWS and protracted withdrawal are synonyms. Protracted withdrawal is defined as, “…the presence of substance-specific signs and symptoms common to acute withdrawal but persisting beyond the generally expected acute withdrawal timeframes,” by the Substance Abuse and Mental Health Services Administration.
- How Long Do Ativan Withdrawal Symptoms Last?
The duration of Ativan withdrawal symptoms varies depending on the duration and amount of Ativan use. For moderate, short-term users, Ativan withdrawal may be over within a week or two. However, many people in recovery from Ativan use disorder struggle with withdrawal symptoms for months, even years.
Can Ativan Withdrawal Kill You?
Benzodiazepine withdrawal (including Ativan) can be lethal. When an Ativan user stops using the drug “cold-turkey,” significant changes in brain chemistry rapidly occur. For individuals who used Ativan for a long time, suddenly depriving the brain of the drug can cause a hyperexcitable state, leading to elevated temperatures, hypertension, seizures and death.
A different type of risk associated with Ativan withdrawal can be suicidal tendencies. A recent meta-analysis of 17 studies found that benzodiazepines (including Ativan) are associated with an increased risk of attempting or completing suicide.
It is strongly recommended that anyone who developed Ativan addiction undergo detox and withdrawal in a rehab facility that is equipped to deal with potential medical complications. Medical consultation before quitting can provide a scheduled taper that can increase the likelihood of safe, successful withdrawal and rehab.
Ativan Withdrawal Timeline
For who used Ativan lightly, acute withdrawal symptoms last for several days to about one week. Prolonged symptoms can persist for another two weeks or more. For moderate to heavy Ativan users, acute symptoms generally occur over the course of two weeks to a month or more. Prolonged symptoms (PAWS) can last for months, even years.
The withdrawal timeline is only partly related to how long Ativan stays in your system; the half-life of Ativan is relatively short (12 to 18 hours), so even heavy users will metabolize Ativan within a few days. Ativan use causes substantial chemical changes in the brain that underlie persistent withdrawal symptoms.
Undergoing Ativan detox and withdrawal is at best uncomfortable and can be incredibly debilitating physically and mentally. To reduce symptoms and maximize successful outcomes, Ativan is generally tapered to prevent overwhelming acute symptoms. For long-term users, tapering may be essential for preventing potentially lethal symptoms. Pharmacological intervention is generally not considered to be significantly beneficial in the treatment of Ativan withdrawal.
Ativan detox is best conducted under the supervision of medical professionals in a quality rehab facility. In some cases, medically assisted detox may be appropriate. Medical detox often includes a tapering program or supplementation with other benzodiazepines that have longer half-lives than Ativan.
- What to Take for Ativan Withdrawal? It is important to understand that Ativan detox and withdrawal should be done under the care of medical professionals. There are no over-the-counter remedies for Ativan withdrawal symptoms.
- Alternative Treatments for Ativan Withdrawal. In some cases, benzodiazepines with longer half-lives than Ativan can be helpful for someone going through withdrawal. All benzodiazepines require a prescription and should only be used as directed. There are no medically approved alternative treatments for Ativan withdrawal. Although some anecdotal reports may suggest that there are herbal remedies or supplements that can provide shortcuts, these reports have not been proven.
Clients with mild dependency issues are potential candidates for outpatient detox. The first step in any detox program is to undergo an initial evaluation with a medical professional who will generally prescribe an Ativan taper. The goals of the evaluation are to ensure that the client has a solid understanding of what to expect as they undergo detox and withdrawal, and to identify goals for immediate and long term recovery. The client should also feel confident that they can contact the rehab facility at any time if they encounter unexpected challenges or complications.
Detoxing at Home
Ativan detox at home is possible but is not recommended. Ativan detox and withdrawal are medically complicated and involve substantial changes in brain chemistry. Physical and psychological symptoms can be overwhelming, and people who attempt to quit using Ativan on their own can face very serious complications that reduce the likelihood of a successful outcome.
- Withdrawal While Stopping Cold Turkey. Quitting Ativan cold turkey is never recommended. Heavy Ativan users who quit cold turkey face serious, potentially fatal complications as they undergo detox and withdrawal.
- How to Wean Off Ativan. The most effective way to quit using Ativan is to gradually wean off of the drug (i.e., taper the drug use). This method is best accomplished after establishing a tapering schedule with a medical professional who understands the withdrawal process and how to best manage the symptoms. Tapering rates should be tailored to the individual.
Finding a Detox Center
All detox centers are not alike. Several factors should be considered when making the decision on which center to go to.
- Location: In many cases, the closest detox center may not be the most effective.
- Cost: Rehab can be expensive, but many insurance programs (including Medicaid) can help defray some or all of the cost.
- Effectiveness: Many rehab centers provide statistics on their success rates and endorsements from satisfied clients.
- Accreditation: Accreditation through The Joint Commission (jointcommission.org) or CARF International (carf.org) guarantees a certain standard of care.
- Dual diagnosis: Many substance use disorders are associated with underlying mental health issues or traumas. Multidisciplinary rehab centers that can evaluate whether a dual diagnosis is appropriate frequently offer the most effective treatment programs
- Staff-to-Patient Ratio: Inpatient facilities should have low staff-to-patient ratios
Key Points: Understanding Ativan Withdrawal
Keep the following key points in mind when considering Ativan withdrawal:
- Detox and withdrawal can be incredibly debilitating, physically and psychologically
- Physical symptoms of Ativan withdrawal can be lethal. It is imperative that detox and withdrawal be done only after a medical consultation and under the supervision of medical professionals.
- Even though Ativan has a short half-life, withdrawal symptoms can last for months, even years
- Ativan should be gradually tapered and not quit cold turkey
If you struggle with Ativan addiction, help is available. Contact The Recovery Village Palm Beach at Baptist Health to speak with a representative about how addiction treatment can address a substance use disorder alongside any co-occurring mental health disorders. You deserve a healthier future, call today.
Tan, Kelly; Rudolph, Uwe; Luscher, C. “Hooked on benzodiazepines: GABAA receptor subtypes and addiction.” Trends in Neuroscience, May 2014. Accessed July 27, 2019.
Ashton, Heather. “Protracted Withdrawal Symptoms from Benzodiazepines.” Comprehensive Handbook of Drug & Alcohol Addiction, 2004. Accessed July 27, 2019.
Substance Abuse and Mental Health Services Administration. “Protracted Withdrawal: Substance Abuse Treatment Advisory.” July 2010. Accessed July 27, 2019.
Lann, Meredith; Molina, D.K. “A Fatal Case of Benzodiazepine Withdrawal.” The American Journal of Forensic Medicine and Pathology, June 2009. Accessed July 27, 2019.
Dodds, Tyler J. “Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature.” The Primary Care Companion for CNS Disorders, 2017. Accessed July 27, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.