Ativan Withdrawal: Symptoms, Timeline, and Treatment

Ativan (lorazepam) is a prescription drug used to treat anxiety disorders, seizures, and insomnia. As a benzodiazepine, discontinuing Ativan use can result in withdrawal symptoms such as headache, heart palpitations, sweating, muscle pain and stiffness, and more.

If you’re concerned about Ativan withdrawal, here’s what you need to know about its signs and symptoms, warnings, and long-term treatment. We also share ways to cope with Ativan withdrawal symptoms, providing some relief.

About Ativan Dependence

Ativan belongs to a class of drugs called benzodiazepines. Benzodiazepines are central nervous system depressants that have a sedating and relaxing effect. These medications can also lead to tolerance and dependence, even when taken at therapeutic doses.

Ativan is one of the most widely prescribed benzodiazepines. In 2017, doctors wrote almost 26.5 million prescriptions for Ativan alone. As of 2018, an estimated 5.4 million people over the age of 12 misused prescription benzodiazepines like Ativan. Ativan can lead to dependence even if you take it exactly as prescribed.

Many people take Ativan regularly for years without realizing how dependent they have become. It is only when withdrawal symptoms emerge after they try to stop taking the medication that this dependence becomes clear.

Overview of Ativan Withdrawal

Benzodiazepines like Ativan were originally intended for short-term use, but their long-term use for anxiety and insomnia has become more commonplace. The issue is that taking Ativan for as little as three to six weeks, even at therapeutic doses, can cause physical dependence and mild withdrawal symptoms.

Ativan withdrawal can be a challenging, uncomfortable experience. Around 40% of people on benzodiazepines for more than six months have moderate to severe withdrawal symptoms if they stop taking the drug abruptly. The other 60% have mild symptoms.

The severity of withdrawal symptoms is also associated with your current dose. If you are on a high dose of Ativan or if you mix Ativan with other benzodiazepines, your withdrawal symptoms may be more severe.

Ativan Withdrawal Timeline

When your daily dose of Ativan is suddenly stopped or significantly reduced, withdrawal symptoms can appear in as little as eight to 12 hours. Acute symptoms or lorazepam withdrawal typically last between one and four weeks.

Research indicates that the severity and duration of withdrawal symptoms depend on the medication’s half-life, how long it was taken, and the daily dose used. Although, you can expect to feel extremely anxious and irritable for several weeks.

The anxiety you feel during Ativan withdrawal will probably be worse than the level of anxiety you were experiencing before you started taking it, a phenomenon known as the rebound effect. Insomnia can compound the effects of anxiety and it can feel like your sleep patterns will never return to normal.

Signs and Symptoms of Ativan Withdrawal

Some of the most common benzodiazepine withdrawal symptoms include:

• Anxiety or panic attacks
• Cognitive issues (trouble with memory or concentration)
• Confusion
• Depression
• Dizziness or unsteadiness
• Gastrointestinal issues (nausea, diarrhea)
• Headache
• Heart palpitations
• Irritability
• Increased sweating
• Muscle pain and stiffness
• Nightmares
• Tremors
• Vision issues or ringing of the ears

In severe cases of high-dose withdrawal, some people experience serious side effects such as hallucinations, delirium, and grand mal seizures. 

Coping and Relief for Ativan Withdrawal

The best way to deal with benzodiazepine withdrawal is to taper your medication slowly under the supervision of a physician instead of trying to quit “cold turkey.” You can avoid the worst of Ativan withdrawal by working with your care provider to taper your dose, taking progressively smaller amounts of Ativan over several weeks or months.

Quitting Ativan takes time and planning. Before tapering begins, your physician may switch you to a longer-acting benzodiazepine such as diazepam. A long-acting drug helps stabilize you and can make your taper go more smoothly.

Once you are stabilized on a lower dose of diazepam, your physician may reduce your dose by roughly 10 to 20% every week. They might also prescribe small amounts of the medication at a time to prevent you from taking more than you should.

If you have been using Ativan for longer than six months, tapering is the only safe way to stop taking the drug. While tapering will help reduce your withdrawal symptoms, it won’t get rid of them entirely. You may still have symptoms each time your dose is reduced.

To help you cope with these symptoms, consider the following options:

Warnings About Ativan Withdrawal

Quitting Ativan cold turkey can be dangerous. While it may not feel like a serious drug, especially if you only take it as directed, it has powerful effects on your brain.

However, most people don’t need to undergo inpatient detoxification. Instead, consulting with your primary care physician or psychiatrist on an outpatient level is often sufficient. Your physician can monitor your tapering progress through frequent visits and phone calls.

An inpatient setting may be a better approach if you have a history of complicated withdrawal, seizures, or severe mental illness. This can involve living at a detoxification or rehabilitation facility for several weeks, where you can be monitored for complications.

Return of Psychiatric Symptoms

Ativan withdrawal can coincide with the re-emergence of psychiatric symptoms that may have been dormant while you were using the drug. This can include symptoms associated with severe anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and clinical depression.

Inpatient treatment may be required if severe psychiatric symptoms begin to return. Talk to your psychiatrist or psychologist about helping you work with your insurance company to get treatment. If you are uninsured, certain inpatient facilities may still be an option.

Pregnancy

The FDA prescribing label for Ativan warns that there are potential risks to taking Ativan during pregnancy. As a result, it is recommended that the decision to continue or discontinue its use be made with the help of a medical professional.

If you are pregnant, talk to your psychiatrist or obstetrician about both the risks of continuing the drug and the risks of quitting while pregnant. If you do want to quit while pregnant, a medically supervised taper is the safest way to do so.

Long-Term Treatment for Ativan Withdrawal

Ativan withdrawal can feel long and arduous because it tends to come and go during the course of your taper. Some people finish tapering their dose within three to four weeks, while others may stretch their taper out for as long as 12 months.

Longer tapers are not associated with better outcomes but may be more comfortable for some people. Either way, it is very important to complete your taper without reversing direction. An Ativan taper should move continuously forward with decreasing doses.

For those who have been misusing Ativan, tapering alone may not be enough to maintain abstinence. Cognitive behavioral therapy and other psychotherapies can help you understand why you feel the need to use Ativan and can help you make healthier decisions.

If total abstinence is causing psychological distress, some people may aim for a reduced dose. Tapering toward a reduced dose can reset your tolerance level and help you avoid the negative side effects of high doses.

Before Stopping Ativan Use

If you are interested in stopping or reducing your Ativan dose, start by talking with the prescribing physician. Primary care providers and psychiatrists are both excellent resources.

To make your dose taper easier on yourself, plan to work with a healthcare provider who is conveniently located and easily accessible. The reason for this is that you may need to make a number of office visits when discontinuing Ativan use.