Lorazepam: Understanding Risks, Dependence, and Alternatives for anxiety

Lorazepam, a benzodiazepine, is prescribed for anxiety, panic attacks, and insomnia related to stress.While effective, it carries risks that warrant careful consideration and exploration of alternative treatments.

When Benzodiazepines Are Considered

dr. Leigh, FACOI, an internal medicine specialist, notes that benzodiazepines may be appropriate in specific cases, such as “with anxiety experienced by cancer patients and hospice or palliative care patients.” However, due to the potential for severe side effects, including dependence, SSRIs are often the first choice for generalized anxiety disorder.

The Role of Therapy in Managing Anxiety

Therapy offers practical techniques to manage anxiety symptoms. Merrill explains therapy “can also benefit people by teaching them to notice internal physiological sensations such as racing heartbeat, shortness of breath, numbness and tingling.” Recognizing these sensations as a normal part of the body’s stress response can prevent them from escalating into full-blown panic attacks.

Merrill suggests that individuals can learn to manage these sensations through techniques such as deep breathing or taking a break. While some can manage anxiety with therapy alone, “with more severe cases of anxiety, we see the best outcomes with a combination of meds and therapy, at least over the short-term,” Merrill states. In some instances, patients can “taper off the medications when their anxiety is under better control.”

Potential Side effects of Lorazepam

When used as prescribed, lorazepam can cause several side effects, including:

• Drowsiness
• Dizziness
• Tiredness
• Weakness
• Unsteadiness
• Nausea
• Diarrhea or constipation
• Appetite changes
• Restlessness
• Blurred vision
• Changes in sex drive or ability

Combining lorazepam with opioid medications like codeine, oxycodone, and tramadol can lead to “more serious problems, such as life threatening breathing problems, sedation, or coma.” These risks are also heightened by drinking alcohol or using certain illegal drugs.

The Risk of Dependence and Addiction

While “benzodiazepines are generally safe when used as directed,” Merrill cautions, “but they have the potential to be habit forming, so you can become physiologically or psychologically dependent on them.” Individuals with a history of alcohol dependence or substance abuse should exercise caution. According to Leigh, “Because lorazepam is short-acting, its onset is faster, making addiction more likely.” The abrupt nature of withdrawals also poses a challenge.

Stopping lorazepam suddenly after dependence can result in “withdrawal symptoms can lead to seizures,altered [thoughts],and can be fatal,” according to Leigh. A gradual tapering of the dosage under medical supervision is essential to avoid these severe effects.

Recognizing lorazepam Dependence and Withdrawal

Even when taken as directed, lorazepam can cause physical dependence and withdrawal symptoms. The severity depends on dosage, duration of use, and other medications. Withdrawal symptoms may include:

• Agitation
• Poor memory
• Insomnia
• Anxiety
• Panic attacks
• Irritability
• Headache
• Muscle fatigue
• Weakness
• Tremor
• Seizures

Merrill identifies additional signs of dependence, such as needing to refill prescriptions early, using the drug in higher amounts, using someone else’s pills, using it with alcohol, and neglecting responsibilities.

If dependence or withdrawal symptoms occur, consult a doctor about tapering the dose gradually to safely discontinue the drug.

Non-Medication Options for Anxiety Relief

Alternative approaches to managing anxiety focus on understanding the nervous system’s role in the body’s stress response. Armstrong, based near Washington, D.C., explains that symptoms “make sense when put into the context of basic biological needs, your past trauma history, and how that gets stored in your body.” Anxiety symptoms are framed as a survival response rooted in personal experiences.

Other factors contributing to anxiety include sleep deprivation, stress, excessive caffeine, micronutrient deficiencies, and lack of social connection.

Armstrong utilizes two types of tools:

1. In-the-moment tools: These include visual orienting, biting into a lemon, and specific breathing exercises. These techniques aim to shift the autonomic nervous system away from the “fight or flight” response towards a state of calm and connection.
2. Long-term tools: These address factors contributing to anxiety, such as past trauma, current life stressors, lifestyle habits, relationships, micronutrient deficiencies, and health conditions.by identifying these factors, clients can take meaningful steps to manage their anxiety proactively.

Armstrong emphasizes education and empowerment, offering clients tools to manage anxiety, which “gives you an entire new framework for understanding yourself, and navigating your world and your symptoms in a way that is not associated with brokenness.” This approach fosters compassion and curiosity, perhaps enhancing the effectiveness of therapy.

Lorazepam in Popular Culture and Clinical Reality

The HBO series “The White Lotus” portrays characters using lorazepam casually. While studies show that lorazepam and similar benzodiazepines are effective for managing anxiety symptoms, SSRIs are often preferred due to a lower risk of severe side effects.

Lorazepam poses a risk of dependence and misuse, which can be life-threatening when combined with opioid pain relievers, alcohol, or certain illicit drugs.

Conclusion

Lorazepam can be a valuable tool for managing anxiety in specific situations, but it’s essential to understand the potential risks, including dependence and severe side effects. Exploring alternative treatments, such as therapy and lifestyle modifications, alongside medical guidance, can lead to safer, more enduring relief. If you are concerned about your anxiety or lorazepam use, consult a healthcare professional to discuss the best course of action for your individual needs.