Ativan Withdrawal and Supportive Care

Ativan (lorazepam) is a drug in the benzodiazepine class that’s used to treat anxiety, but it has a risk of misuse, abuse, physical dependence, and addiction. Even when used as prescribed, taking Ativan for long periods can build dependence, leading to withdrawal if you stop taking it abruptly.

Find out about Ativan withdrawal symptoms, treatment options, and supportive care during benzodiazepine withdrawal.

What Is Ativan?

Lorazepam, or the brand Ativan, is a benzodiazepine medication that’s used to treat anxiety disorders and anxiety symptoms.[1] Like other drugs in the benzodiazepine class, Ativan influences the effects of the neurotransmitter gamma-aminobutyric acid (GABA) and acts on the central nervous system (CNS) to produce feelings of calm and relaxation.

Besides treating anxiety, Ativan has other uses including helping the symptoms of alcohol withdrawal from alcohol use disorder (alcohol addiction) and treating nausea and vomiting from cancer treatment.

Ativan Withdrawal

Ativan is intended for short-term use because of its dependence risks. With regular use, your body adjusts to the presence of Ativan and relies on it to function. If you stop taking it suddenly or drastically reduce your dose, withdrawal symptoms occur.

Withdrawal from a benzodiazepine like Ativan can have serious symptoms, including some that are potentially dangerous or fatal, like seizures.

Ativan has a half-life of 10-12 hours on average. Withdrawal symptoms often occur within 24 hours after the last dose and typically last 3 to 4 days.[2] Acute withdrawal may have rebound symptoms like increased anxiety, high blood pressure, trouble sleeping, and an increased heart rate. Some other symptoms include:[3]

• Headache
• Tremors
• Sweating
• Difficulty concentrating
• Rapid heart rate
• Heart palpitations
• Irritability
• Mood swings
• Panic attack
• Seizures

Ativan withdrawal rebound symptoms involve a temporary return of the symptoms the drug is intended to treat, such as anxiety or insomnia, and often worse. Rebound anxiety or insomnia may happen about 2 or 3 days after the acute withdrawal phase of detox. There’s a risk of relapse during rebound symptoms to relieve the symptoms.

The protracted withdrawal syndrome occurs after the acute phase and typically lasts 10 to 14 days.[4] If you use high doses of Ativan, however, protracted withdrawal can last much longer. Some of the symptoms include nausea, anxiety, intense cravings, headache, vomiting, and feeling ill. Protracted withdrawal is also known as post-acute withdrawal syndrome (PAWS).

How Long Does Ativan Rebound Anxiety Last?

Rebound anxiety is one of the most common psychological symptoms people notice during Ativan withdrawal. It happens when anxiety symptoms return after reducing or stopping Ativan, often feeling stronger than they did before treatment. For someone who was prescribed Ativan for anxiety disorders or panic disorders, this can be confusing and frightening.

Rebound symptoms can begin within the first few days after the last dose, especially because Ativan, also called lorazepam, is a shorter-acting benzodiazepine compared with longer-acting benzodiazepines. A review of benzodiazepine withdrawal describes rebound anxiety and insomnia as a short-lived pattern that can begin within 1 to 4 days after stopping, depending on the half-life of the particular drug.[5]

For many people, rebound anxiety improves as the acute withdrawal phase settles. However, the exact timeline varies. Some people feel more stable within several days, while others have anxiety, panic attacks, sleep disturbances, mood swings, difficulty concentrating, or physical symptoms for weeks. In some cases, ongoing symptoms may become part of post acute withdrawal syndrome, also called protracted withdrawal syndrome.

Rebound anxiety may last longer or feel more severe when risk factors are present, such as high doses, long-term Ativan use, abrupt cessation, misuse, co-occurring mental health conditions, other drugs, or a history of substance use disorder. Because severe anxiety can increase relapse risk, a taper plan should be created with medical supervision rather than attempting to quit Ativan suddenly.

Ativan Withdrawal Timeline at a Glance

This table gives a general overview. It should not be used as a personal detox plan.

Factors that Affect Withdrawal Symptoms

The intensity of withdrawal symptoms and their duration can depend on different factors.[6] They include:

• The type of substance
• How long the substance has been in use
• Patient’s age
• Overall physical health
• Mental and emotional state
• Type of withdrawal process

How Is Ativan Withdrawal Treated?

If you want to stop taking Ativan, it’s important not to do it yourself. If you stop taking Ativan suddenly, benzodiazepine withdrawal and severe symptoms can occur. Your doctor can give you a taper schedule to gradually reduce the Ativan dosage to reduce the severity of withdrawal symptoms and complications.

Medical detox is often the first step to ensure your health is monitored during withdrawal. Along with your doctor’s taper schedule, you will have a 24/7medical team to address withdrawal symptoms and prevent complications while the drug clears your system.

Though Ativan is generally safe when taken as prescribed, addiction is possible. Withdrawal can be managed with medical detox, but it’s not enough to treat addiction on its own. You may need a comprehensive addiction treatment program on an inpatient or outpatient basis to address the underlying causes of addiction. Treatment is individualized but may include individual counseling, group therapy, and behavioral therapies like cognitive behavioral therapy.

Medications for Ativan Withdrawal

Like other benzodiazepine withdrawal, Ativan withdrawal may be managed with medications. Melatonin, a hormone that induces sleep, may be used for insomnia symptoms that are common with withdrawal.[7] The antidepressant Paxil (paroxetine) can ease other withdrawal symptoms, such as psychological symptoms.[8]

While these medications can help with specific symptoms, there are no medications that are used just for benzodiazepine withdrawal. Medications used in medical detox can be used to help with severe symptoms like anxiety or insomnia. Adjusting the taper schedule can be effective in reducing the severity of symptoms.[9]

Seek Help for Ativan Addiction

Ativan can help treat anxiety, but it carries a risk of dependence and addiction. If you’ve been taking Ativan for a long time, don’t try to quit on your own. Ask your doctor how you can stop taking Ativan safely. If you misuse or abuse Ativan on its own or with other drugs, medical detox with an addiction treatment program may be the best choice for Ativan withdrawal and supportive care.