Benzos, as they are often called, are central nervous system depressants that have a sedating and relaxing effect. Unfortunately, tolerance and dependence are not uncommon.
Ativan Withdrawal
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. If you’ve been using Ativan daily for more than a few weeks, you can expect some withdrawal symptoms. Ativan withdrawal is a challenging, uncomfortable experience. Many people take Ativan regularly for years without realizing quite how dependent they have become. You may know the feeling of wanting to take an Ativan when you don’t have one, or of waiting too long in between doses, but withdrawal is a whole different beast.
Signs and Symptoms
Benzos like Ativan were originally intended for short-term use, but long-term use for anxiety and insomnia has become commonplace. Taking Ativan for as little as three to six weeks, even at therapeutic doses, can cause physical dependence and mild withdrawal symptoms. Around 40% of people on benzodiazepines for more than six months will have moderate to severe withdrawal symptoms if they stop taking it abruptly. The other 60% will 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 benzos, your withdrawal symptoms may be more severe. 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. Insomnia can compound the effects of anxiety and it can feel like your sleep patterns will never return to normal. Many people experience bad headaches, hand tremors, and muscle aches. You may find it hard to concentrate or have problems with your memory. In severe cases of high-dose withdrawal, some people experience hallucinations, delirium, and grand mal seizures. Further potential symptoms include:
Anxiety Insomnia Irritability Restlessness Hand tremors Muscle spasms Headache Sweating Racing pulse Hyperventilation Nausea or vomiting Aches and pains Panic attacks Hypersensitivity to stimuli like light and touch Abnormal bodily sensations (skin-crawling, goosebumps) Depression Problems with concentration and memory Visual disturbances (flashes of light or blurred vision) Auditory, tactile, or visual hallucinations Feelings of unreality Delirium Grand mal seizures
Some studies describe acute lorazepam withdrawal is at its worst on the second day and improves by the fourth or fifth day. Other researchers, including the World Health Organization (WHO), have found that acute symptoms last longer, typically between one and four weeks. It has been estimated that anywhere from 10 to 25% of long-term benzo users experience what’s known as protracted withdrawal. Protracted withdrawal involves milder symptoms that come and go for several months. It’s definitely not easy, but it typically resolves on its own within one year.
Coping & Relief
The best way to deal with benzo withdrawal is to abandon any attempt to quit “cold turkey” or all at once. Quitting Ativan takes time and planning. You can avoid the worst of Ativan withdrawal by working with your doctor to taper down your dose. Tapering involves taking progressively smaller doses of Ativan over a period of several weeks or months. Before your tapering begins, your doctor may switch you from Ativan to a longer-acting benzo such as diazepam. A long-acting drug helps stabilize you and make your taper smoother. Once you are stabilized on a lower dose of diazepam, your doctor will reduce your dose by roughly 10 to 20% every week. Your doctor may 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 reduce your withdrawal symptoms, it won’t get rid of them entirely. You may have symptoms each time your dose is reduced. To help you cope with these symptoms, consider the following options:
Cognitive behavioral therapy (research is mixed on the effectiveness of CBT after three months) Meditation Mindfulness Exercise
Warnings
Quitting Ativan cold turkey can be dangerous. While it may feel to you like Ativan is not a very serious drug, especially if you only take it as directed, it has powerful effects on your brain. Some drugs, even serious illicit ones like cocaine, are safe to quit on your own. Benzos are not. However, most people don’t need to undergo inpatient detox. Consulting your primary care doctor or psychiatrist on an outpatient level should be sufficient. Your doctor can monitor your tapering progress through frequent visits and phone calls. If you have a history of complicated withdrawal, seizures, or severe mental illness, you may be better off in an inpatient setting. This can involve living at a detox or rehab facility for several weeks, where you can be monitored for complications.
Psychiatric Symptoms
Ativan withdrawal can coincide with the reemergence of psychiatric symptoms that may have been dormant while you were using the drug. This can include severe anxiety, PTSD symptoms, OCD symptoms, and depression. Inpatient treatment may be required if severe symptoms emerge. The FDA prescribing label for Ativan warns that there are potential risks to taking Ativan during pregnancy, and recommends that the decision to continue or discontinue use is one that each woman has to consider with the help of her doctor. If you are pregnant, talk to your psychiatrist or OBGYN about 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 only safe way to do it.
Long-Term Treatment
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, but others may stretch their taper out for as long as 12 months. Longer tapers are not associated with better outcomes, but they may be more comfortable for some people. 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 abusing Ativan, tapering alone may not be enough to maintain abstinence. Cognitive behavioral and other psychotherapies can help you understand why you feel the need to use or abuse 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 help reset your tolerance level and help you avoid the negative side effects of high doses. Follow Now: Apple Podcasts / Spotify / Google Podcasts
Resources
If you are interested in stopping or reducing your Ativan dose, start by talking with your prescribing doctor. Primary care doctors and psychiatrists are both excellent resources. To make your dose taper easier on yourself, plan to work with a doctor who is conveniently located and easily accessible. You may need to make a number of office visits.
A Word From Verywell
It’s easy for Ativan use to get away from you. Maybe your dose has crept up over the years and you’re having trouble concentrating and remembering things. Maybe you’ve only been using for a few months, but you’re worried that it’s becoming an emotional crutch. Maybe you don’t remember what it’s like to sleep without it. Whatever your reason for quitting Ativan, focus on it as much as you can. Withdrawal can be hard, but everything worth doing is. You’ll thank yourself in the end. For more mental health resources, see our National Helpline Database.
