Available generically as lorazepam, Ativan® is a short-acting benzodiazepine used primarily to treat anxiety and anxiety-related disorders. It can be administered by mouth (PO), sublingually (SL), intramuscularly (IM) or intravenously (IV). This medication is considered short acting as it is eliminated fairly quickly from the body with a half-life averaging 15 hours and no active metabolites that might enhance and lengthen a sedative effect. Ativan® withdrawal symptoms can therefore actually develop sooner than with longer-acting benzodiazepines, sometimes even before a patient's next prescribed dose is due. Benzodiazepines share numerous common withdrawal symptoms that include insomnia and restlessness; however, Ativan® is particularly well known for its rebound anxiety — where the patient's anxiety returns with stronger and more disturbing symptoms than the original condition that first necessitated the prescription.
Ativan® withdrawal symptoms are diverse and involve all body systems, particularly those associated with the GABA neurotransmitter system in the brain. The most common Ativan® withdrawal symptoms will therefore include insomnia, restlessness, nervousness and racing thoughts — precisely those symptoms that often led to a diagnosis of anxiety and treatment with this medication. Relaxation in any form is difficult and the patient may express this inability by grinding his teeth, and by developing tics, muscle spasms, or a racing pulse. Motor symptoms may be present in the form of clumsiness, uncoordinated movements and impaired balance. These observable symptoms may also be accompanied by distortions in the patient's perception of his body in space or the connection of his limbs to his body.
A tendency toward hyperexcitability can extend to the neurological system and for some patients Ativan® withdrawal symptoms may include seizures and delirium. Significant amnesia has been reported. Suicidal thoughts and an abrupt worsening of depression are not unheard of. For these reasons, abrupt discontinuation of any benzodiazepine, including Ativan®, is never recommended. Attending physicians often use a slow taper program wherein the patient gradually reduces his daily dose of the medication over many weeks.
Whether a patient will experience Ativan® withdrawal symptoms depends upon his age, usual dosage and, in particular, the length of time he has been regularly using the medication. Clinical studies and medication information sites provide varying estimates as to the length of time a patient need take the medication before becoming physiologically and psychologically dependent on it. Four months of regular use is the most frequently cited period after which withdrawal symptoms can be expected with discontinuance of the medication. Another research paper estimates that between 25 and 50 percent of patients on Ativan® for three to four years can expect significant Ativan® withdrawal symptoms. The length of time that the Ativan® withdrawal symptoms will persist ranges from weeks to up to a year and depends upon the length of action of the benzodiazepine and the length of regular use of the medication.