While lorazepam (brand name Ativan) is a fast-acting and effective medication for the short-term relief of severe anxiety, doctors are increasingly hesitant to prescribe it, particularly for extended periods. This caution stems from a wide range of concerns, including the high potential for dependence and abuse, dangerous withdrawal symptoms, and significant side effects that become more pronounced with prolonged use.
The High Risk of Dependence and Withdrawal
One of the most significant issues with lorazepam is its potential for creating both physical and psychological dependence, even when taken as prescribed. While it is generally considered safe for short-term use (2–4 weeks), taking it for a month or longer significantly increases the risk of dependence. When a person becomes dependent, their body adapts to the drug, leading to tolerance where higher doses are needed to achieve the same effect.
Abruptly stopping or rapidly tapering lorazepam can trigger a severe withdrawal syndrome. This process can be both uncomfortable and dangerous, with symptoms that may last for weeks or even months and can include:
- Rebound anxiety and panic attacks
- Insomnia
- Irritability and mood swings
- Tremors and seizures (in severe cases)
- Hallucinations
- Cognitive issues like memory problems and confusion
The severity and risk of withdrawal are why medical supervision is essential for tapering off lorazepam.
The Dangers of Combined Substance Use
An additional critical concern for doctors is the risk of combining lorazepam with other central nervous system (CNS) depressants. In fact, the FDA has placed a boxed warning on benzodiazepines highlighting the risk of severe sedation, respiratory depression, coma, and even death when combined with opioid medications. Similarly, consuming alcohol while on lorazepam can amplify its effects, leading to excessive drowsiness and impaired breathing. The widespread misuse of benzodiazepines alongside opioids has become a major public health crisis, contributing to overdose deaths.
Significant Side Effects and Vulnerable Populations
Lorazepam's side effect profile is a major reason for its limited use, especially in certain patient populations. The most common side effects are significant and can impact a patient's daily life, including drowsiness, dizziness, and unsteadiness. For older adults, these side effects are particularly dangerous. Elderly patients have a reduced ability to metabolize and clear benzodiazepines from their system, leading to a prolonged and intensified effect. This increases their risk of falls, hip fractures, and other injuries. Long-term use in older adults is also associated with cognitive decline and memory impairment. In some cases, patients may also experience paradoxical reactions, such as increased agitation, anxiety, or aggression.
The Preference for Safer, Long-Term Alternatives
For chronic anxiety management, doctors today prefer prescribing non-addictive alternatives that are effective and safer for long-term use. Unlike lorazepam, which provides immediate, but short-lived, relief, medications like SSRIs and SNRIs work by gradually adjusting neurotransmitter levels over several weeks to provide sustained symptom control without the high risk of dependence. Other options, like buspirone, offer anxiety relief without the sedative effects or addiction potential associated with benzodiazepines.
Comparing Lorazepam to Other Anxiety Treatments
| Feature | Lorazepam (Ativan) | SSRIs (e.g., Lexapro, Zoloft) | Buspirone (BuSpar) |
|---|---|---|---|
| Onset of Action | Fast (30 minutes to 1 hour) | Gradual (2 to 6 weeks) | Gradual (2 to 4 weeks) |
| Long-Term Use | Not recommended (max 2–4 weeks) | First-line treatment for chronic anxiety | Suitable for long-term use |
| Addiction Potential | High potential for physical and psychological dependence | No potential for abuse or dependence | No potential for abuse or dependence |
| Withdrawal | Can cause severe, life-threatening withdrawal | Requires gradual tapering to avoid discontinuation syndrome | Not associated with significant withdrawal |
| Common Side Effects | Drowsiness, dizziness, unsteadiness, confusion | Nausea, fatigue, sexual dysfunction, weight changes | Dizziness, nausea, headache, nervousness |
| Primary Purpose | Acute anxiety, panic attacks, seizures | Chronic anxiety, depression, panic disorders | Generalized anxiety disorder |
The Clinical Challenge of Discontinuation
For patients who have been on lorazepam for an extended period, doctors face the difficult challenge of safely tapering the medication. This requires significant time and effort from both the patient and the physician, and patient resistance is a common obstacle. Some practitioners acknowledge that continuing a stable, long-term prescription can be the “path of least resistance” but that this approach conflicts with best-practice guidelines. The process of tapering is essential to minimize withdrawal effects and requires careful, compassionate management and monitoring. To prevent future dependency issues, increased patient education and vigilant monitoring are critical.
Conclusion
In summary, while lorazepam remains a valuable tool for short-term, acute anxiety relief, the reasons why do doctors not like lorazepam for chronic conditions are plentiful and well-founded. The significant risks of dependence, severe withdrawal, and dangerous side effects—especially for older adults—necessitate a cautious approach. Modern prescribing guidelines emphasize short-term use and prioritize safer, more sustainable alternatives like SSRIs, SNRIs, and buspirone for long-term anxiety management. This shift reflects a move towards patient safety and a more comprehensive approach to treating mental health disorders.
For more information on the risks associated with lorazepam and other benzodiazepines, visit the MedlinePlus Drug Information page.
