Ativan Withdrawal: Timeline, Side Effects, Detox

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Ativan is the brand name for a drug called lorazepam. Lorazepam is in a class of drugs called benzodiazepines, which are central nervous system depressants that work on the brain’s main rest-and-relax chemical called gamma-Aminobutyric acid (GABA). 

Ativan is used to treat anxiety disorders, which can be caused by an overactive nervous system. Benzodiazepines like Ativan are also used to treat insomnia, especially if a person’s condition is related to anxiety. Ativan, and other benzodiazepines, are useful medications for people who struggle with very common anxiety and sleep issues, but the drug can also cause uncomfortable and even dangerous withdrawal symptoms. 

Will You Experience Ativan Withdrawal?

Withdrawal occurs when you stop taking a drug after becoming chemically dependent on it. Chemical dependence is caused by the consistent use of a drug, especially when it’s used in high doses. Your brain and body adapt to the presence of the foreign substance. To balance brain chemistry your body might start producing more excitatory chemicals to counteract Ativan. When you stop using, your brain chemistry is temporarily thrown out of balance. While you readapt to life without the drug, you’ll experience uncomfortable withdrawal symptoms. 

Ativan dependence can develop after using the drug consistently for several weeks in a row. Generally, doctors prescribe Ativan for short-term therapeutic use. Dependence can develop after three to six weeks of consistent use. Symptoms of dependence can include:

  • Needing the drug in higher doses
  • Growing tolerance
  • Jitters when you try to quit
  • Trying and failing to cut back
  • Drug cravings
  • Needing to take Ativan more often

Dependence and addiction may be more likely if you misuse the drug recreationally or take it in very high doses. Benzodiazepines may also be riskier for people over the age of 65. Older adults may not be able to process Ativan efficiently, causing a higher risk of side effects like drowsiness and dependence. 

withdrawal-from-ativan

What Are the Symptoms of Ativan Withdrawal?

As a depressant, Ativan often causes withdrawal symptoms that are related to a sudden lack of calming chemicals in your nervous system. You may feel overstimulated both mentally and physically. The most common withdrawal effects you might experience when you quit a benzodiazepine are related to rebounding. Rebounding refers to the return of symptoms that a drug was intended to alleviate. 

Ativan is used to treat anxiety disorders, so rebounding symptoms may cause anxiety, panic, racing thoughts, irritability, and insomnia. Ativan withdrawal can also cause some uncomfortable physical symptoms, including headaches, sweating, heart palpitations, muscle spasms, and shaky hands. 

If you experience severe withdrawal, you might have a tonic-clonic seizure. Seizures that are caused by depressant withdrawal are similar to the kind you might experience if you have epilepsy. It’s also possible to experience a life-threatening condition called delirium tremens that can cause seizures and heart-related complications. Delirium tremens is more commonly associated with alcohol, but benzodiazepines like Ativan also have the potential for these dangerous symptoms.

When Will Symptoms Show Up?

Your experience with withdrawal can depend on several factors, including the time you spent using the drug and the size of the dose you were used to. Ativan’s effects may start to wear off between 12 and 24 hours, though they may last longer if you took an extended-release pill. Usually, you’ll start to experience withdrawal symptoms within three days without the drug. Withdrawal symptoms may start mild and become more intense over time. If you’re used to a very high dose and quit cold turkey, you may experience more severe symptoms more quickly. 

How Long Does Withdrawal Last?


Ativan withdrawal symptoms are likely to peak sometime within the first week after your last dose. Peak symptoms are when the withdrawal is at its most intense. Seizures and other dangerous symptoms can happen at any time during the acute withdrawal phase, but they’re more likely around peak symptoms. 

After your symptoms reach their peak, you’ll start to feel better. The acute withdrawal phase can last between 10 days and two weeks. However, some symptoms can linger. Psychological issues like depression and anxiety can last for months unless they’re addressed in treatment. If you were taking Ativan to treat anxiety and it returns when you quit, you may need to explore other treatment options.

Is Ativan Withdrawal Dangerous?

Ativan is a benzodiazepine and a central nervous system depressant. Depressants are one of the most dangerous substances during their withdrawal phase. Since Ativan suppresses activity in the nervous system, your brain may increase excitatory chemicals to achieve a chemical balance. 

When you stop using, the depressing effects are suddenly removed, leading to overexcitement in the nervous system. This can cause common symptoms like insomnia and anxiety, but it can also cause more severe symptoms like seizures. Seizures can be dangerous, especially if you experience them while you’re standing. Seizures can come on suddenly, leading to injuries.

Depressants like Ativan can also cause a serious condition during withdrawal called delirium tremens. Delirium tremens is a set of symptoms that come on suddenly, including panic, extreme confusion, seizures, sweating, heart palpitations, hallucinations, shivering, and chest pains. 

In some cases, the condition can limit the oxygen that reaches your brain, leading to strokes. An increased heart rate and heart palpitations can cause a stroke or heart attack that can be fatal. Not everyone that goes through a depressant withdrawal period will experience life-threatening delirium tremens, but it can happen with very little warning.

Ativan withdrawal may be more severe if you take the drug for a long time in high doses. Your dependence may be even more intense if you mix alcohol with your prescription. Quitting suddenly can also contribute to more severe withdrawal symptoms. Tapering off Ativan gradually may be safer, but it’s challenging to do on your own successfully. Instead, your doctor may be able to help.

How Is Ativan Withdrawal Treated?

Since Ativan withdrawal can be potentially dangerous, it’s important to speak to a doctor before attempting to quit cold turkey. When you talk to a doctor or enter an addiction treatment program, they can help evaluate your needs in treatment. If you have only used Ativan for a few weeks and you’ve developed a mild dependence on the drug, your doctor may help taper you off with prescription depressants. Your doctor may even give you another benzodiazepine or depressant for the tapering process. 

If you’re likely to experience uncomfortable or dangerous Ativan withdrawal symptoms, you may need to go through a medical detox program. Medical detox is a high level of care in addiction treatment that involves 24-hour treatment from medical professionals. 

Detox is an inpatient program that’s managed by doctors, nurses, and other medical professionals. Through detox, you may be treated with medications to help taper you off Ativan or manage uncomfortable symptoms, such as insomnia. You may also attend therapy sessions with clinicians to address other psychological or social issues that often come with substance use disorders. 

The goal of medical detox is to keep you safe by avoiding or addressing any complications that may be caused by withdrawal. However, detox will also help alleviate some of the discomforts that can come with withdrawal symptoms. You’ll also start to address some of the deeper issues that may contribute to your substance use disorder like mental health issues or unresolved trauma. Medical detox typically lasts for five to 10 days, but it will ultimately depend on your process and needs.

What Happens After Ativan Detox?

After you complete detox, or if your doctor determines you don’t need medical detox, you may move on to the next level of care in addiction treatment. When you go through an assessment process with doctors and clinicians, they may use the ASAM Criteria to determine the next step in your treatment process. 

The criteria is a set of factors that are important to address in treatment, including your withdrawal potential, medical complications, psychological issues, relapse potential, and your living situation. Medical detox can help you achieve sobriety, but it’s usually not enough to lead to lasting recovery. If any of these issues are left unaddressed, it could lead to a relapse. 

If you have a severe substance use disorder related to Ativan or other drugs, you may need to continue in an inpatient program. Inpatient treatment after detox can involve 24-hour medically monitored or clinically managed treatment. When you can live on your own safely, you may move on to outpatient treatment. Intensive outpatient treatment involves more than nine hours of treatment services each week. 

If you have high-level needs, you may go through a partial hospitalization program with more than 20 hours of treatment each week. As you progress, the intensiveness of your treatment may scale back. Outpatient treatment with fewer than nine hours of services each week is the lowest level of care. 

Even after formal addiction treatment has ended, you should continue to pursue recovery. Twelve-step programs and community-based resources can help you connect with more people who have similar goals.

Sources

ASAM. (n.d.). What is the ASAM Criteria? from https://www.asam.org/resources/the-asam-criteria/about

National Institute on Drug Abuse. (2018, January). Types of Treatment Programs. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs

National Institute on Drug Abuse. (2019, November). 8: Definition of dependence. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/8-definition-dependence

National Institute on Drug Abuse. (2019, November). 6: Definition of tolerance. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance

RxList. (2019, September 17). Gamma-aminobutyric Acid: Health Benefits, Uses, Side Effects, Dosage & Interactions. from https://www.rxlist.com/gamma-aminobutyric_acid/supplements.htm

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