From the Guidelines
Chronic Ativan (lorazepam) use can lead to significant and potentially long-lasting changes in brain function and structure, emphasizing the need for cautious and limited use of this medication. The effects of chronic lorazepam use on the brain are multifaceted, involving alterations in cognitive function, brain structure, and neurotransmitter systems. Long-term use of benzodiazepines like lorazepam results in the downregulation of GABA receptors, leading to tolerance and physical dependence 1. This dependence is characterized by the need for higher doses to achieve the same therapeutic effect and the occurrence of withdrawal symptoms upon discontinuation.
Key aspects of chronic Ativan use include:
- Cognitive impairments: Chronic use is associated with memory problems, decreased attention, reduced processing speed, and impaired executive function, which may persist for months or even years after discontinuation.
- Structural changes: Some studies suggest that prolonged use of lorazepam can lead to reduced volume in certain brain regions.
- Increased risk of dementia: Particularly in elderly patients, chronic use of Ativan has been linked to an increased risk of developing dementia.
- Neurotransmitter system alterations: The brain compensates for the enhanced GABA activity caused by lorazepam by reducing natural GABA activity, leading to these adverse effects.
Given these risks, it is crucial to use Ativan only for short-term periods (2-4 weeks) at the lowest effective dose, with gradual discontinuation under medical supervision to minimize withdrawal symptoms. This approach is essential for mitigating the potential long-term effects of chronic lorazepam use on the brain, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. The development of biomarkers for dependence and the use of non-invasive brain stimulation techniques, as discussed in recent research 1, may offer future avenues for managing and treating substance use disorders, including those related to benzodiazepines like Ativan.
From the FDA Drug Label
Lorazepam Oral Concentrate can cause physical dependence and withdrawal reactions. Do not suddenly stop taking lorazepam oral concentrate Stopping lorazepam oral concentrate suddenly can cause serious and life-threatening side effects, including, unusual movements, responses or expressions, seizures, sudden and severe mental or nervous system changes, depression, seeing or hearing things that others do not see or hear, an extreme increase in activity or talking, losing touch with reality, and suicidal thoughts or actions Some people who suddenly stop benzodiazepines have symptoms that can last for several weeks to more than 12 months, including anxiety, trouble remembering, learning, or concentrating, depression, problems sleeping, feeling like insects are crawling under your skin, weakness, shaking, muscle twitching, burning or prickling feeling in your hands, arms, legs or feet, and ringing in your ears
The effects of chronic Ativan (lorazepam) use on the brain include physical dependence and withdrawal reactions. Stopping the medication suddenly can lead to serious and life-threatening side effects, such as seizures, depression, and suicidal thoughts or actions. Additionally, some people may experience prolonged withdrawal symptoms lasting several weeks to more than 12 months, including anxiety, trouble remembering or concentrating, and depression 2.
From the Research
Effects of Chronic Ativan Use on the Brain
- Chronic use of Ativan (lorazepam), a benzodiazepine, has been associated with cognitive impairment, including visuospatial ability, speed of processing, and verbal learning deficits 3.
- Long-term treatment with benzodiazepines has been shown to cause transient changes in the brain, but no brain abnormalities have been found in patients treated long term with benzodiazepines 3.
- Physiological dependence on benzodiazepines can occur following prolonged treatment with therapeutic doses, and withdrawal from normal dosage benzodiazepine treatment can result in a number of symptomatic patterns, including rebound anxiety and insomnia, and a full-blown withdrawal syndrome 4.
Neurological Consequences
- Heavy use of drugs, including benzodiazepines, can impact daily activities and result in changes in cognitive performance, including cognitive dysfunctions and neuropathological changes 5.
- Chronic drug use has been associated with alterations in brain structure and functional connectivity, including volumetric loss in the amygdala and decreased anisotropy in axonal pathways 6.
- Cognitive deficits associated with chronic drug misuse can reflect changes to the underlying cortical, sub-cortical, and neuromodulatory mechanisms that underpin cognition, and can interfere directly with rehabilitative programs 7.
Key Findings
- Chronic Ativan use can lead to cognitive impairment and physiological dependence 3, 4.
- Long-term benzodiazepine use can result in transient changes in the brain, but no brain abnormalities have been found in patients treated long term with benzodiazepines 3.
- Chronic drug use, including benzodiazepines, can have significant neurological consequences, including alterations in brain structure and functional connectivity 5, 6, 7.