From the Guidelines
Ativan (lorazepam) is not a suitable treatment for rumination disorder due to its potential for dependence, tolerance, sedation, and cognitive impairment, and its inability to address the core behavioral mechanisms of rumination. Rumination, which involves repetitive regurgitation of food after eating, is primarily treated through behavioral techniques rather than medication. Cognitive behavioral therapy (CBT), diaphragmatic breathing, and habit reversal training are more appropriate initial approaches 1. While Ativan, a benzodiazepine, can reduce anxiety that might accompany rumination, its use is not recommended due to the significant risks associated with its use, particularly in the long term 1.
Some key points to consider when evaluating the use of Ativan for rumination include:
- The potential for dependence and tolerance, which can lead to increased dosages and worsening of symptoms 1
- The risk of sedation and cognitive impairment, which can impact daily functioning and quality of life 1
- The lack of evidence supporting the use of benzodiazepines in addressing the core behavioral mechanisms of rumination 1
- The availability of alternative treatments, such as CBT and habit reversal training, which have been shown to be effective in managing rumination symptoms 1
If medication is needed, options like low-dose SSRIs might be considered for anxiety components, but only as part of a comprehensive treatment plan that includes behavioral therapy 1. Any medication approach should be discussed with a healthcare provider who can evaluate individual circumstances and monitor for side effects.
From the Research
Treatment Options for Rumination
- Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation, often accompanied by anxiety and psychological stress 2, 3, 4.
- The main therapy for rumination syndrome is behavioral modification with postprandial diaphragmatic breathing 3, 4.
- Other treatment options include tricyclic antidepressants (TCAs) combined with diaphragmatic breathing/relaxation techniques, which have been shown to be effective in managing rumination syndrome 2.
- Baclofen is also considered a reasonable next step in refractory patients 3.
Use of Benzodiazepines
- Benzodiazepines, such as Ativan (lorazepam), are not specifically mentioned as a treatment for rumination syndrome in the provided studies 2, 3, 4.
- However, benzodiazepines are used to treat anxiety, which is often an accompanying complaint in patients with rumination syndrome 5.
- The use of benzodiazepines should be considered carefully, as they can have adverse effects, such as psychomotor impairment, and can lead to tolerance, dependence, and withdrawal effects with long-term use 5.
Alternative Treatments
- Mindfulness-based and cognitive behavioral interventions have been shown to be effective in reducing rumination and worry, which are key components of mental illnesses such as depression and anxiety 6.
- These interventions may be useful in reducing the incidence of rumination and worry, and could be considered as alternative or adjunctive treatments for rumination syndrome.