From the FDA Drug Label
In patients with depression, a possibility for suicide should be borne in mind; benzodiazepines should not be used in such patients without adequate anti-depressant therapy. Serious side effects including coma and death have happened in people who have abused or misused benzodiazepines, including lorazepam oral concentrate These serious side effects may also include delirium, paranoia, suicidal thoughts or actions, seizures, and difficulty breathing. 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 Lorazepam has a risk of suicide in certain patients, particularly those with depression. Patients should be closely monitored for signs of suicidal thoughts or behavior, especially when using lorazepam without adequate anti-depressant therapy or when stopping the medication suddenly 1 1.
- Key points:
- Patients with depression should be treated with caution when using lorazepam.
- Suicidal thoughts or actions are a possible side effect of lorazepam, especially when misused or abruptly stopped.
- Close monitoring is necessary to prevent and detect suicidal behavior in patients taking lorazepam.
From the Research
Lorazepam carries a significant suicide risk, as evidenced by a recent study published in 2024, which found that lorazepam was associated with a nearly two-fold increased risk of suicide attempts (HR=1.83,95% CI=1.69,2.00) 2.
Key Points to Consider
- The risk of suicidal thoughts and behaviors is higher in individuals with pre-existing depression or a history of suicidal thoughts.
- The FDA requires a boxed warning on lorazepam and other benzodiazepines about this potential risk.
- Lorazepam affects brain chemistry by enhancing the effects of GABA, a neurotransmitter that inhibits brain activity, which can worsen depression or trigger suicidal ideation in some individuals.
- Patients taking lorazepam should be monitored closely for mood changes, especially during the first few weeks of treatment.
- Warning signs include new or worsening depression, unusual changes in behavior, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, and thoughts about suicide or dying.
Recommendations
- Patients experiencing these symptoms should contact their healthcare provider immediately.
- Lorazepam should never be abruptly stopped without medical supervision, as withdrawal can worsen these risks.
- Alternative treatments, such as buspirone, may be considered, as they have been shown to have a lower risk of suicidal thoughts and behaviors compared to benzodiazepines 2.
Important Considerations
- The study published in 2024 provides the most recent and highest-quality evidence on the association between lorazepam and suicide risk, and its findings should be prioritized in clinical decision-making 2.
- Other studies, such as those published in 2021,2020, and 2017, also support the association between benzodiazepines and increased suicide risk, but the 2024 study provides the most up-to-date and robust evidence 3, 4, 5.