What advice is recommended for taking Ativan (lorazepam) 1mg every evening for anxiety?

Critical Advice for Daily Lorazepam 1mg Use for Anxiety

You should not continue taking Ativan (lorazepam) 1mg every evening long-term for anxiety, as benzodiazepines like lorazepam are intended for short-term use only and carry significant risks of tolerance, dependence, cognitive impairment, and withdrawal reactions with chronic daily use.

Immediate Concerns with Your Current Regimen

Risks of Chronic Benzodiazepine Use

• Regular daily use leads to tolerance, addiction, depression, and cognitive impairment 1
• Approximately 10% of patients experience paradoxical agitation rather than anxiety relief 1
• Concurrent use with opioids (if applicable) increases overdose death risk nearly four-fold compared to opioids alone 2
• Abrupt discontinuation after chronic use can cause rebound anxiety, hallucinations, seizures, delirium tremens, and rarely death 2

Rebound Anxiety Risk

• Lorazepam's short half-life makes rebound anxiety more intense and occur earlier compared to longer-acting benzodiazepines when discontinued 3
• About 30% of patients experience rebound anxiety when stopping benzodiazepines, even after appropriate use 3

What You Should Do Instead

Transition to Evidence-Based Long-Term Treatment

• SSRIs (selective serotonin reuptake inhibitors) are the preferred first-line treatment for chronic anxiety 2

  • Options include sertraline 25-50mg daily (maximum 200mg), paroxetine 10mg daily (maximum 40mg), or citalopram 10mg daily (maximum 40mg) 2
  • These require 4-8 weeks for full therapeutic effect 2

• Buspirone is an alternative non-addictive option for mild to moderate anxiety 2

  • Starting dose: 5mg twice daily, maximum 20mg three times daily 2
  • Takes 2-4 weeks to become effective 2

Safe Discontinuation Protocol

If you've been taking lorazepam nightly for more than a few weeks, DO NOT stop abruptly 4

• Use gradual taper to reduce withdrawal risk 4
• A commonly recommended schedule: reduce dose by 25% every 1-2 weeks 2
• Cognitive behavioral therapy (CBT) significantly increases tapering success rates and should be offered during the taper 2
• If withdrawal symptoms emerge, pause the taper or increase back to the previous dose level, then decrease more slowly 4

Appropriate Short-Term Use (If Continuing Temporarily)

FDA-Approved Dosing

• Usual anxiety dosage range: 2-3mg daily divided into 2-3 doses 4
• Your current 1mg evening dose is below the typical therapeutic range 4
• Elderly or debilitated patients should start at 1-2mg daily in divided doses 4
• Maximum daily dose can reach 10mg, but higher doses increase adverse effects 4

Duration Limitations

• Lorazepam is indicated for anxiety or transient situational stress, not chronic daily use 4
• Studies showing efficacy were 4 weeks in duration 5, 6, 7
• No evidence supports safety or efficacy beyond short-term use for anxiety

Critical Action Steps

1. Schedule an appointment with your prescribing provider immediately to discuss transitioning to appropriate long-term anxiety treatment 2
2. Do not adjust or stop your current dose without medical supervision due to withdrawal risks 4
3. Request evaluation for evidence-based anxiety treatments including SSRIs and/or CBT 2
4. Develop a structured taper plan if you've been using lorazepam for more than 2-4 weeks 2, 4
5. Avoid alcohol and other central nervous system depressants while taking lorazepam 2

Common Pitfall to Avoid

The biggest mistake is continuing benzodiazepines indefinitely because they provide immediate relief - this creates a cycle of dependence where stopping becomes increasingly difficult, and the medication becomes less effective over time due to tolerance 1, 3. The appropriate path is transitioning to treatments designed for long-term use while safely tapering the benzodiazepine under medical supervision.