What Is Lorazepam? The Drug From ‘The White Lotus’ Carries Real Risks - The New York Times

Don’t Underestimate the Risks of Benzodiazepines

"Other common benzodiazepines include diazepam (Valium), clonazepam (Klonopin) and alprazolam (Xanax).

Unlike antidepressants, which can take weeks to start working, most benzodiazepines can provide relief within minutes — which can comfort nervous fliers and others who need quick anxiety relief for a specific situation. But if taken for longer periods, patients can develop a tolerance within weeks of starting the drug, even when using it as prescribed, said Dr. Ludmila De Faria, chair of the American Psychiatric Association’s council on women’s mental health.

“That’s where people get into trouble,” she added, and start to take more of the medication. “The same dose will no longer get rid of the symptoms.”

In addition, drugs like clonazepam and diazepam last longer in the body than short-acting drugs such as alprazolam. “People don’t realize that,” she said. “So they take multiple doses and it accumulates,” which can result in people “walking around like they have a couple of drinks in them.”

The geriatric population that Dr. Neel treats is especially vulnerable because benzodiazepines are metabolized differently as we age, he added, lingering in the body for a longer period of time. As a result, older people who take them may be more prone to falls or car accidents. The drugs can also cause delirium in patients who have dementia.

But the medications can be risky for people of any age, which is why they are typically prescribed for a short period of time — usually four weeks or less — and they are considered a last resort to treat a chronic condition, Dr. Neel said.

A Delicate Withdrawal Process

A 2019 study found that nearly 20 percent of people who take benzodiazepines misuse them. If someone develops a dependence, quitting can be difficult, in part because of the intense withdrawal symptoms.

Those symptoms can include sleep disturbances, irritability, sweating, heart palpitations, elevated blood pressure and stomach problems like dry heaving.

Tapering off the drug needs to be done in a gentle way, ideally under the supervision of a doctor.

It’s “almost like landing an airplane, where there’s a gradual descent,” said Dr. John Torous, a psychiatrist at Beth Israel Deaconess Medical Center in Boston."

What Is Lorazepam? The Drug From ‘The White Lotus’ Carries Real Risks - The New York Times