Lorazepam - how dangerous is the medication from the hit series "The White Lotus"?

Since the third season of the cult series "The White Lotus," the drug Lorazepam, a drug from the benzodiazepine group, has received increased public attention. The series portrays the wealthy family mother Victoria Ratliff, who seemingly takes the tranquilizer without concern during her stay at a luxurious five-star resort in Thailand.

What initially appears to be a help against jet lag develops into a worrying consumption pattern over the course of the season. Victoria regularly reaches for the tablets and appears increasingly dazed. When her husband also seems to suffer from sleep problems, she offers him her medication and assures: "They're not addictive. I just take them when I need it. [...] Not a big deal."

But even after the first dose, he also shows signs of addiction. This portrayal raises important questions: How does Lorazepam actually work, and what risks does its use entail?

What is Lorazepam?

PD Dr. Richard Musil, Psychiatrist and Medical Director of the Oberberg Fachklinik Bad Tölz, has explained the drug and its mode of action for us. "Lorazepam is a benzodiazepine with a fast-acting and reliable anxiety-relieving effect. The drug works on the GABA receptors in the central nervous system, enhancing the inhibitory effect of the neurotransmitter. It is generally used to provide quick relief in acute situations."

In which cases do you prescribe Lorazepam?

I use Lorazepam in patients with severe depressive episodes accompanied by restlessness, severe worries, or fears. The same applies to patients with schizophrenic psychoses or bipolar disorders. In such cases, Lorazepam is usually administered parallel to the initiation of treatment with antidepressants or antipsychotics, as their effects often only set in after days or weeks. Lorazepam bridges this period and ensures short-term stabilization.

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Lorazepam is prescribed, among other things, for bipolar disorders.

When do you recommend alternative treatment methods?

Lorazepam should rarely be used as a sole therapy unless it is a temporary mental state exception without severe psychiatric illness. In most cases, an alternative therapy – with antidepressants or antipsychotics – is started in parallel. In panic attacks or anxiety within the framework of personality disorders, I rather recommend other preparations or entirely non-drug treatment approaches such as psychotherapy.

Lorazepam and the side effects

Which side effects of Lorazepam cause you the most concern as a practitioner?

Administration leads to tiredness, which can be tolerable in cases of acute restlessness. However, it becomes problematic when Lorazepam is administered together with other sedative substances like certain antipsychotics. In states of restlessness associated with alcohol or drug use, Lorazepam should also not be used as it could impair breathing.

Lorazepam is generally well tolerated but carries a significant potential for dependency. Even when administered over several days, the medication must always be tapered off graduallyPatients with a history of addiction disorders should therefore avoid Lorazepam.

How do you assess the unsupervised intake of benzodiazepines like lorazepam?

Lorazepam should never be taken without reflection or medical supervision due to its rapid onset of action and high potential for dependence.

In my practice, I only prescribe lorazepam for valid medical reasons. Lorazepam has a high potential for abuse, but it is entirely unsuitable as a lifestyle drug - anyone who has undergone lorazepam withdrawal knows the risks.

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Lorazepam has a high potential for abuse, says Dr. Richard Musil.

Lorazepam - does it cause dependency?

How do you handle the addiction potential of lorazepam, especially in patients with anxiety disorders?

In anxiety disorders, lorazepam should be avoided as much as possible. While it works in the short term against anxiety attacks, in the long term it hinders the psychotherapeutic process because it limits the ability to learn. Primarily, such disorders should be treated psychotherapeutically - antidepressants with serotonergic effects can be used as supportive medication.

What effects can long-term use of lorazepam have on cognitive performance?

Long-term use can significantly impair cognitive performance. Concentration and attention problems are typical consequences. Therefore, lorazepam should only be used long-term in exceptional cases - for instance, when no other medications can achieve the same calming effect. Special caution is advised, particularly in older patients, because discontinuing the medication is often difficult.