What to Know About the Drug

• Lorazepam, a common anti-anxiety medication, makes frequent appearances in Season 3 of “The White Lotus” on HBO.
• This type of benzodiazepine used to treat anxiety, panic attacks, and certain types of insomnia.
• The drug slows activity in the brain, promoting physical relaxation and reducing anxious thoughts.
• Lorazepam has the potential for dependence and may cause life threatening problems when used with opioid medications, alcohol, and certain illegal drugs.

HBO’s third season of “The White Lotus” is underway. A mostly new cast of guests flock to Thailand’s Koh Samui to stay at the show’s namesake luxury spa and wellness sanctuary. Here, spirituality and a possible whodunnit are served up to loyal fans of the beloved comedy-drama series.

This season begins similarly to others, with plenty of intrigue, leaving behind a string of mysteries about who died and how. The show opened with gunshots and a dead body, this time floating face down in a lotus pond.

As storylines are introduced, a surprising theme running throughout this season is the frequent mention of lorazepam, a prescription medication used to treat anxiety and certain types of insomnia.

Victoria Ratliff, played by Parker Posey, whose Southern drawl brings a distinctive ring to the word “lorazepam,” can’t seem to get through the day without popping these anti-anxiety pills like candy, sometimes downing them with white wine at dinner.

Her overuse of the pills leaves her slurring her words, zoning out, and dozing off at the dinner table. At one point in episode 4 (which was released on March 9), Victoria’s daughter Piper exclaims, “You don’t have enough lorazepam to get through one week at a wellness spa?”

In this episode, Victoria’s husband Timothy (played by Jason Isaacs) steps into lorazepam misuse territory to cope with a work-related scandal that could ruin his reputation. While attending a yacht party with their three children, he steals Victoria’s prescription bottle from her bag, drinks a few glasses of what looks like whiskey and becomes incoherent.

If you’re wondering about this drug and whether it’s safe for anxiety, read on. We’ll break down how the drug is meant to be used, the main risks, and other ways to manage your anxiety.

Lorazepam is the generic name for the prescription medication Ativan. It belongs to a class of drugs called benzodiazepines, which also include:

• Valium
• Xanax
• Halcion
• Klonopin

“Lorazepam is a commonly prescribed medication for anxiety. It’s also used to treat panic attacks and can be used for insomnia,” said David Merrill, MD, PhD, a geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA.

The drug works by slowing the activity in the brain, which promotes relaxation in the body and a reduction in anxious thoughts.

However, “the first-line treatment [for anxiety] is typically antidepressants like SSRIs [antidepressants], plus psychotherapy,” Merrill told Healthline.

“Something like cognitive behavioral therapy or mindfulness-based stress reduction — where you get a better understanding of what’s driving your anxieties and how to manage the anxiety when it comes up, versus just popping a pill like is done on a TV show.”

Victoria L. Leigh, DO, FACOI, an internal medicine specialist with Providence St. Joseph Hospital in Orange, CA, said in certain cases, benzodiazepines may be used first, such as with anxiety experienced by cancer patients and hospice or palliative care patients.

Lorazepam may also be used for short-term anxiety related to a medical procedure, she said, such as when people experience panic symptoms in the confined space of an MRI machine.

However, because benzodiazepines have more severe side effects, including a risk of dependence, SSRIs are often recommended first for generalized anxiety disorder.

Therapy can also benefit people by teaching them to notice internal physiological sensations such as racing heartbeat, shortness of breath, numbness and tingling. These are a normal part of the body’s stress response, said Merrill, not something that is dangerous or harmful.

“If you learn how to counteract those sensations when they come up, whether by taking a deep breath or taking a break from what you are doing, you can keep them from becoming a full-blown panic attack,” Merrill said.

Some people can manage their anxiety without medication, using therapy alone. However, “with more severe cases of anxiety, we see the best outcomes with a combination of meds and therapy, at least over the short-term,” Merrill noted. “Then sometimes people can taper off the medications when their anxiety is under better control.”

When used as prescribed, lorazepam can cause the following side effects:

• drowsiness
• dizziness
• tiredness
• weakness
• unsteadiness
• nausea
• diarrhea or constipation
• appetite changes
• restlessness
• blurred vision
• changes in sex drive or ability

More serious problems, such as life threatening breathing problems, sedation, or coma, can occur if lorazepam is used alongside opioid medications such as codeine, oxycodone, and tramadol.

Drinking alcohol or using certain illegal drugs alongside lorazepam can also increase these risks.

“Benzodiazepines are generally safe when used as directed,” said Merrill, “but they have the potential to be habit forming, so you can become physiologically or psychologically dependent on them.”

People who are using illegal drugs or other substances should not use lorazepam. People with a history of alcohol dependence or abuse should not use lorazepam unless recommended by their doctor.

“Because lorazepam is short-acting, its onset is faster, making addiction more likely,” Leigh told Healthline. In addition, “withdrawals from this medication are more abrupt than the longer-acting medications in this family.”

Once dependence occurs, “if lorazepam is stopped suddenly, withdrawal symptoms can lead to seizures, altered [thoughts], and can be fatal,” she said.

Lorazepam and other benzodiazepines can cause physical dependence and withdrawal symptoms, even when taken as directed.

The severity of withdrawal symptoms depend upon the dose you are taking, how long you’ve been taking the drug, other sedating drugs you are taking, and other factors.

• agitation
• poor memory
• insomnia
• anxiety
• panic attacks
• irritability
• headache
• muscle fatigue
• weakness
• tremor
• seizures

Merrill said other signs of lorazepam dependence include:

• needing to fill your prescription early
• using the drug above the amounts or more often than recommended by your doctor
• having to use someone else’s pills because you ran out early
• using the drug alongside alcohol in order to manage your anxiety symptoms
• neglecting your responsibilities at work or in your personal life

If you are experiencing physical dependence or if you had withdrawal symptoms when you tried to stop taking lorazepam, ask your doctor about tapering your dose. Tapering means taking smaller doses over the course of a few or several weeks until you can safely stop the drug.

Many non-medication options have been shown to help relieve anxiety symptoms. Some of these may include:

“Focusing on exercise can also help to balance the ‘fight or flight’ nervous system response that drives anxiety-related feelings,” said Leigh. “Reduction in alcohol consumption and focusing on a balanced diet can also impact the ‘gut-brain axis’ and can improve mental health as well.”

This part of the nervous system controls unconscious processes such as breathing, heartbeat and digestion. It’s also in charge of keeping us safe through the body’s fight, flight, fawn and freeze responses.

“Understanding the role of the nervous system really shifts the paradigm from ‘I’m broken,’ to seeing that your symptoms make sense when put into the context of basic biological needs, your past trauma history, and how that gets stored in your body,” said Armstrong, who is based near Washington, D.C.

When viewed through the lens of the nervous system, anxiety symptoms are a survival response, one that makes sense in the context of the human body and a person’s current and past experiences.

Other factors can also contribute to anxiety, such as sleep deprivation, being overstressed or over-caffeinated, suffering from micronutrient deficiencies, or lacking connection to other people and community.

In her practice, Armstrong teaches clients two types of tools for managing their anxiety.

First are tools that people can use in the moment if they are feeling anxious or having a panic attack. This includes visual orienting (slowly looking around your space), biting into a lemon, and certain kinds of breathing.

These help people move up what Armstrong refers to as the autonomic nervous system ladder — away from the sympathetic activation response (also known as fight or flight mode) toward a state of calm and connection.

The other group of tools helps reduce people’s anxiety symptoms long-term. Part of this proactive approach is helping people understand what might be contributing to their anxiety symptoms, including:

• past trauma
• current life stressors
• lifestyle habits
• relationships
• micronutrient deficiencies
• health conditions (i.e., thyroid issues or hormone imbalance)

Once clients have mapped out these factors, Armstrong asks: “What feels meaningful, and what feels accessible for you to take on right now?”

While Armstrong said there’s a time and a place for the use of anti-anxiety medications, she empowers clients by educating them about how their bodies work and giving them tools to manage their anxiety.

This approach can also pave the way for deeper work with a therapist, whether it’s talk therapy, shadow work, or somatic parts (aka inner child) work. If the nervous system is well regulated, therapy is often more productive.

Overall, “the approach I use gives you an entire new framework for understanding yourself, and navigating your world and your symptoms in a way that is not associated with brokenness,” Armstrong told Healthline. “There’s also more space for compassion and curiosity.”

In Season 3 of the HBO series “The White Lotus,” some characters appear to pop lorazepam like candy. This prescription drug is used to treat anxiety, panic attacks, and insomnia due to anxiety or situational stress.

Studies show that benzodiazepines such as lorazepam are effective for treating both the physical and psychological symptoms of anxiety. However, antidepressant SSRIs are more commonly used first because they have a lower risk of severe side effects.

Lorazepam carries a risk of dependence and potential for misuse. This drug can also cause life threatening breathing problems, sedation, or coma when used alongside opioid pain relievers, alcohol, or certain illegal drugs.