Are lorazepam withdrawal symptoms followed by suicide described in the literature?/nA 45-year-old w

Fråga: Are lorazepam withdrawal symptoms followed by suicide described in the literature? A 45-year-old woman with anxiety developed dependence after being treated with lorazepam (Temesta), 3.5-4 mg daily, for many years (probably 8 years). During an attempt to discontinue the treatment the patient committed suicide. For further information, please look at follow up notes.

Sammanfattning: Besides anxiety, depression is described in the literature during withdrawal of lorazepam. We also found one case of suicide during withdrawal of the drug.

Svar: Lorazepam is a short-acting benzodiazepine (1). It is known that long-term benzodiazepine usage, for example lorazepam, in therapeutic doses may lead to pharmacological dependence (1,2,3). Chronic use of benzodiazepines can induce depression or provoke suicide (4).

In general, long-term treatment, high plasma concentrations, short half-life and abrupt withdrawal are factors that provoke a withdrawal syndrome (5). Symptoms of benzodiazepine withdrawal include anxiety (6). Masked depressive states can also emerge after the acute withdrawal state which will demand specific pharmacological treatment (7). In one case report a 28-year-old man developed depression during withdrawal of lorazepam 3-4 mg daily. Treatment with amitriptyline was successful (8). It has been stated that when compared to other benzodiazepine, lorazepam withdrawal symptoms may be particularly severe (1). Symptoms are also occurring sooner (9) after discontinuing lorazepam treatment. Furthermore, in spite of a shorter half-life, lorazepam has a longer effect duration compared to diazepam probably due to higher affinity to the receptor (13). In a double-blind study (10), 68 patients with BZ dependence were given lorazepam, diazepam or bromazepam gradually reducing the dose. Seven and six patients respectively on diazepam or bromazepam dropped out during study. The corresponding number in the lorazepam group was ten, one of whom committed suicide after 12 weeks treatment.

It is strongly recommended that all benzodiazepine therapy, and particularly with short-acting compounds, should be withdrawn gradually (11) and generally without the use of another drug (12).

No case of death has been reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) in relation to lorazepam treatment. There are 2 cases of anxiety during lorazepam withdrawal and 3 cases of dependence connected to lorazepam treatment.

The case should be reported to SADRAC.