Here’s What Doctors Think About the Real Star of ‘The White Lotus’: Lorazepam

One of the (oh so many) stressful plot lines in season three of The White Lotus has to be North Carolina mom Victoria Ratliff’s dependence on lorazepam—a popular anti-anxiety medication. The character, played by actress Parker Posey, talks incessantly about the medication and claims she can’t sleep, let alone get through a relaxing Thailand vacation, without it.

The show is fictional, yes, but experts say Ratliff's dependence on the benzodiazepine (a class of anxiety meds) isn't unique. Lorazepam, also sold under the brand name Ativan, is widely prescribed in the US: a 2023 report even claimed more than 10 million lorazepam prescriptions are filled annually. But many people don’t know about its dangerous side effects.

Occasional use for anxiety-inducing events is one thing, but long-term, consistent use of lorazepam is risky. The longer you take it, the more likely your body will form a dependence, says Anna Lembke, MD, professor of psychiatry and behavioral sciences at Stanford Health Care. “Many people don’t even realize [lorazepam pills] are addictive and that you can be physically dependent on them.”

As with most medications, taking lorazepam as directed by your healthcare provider will lessen the likelihood of side effects and dependence—a memo that Ratliff seems to have missed (or dismissed) in the show. She pops her pills with significant amounts of wine, dispenses them to her husband when he can't sleep, and relies on them to get through social engagements. Even her husband, Tim Ratliff, appears to rely on the medication to drown out his work woes, as evidenced when he sneakily steals some of her pills. (Cue: "Tim? Where's my lorazepam?!" in a southern drawl.)

This scenario happens IRL all the time, as benzodiazepines are casually shared between family and friends, regardless of who has the prescription. "This stuff is out there, and it's become part of our culture," Akhil Anand, MD, a psychiatrist and psychologist at Cleveland Clinic, tells Well+Good. “[New] patients sometimes say what they 'need to say' to get it” after trying someone else’s lorazepam, he adds.

But this medication isn't all bad news: “Lorazepam can be an effective, short-term medication to treat anxiety and to be used alongside other longer-term treatments, whether other medications or psychotherapy,” says Douglas Misquitta, MD, clinical assistant professor of psychiatry and behavioral health at The Ohio State University Wexner Medical Center.

Since the writers of The White Lotus have brought benzodiazepine use back into the cultural zeitgeist, you may be wondering: What does lorazepam actually do? And how can you use it safely if you've been prescribed the medication for anxiety relief? Read on to learn more.

What is lorazepam?

Lorazepam is a benzodiazepine that's prescribed for a variety of mental health issues, including anxiety, insomnia, and situational stress. It helps slow brain activity by increasing the calming chemical GABA (gamma-aminobutyric acid) levels in your system. Dr. Lembke says it's helpful to think of lorazepam like alcohol in a pill form.

Like alcohol, lorazepam is a nervous system depressant, so it can cause similar side effects, including:

• Drowsiness
• Dizziness
• Blurred vision and slurred speech
• Gastrointestinal problems
• Changes in sex drive

These can be exacerbated when you take too much lorazepam, take it too frequently, or take it with other substances. “In combination with other sedatives like opioids (pain meds) or alcohol, you increase the risk of accidental overdose,” Dr. Lembke says. Unfortunately, if misused, people can "fall asleep, their heart stops, and they don’t wake up again," she adds.

Most healthcare providers only prescribe lorazepam for up to two weeks. “It’s really not an evidence-based treatment for anything beyond a couple of weeks,” Dr. Lembke says. Yet she says some providers still prescribe it long-term, which runs the risk of dependence—both mentally and physically. “Very quickly, people become tolerant, which means if they just suddenly stop they’re going to have withdrawal symptoms," says Dr. Anand. This could lead to a range of health problems, including anxiety, irritability, or, in severe cases, even seizures.¹

If you're dealing with severe anxiety, panic attacks, insomnia, or stress, your healthcare provider might prescribe a short-term course of lorazepam or other anti-anxiety medication. The National Library of Medicine says most dosages for anxiety start at 2 to 3 milligrams two to three times per day, or 0.5 to 2 milligrams at bedtime for insomnia. But providers may prescribe even smaller doses for certain groups of people, including adults over 65.

What experts really think about the anti-anxiety medication

Most experts agree that lorazepam should never be a long-term solution—no matter the reason you're taking it. "It really shouldn't be taken for very long because it's treating a symptom, not the root cause," Dr. Anand says. He adds that some providers might be too quick to prescribe benzodiazepines before trying alternative therapies—like talk therapy or lifestyle changes—especially when treating alcohol use disorder or insomnia. But this can set you up for dependency or withdrawal.

Despite the risks, some experts say that a short-term course of lorazepam can be a game-changer for certain people living with anxiety. "It's so effective, and it does help patients," Dr. Anand adds. It can afford you the time and the relief you need to begin other anxiety management techniques, like meditation, exercise, and therapy, so you'll have more tools in your mental health toolbox once you come off of it.

Ultimately, the choice to start a course of lorazepam (or any other benzodiazepine) is a highly personal one made between you and your healthcare team. If you start the medicine, check in with your providers regularly to make sure it's right for you. If you experience side effects or withdrawal symptoms, your provider may recommend you switch to another type of anxiety medication with less habit-forming risk, such as SSRIs (or selective serotonin reuptake inhibitors).

Lastly, lorazepam may not be worth the potential benefit for people with a history of substance use disorders, given that it can be addictive. “I will [only] use these medications if I’ve tried every other avenue and the patient is actively engaged in treatment,” Dr. Anand says.

What to do if you’ve been prescribed lorazepam

If you live with severe anxiety, insomnia, or situational stress, and you've exhausted all other treatment options, your provider may prescribe lorazepam or another benzodiazepine. Here are some things to keep in mind as you start:

• Seek a second opinion: If your provider prescribed lorazepam without suggesting other anxiety relief options first (like talk therapy or lifestyle changes), you may want to get a second opinion. This ensures you're not jumping into a decision without being well-informed.
• Note the possibility of withdrawal: Even if you take lorazepam as prescribed, there is still a chance you'll experience mild withdrawal symptoms. "Acute withdrawals will last for a week or two," says Dr. Anand. But "there's also a post-acute withdrawal that can last months to close to a year," if you've taken it for a while.
• Take it exactly as prescribed: If you and your provider determine lorazepam is right for you, it's crucial to take it exactly as directed. Don't mix it with alcohol or other depressants or prescription drugs. Talk to your provider and pharmacists about possible negative interactions with other meds you're taking. And don't take more than prescribed.
• Monitor yourself: If you find yourself relying on lorazepam to get through daily life or stressful situations, bring this up to your provider. Monitor yourself closely and take note of any adverse effects. You may need to stop taking the medicine or find another that's better suited for your needs.
• Come up with a plan to get off of it: Make sure you and your provider have a detailed plan of when and how you'll stop taking lorazepam. This will help reduce the risk of side effects, withdrawal symptoms, and dependency.
• Don't share it: It may seem obvious but don't take any prescription medication that hasn't been prescribed to you, and don't share your meds with others.

The bottom line

If you don’t have a history of substance use disorders, and you’ve tried other therapies for conditions like insomnia or anxiety but nothing has worked, lorazepam may well improve your health. The key is taking the medication under the supervision of a trusted provider who can help you stop when it’s time.

If you have developed a dependency, you have options. “If you know someone that has an issue with a benzodiazepine, there are doctors, coaches, [and] therapists that really work with these patients,” Dr. Anand says. “There’s a lot of support groups online. There is a community that’s helping each other.”

In other words, learn from Victoria Ratliff: be careful on drugs like lorazepam...and maybe don't mix them with white wine on a luxury yacht in Thailand.