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The anti-anxiety medication is a sedative, and can impair judgment. But one expert says it's unlikely to make a non-suicidal person take their own life.

May 19, 2017

After Chris Cornell’s death on Wednesday night was ruled a suicide by hanging, the musician’s lawyer and family are suggesting that an anti-anxiety medication he was taking may have influenced his final moments.

“Without the results of toxicology tests, we do not know what was going on with Chris—or if any substances contributed to his demise,” the family’s attorney said in a statement, reported by People. “Chris, a recovering addict, had a prescription for Ativan and may have taken more Ativan than recommended dosages. The family believes that if Chris took his life, he did not know what he was doing, and that drugs or other substances may have affected his actions.”

Cornell’s wife Vicky also released a statement, calling his suicide “inexplicable” and noting that, hours earlier, the couple had discussed upcoming plans for Memorial Day weekend. “I know that he loved our children and he would not hurt them by intentionally taking his own life,” she said.

Vicky’s statement also describes how Cornell was slurring his words when he spoke with her by phone on Wednesday night after his performance with Soundgarden in Detroit. “When he told me he may have taken an extra Ativan or two, I contacted security and asked that they check on him,” she said.

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Ativan (and its generic version, lorazepam) is an extremely common drug, prescribed to millions of people every year, says Asher Simon, MD, assistant professor of psychiatry at The Mount Sinai Hospital in New York City. (Dr. Simon did not treat Cornell.) And overall, he says, “it can be an incredibly effective and very safe medication.”

It's in a class of drugs called benzodiazepines, which work by slowing down the central nervous system and enhancing certain chemicals in the brain to produce a calming effect. (Other well-known benzodiazepines include Valium and Xanax.) The drug is usually prescribed on a short-term basis for the treatment of anxiety, and is often helpful for people with depression.

“It lasts about four to six hours, and a lot of times it’s prescribed on an as-needed basis,” says Dr. Simon. “We might say, ‘Take one or two pills three times a day, as needed.’” The drug starts working right away, he says; that’s why they’re sometimes recommended for people who are anxious about flying on airplanes or visiting the dentist, for example.

Ativan might also be prescribed for short-term use alongside antidepressant medications. “A lot of times when someone comes in with anxiety and you start them on an antidepressant, their anxiety can get worse before it gets better,” says Dr. Simon. “So sometimes they need a couple weeks of an anti-anxiety medication to provide immediate relief, until the antidepressant kicks in.”

Because it’s a sedative, Ativan can make people dizzy and tired when they first start taking it. It can increase the risk of falls, especially in older people, and patients are warned about driving or operating heavy machinery until they know how the drug will affect them.

But Dr. Simon says that taking an extra Ativan or two would not cause slurring or serious impairment, especially for people who have been on the drug long-term and developed a tolerance to its sedating side effects. “Yes, of course you should never take more than prescribed,” he says. “But one or two additional pills is usually not a huge deal.”

Taking higher doses, or combining Ativan with alcohol or other drugs, is much more dangerous, he says—mostly because of the potential for impaired judgment and slowed breathing and heart rate. And overdoses of anti-anxiety medications do occur: A 2016 report found that, as more people are prescribed these drugs, more people are also dying from them.

There's less of a chance that Ativan would cause a non-suicidal person to take their own life, says Dr. Simon. “A lot of suicide comes at a time of acute anxiety, and if it treats the anxiety it can actually prevent those suicides,” he says. “It is extremely unlikely to cause suicidal thinking in and of itself.”

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But, he adds, the drug’s effects can work in either direction. “In someone who is already depressed and suicidal, it can impair their judgment—and if someone is intent on killing themselves, it can lower their inhibition and make them more likely to act on their impulses.”

This is a common risk with most anti-anxiety and antidepressant medications, and these drugs carry warnings about the potential for worsening depression or suicide. That’s why doctors should evaluate patients carefully and make sure they’re being treated for their underlying mood disorder, says Dr. Simon, and not just their short-term symptoms.

Benzodiazepines like Ativan can also be habit-forming, he says, and doctors should be extremely careful about prescribing them to people with a history of drug use.

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Until more is known about Cornell’s suicide, the public can only speculate what role his prescription medication played in his death. But for others who have been prescribed Ativan or similar medications, Dr. Simon says there’s little reason to worry.

It’s important to know the risks of any medication, and to report any worsening of depression or suicidal thoughts to your doctor. But when used as directed, says Dr. Simon, people can rest assured that Ativan is safe—and can be extremely beneficial—for millions of Americans.