Ativan: What You Need to Know About Chris Cornell's Anxiety Pills

After wife of late Soundgarden frontman blamed anxiety medication for his suicide, questions remain as to the drug's side effects

Could Ativan have contributed to Chris Cornell's death? Credit: Shawn Brackbill/Redux

On Thursday morning, news broke that Chris Cornell, the groundbreaking singer who helped shape grunge, died by suicide the night before in his Detroit hotel room. Cornell's unexpected death shocked family, friends and fans, some of whom watched the 52-year-old vocalist and guitarist perform with Soundgarden hours before he passed. A local medical examiner ruled the cause of death as suicide by hanging.

Cornell's wife, Vicky Cornell, released a statement on Friday morning remembering her late husband and father of three children, and also calling into question what may have led to his death. According to Vicky, Cornell may have taken more than his recommended dosage of Ativan, a medication used to ease symptoms of anxiety. During one of their last phone conversations, Cornell seemed "different" and was "slurring his words," according to her statement. He had told her he "may have taken an extra Ativan or two," which prompted her to call security to do a welfare check.

"What happened is inexplicable and I am hopeful that further medical reports will provide additional details," Vicky said in the statement. "I know that he loved our children and he would not hurt them by intentionally taking his own life."

It could take days to learn the results of Cornell's full autopsy and toxicology reports, according to a spokesperson with the Wayne County Medical Examiner's Office. So the role that Ativan played in his death by suicide is not yet known – a point Cornell's family attorney, Kirk Pasich, acknowledges. Still, what exactly is Ativan's connection to suicide? Could the drug contribute to a person's death? We talked with medical experts find out more about the anti-anxiety medication. Here, what you need to know. 

What is Ativan?
Ativan is the brand name for lorazepam, a type of benzodiazepine medication used foremost to treat severe anxiety and panic disorders in the short term. Benzodiazepines – or "benzos," as they're commonly called – are a broad class of highly-addictive sedatives that "have some effective medicinal uses," said Dr. Joseph Lee, medical director of the Hazelden Betty Ford Foundation Youth Continuum. (The experts interviewed by Rolling Stone spoke generally about Ativan, suicide and their alleged link. None of them have reported a connection to the Cornell family.) In addition to anxiety, Ativan and other benzodiazepines such as Xanax or Valium can be used to treat seizures and substance withdrawal symptoms, as well as help with sedation during medical procedures, Lee tells Rolling Stone.

Public health officials do not recommended the drug for people with addictive disease, depression, psychosis or lung or breathing problems.

How does Ativan affect your brain?
Benzodiazepines are depressants that slow down your nervous system to make you feel calm. They act on the brain's gamma aminobutyric acid – or GABA – receptors, one of the most common neurotransmitters in the central nervous system. According to The Ochsner Journal, GABA receptors reduce the excitability of neurons, which creates a meditative effective on the brain.

Ativan is a short-acting anti-anxiety medication, often prescribed in low doses for a few weeks at a time. When used correctly, the medication can "work very nicely" for someone dealing with severe anxiety or panic attacks, says Dr. Stuart Gitlow, executive director of the Annenberg Physician Training Program in Addictive Disease and former president of the board of directors for the American Society of Addiction Medicine. For example, a person may take a low dose of Ativan if they're experiencing panic attacks before boarding a plane. But when misused, Ativan could cause harmful side effects similar to alcohol, he says.

Prolonged use or abuse of Ativan will cause a person to "build up too much tolerance" to the point where the drug no longer works, Gitlow tells Rolling Stone. They would have to take higher and higher doses in order to "achieve the original effect" as the brain pushes back against "this outside artificial influence," he says. "When the brain pushes back, what that essentially means is that after the drug wears off, you're more anxious, more irritable, more distressed, more uncomfortable than you were to begin with."

People who've taken an excessive amount of Ativan may exhibit unusual behaviors, shakiness, trouble speaking and slurred speech, among other symptoms, according to the U.S. National Library of Medicine. Those side effects are made worse when the medication is combined with another substance, such as alcohol or barbiturates.

What is the correlation between Ativan and suicide?
Research has shown that benzodiazepines, like alcohol, can cause anterograde amnesia if a person takes an excessive amount of the drug. Anterograde amnesia – or what's otherwise known as "blackouts" – is the inability to create new memories, meaning that the brain doesn’t record events as they happen forward in time. In other words: You lose chunks of time.

Similar to alcoholic blackouts, people experiencing anterograde amnesia from consuming too many benzodiazepines can engage in disinhibited and dangerous behaviors. That can include driving while intoxicated, committing crimes and even attempting suicide, Lee says. "We've seen a lot of people who had no [prior] disruptive behaviors have really serious consequences from their benzodiazepine use," he tells Rolling Stone. "So it can be a serious problem." (Valeant Pharmaceuticals International, Inc., which manufactures Ativan, did not return Rolling Stone's request for comment.)

The experts who spoke with Rolling Stone noted that prolonged use or misuse of Ativan can exacerbate negative feelings in people with depression or a history of suicidal ideation (Cornell, a recovering addict, had been public about his issues with depression). Though rare, researchers have found a correlation between benzodiazepine misuse and increased suicide risk (a similar link has been with alcohol dependency). But it's highly unlikely that Ativan would be the sole cause of a completed suicide, as suicide has no single cause, says Dr. Jeffrey Lieberman, chair of psychiatry at New York-Presbyterian/Columbia University Medical Center and former president of the American Psychiatric Association.

If someone were to die by suicide during an Ativan blackout, he continues, they may have been dealing with underlying mental health issues. "Ativan would be the least contributory factor," Lieberman tells Rolling Stone.

Though not always, people who've attempted or died by suicide often exhibit signs beforehand, says Dr. Joel Dvoskin, a clinical psychologist and assistant professor in the University of Arizona's Department of Psychiatry. They may tell you they have no reason to live or that they feel like a burden to others. They may seem depressed or angry. They may act reckless, abuse drugs, or say goodbye without reason.

Yet routinely, he adds, people take these signs as someone "being dramatic" or as a "cry for help." "A suicide threat is a cry for help, but that doesn't mean they're not going to kill themselves," Dvoskin tells Rolling Stone. "If somebody says something that implies suicide, take it seriously."

What to do if you're concerned about taking Ativan
Do not stop taking Ativan cold turkey. A sudden drop-off in daily use could have harmful consequences; not only could your anxiety worsen, you may also experience withdrawal symptoms such as hallucinations, convulsions, headaches, stomach pains and trouble sleeping, according to the U.S. National Library of Medicine.

"Like alcohol, withdrawal from these drugs like Ativan can be dangerous, potentially deadly," Gitlow says. "So just stopping is not an option."

Instead, Gitlow tells Rolling Stone, people who want to stop taking Ativan would need to decrease their dose slowly and under the care of their doctor. When a person tapers off Ativan, your body will have time to adjust to life without the drug, minimizing withdrawal symptoms. But, he notes, you will feel worse during the process until about a month or two after you've ended use. "There is unfortunately no way around that," Gitlow said.

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255. You do not have to go through this alone.

Chris Cornell's wife Vicky issued a statement about her late husband. Watch here.