What is Lorazepam? The anxiety drug making waves in The White Lotus

If there’s one thing that keeps resurfacing in the latest season of HBO’s The White Lotus, it’s Lorazepam. The commonly prescribed anti-anxiety medication is casually (and frequently) taken by Victoria Ratliff (Parker Posey), the zoned-out matriarch of a wealthy North Carolina family holidaying at the show’s tropical outpost in Koh Samui, Thailand.

The drug takes centre stage from the very first episode, when Victoria insists that a massage could make her feel “very stressed out” and “claustrophobic” - but that Lorazepam helps her “really relax”. Her husband Tim (Jason Isaacs) later dips into the supply to calm his nerves after some stressful work dealings. And at one point, Victoria’s children even question why their mum needs so many anti-anxiety pills during a week-long stay at a wellness spa.

In The White Lotus, Lorazepam is mostly played for laughs - but Victoria’s dependency on it hints at deeper issues. So what exactly is Lorazepam, and how does it work? Dr. Jay Gong, a lecturer in clinical pharmacy practice and a senior clinical pharmacist, breaks down the facts.

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"Lorazepam is a part of a wider class of medication called benzodiazepines, they're known as depressants or sedatives or hypnotics," Dr Gong explains.

"These drugs basically decrease your brain activity, and how it works is it makes these neurochemical receptors in the brain work better, making your brain less excitable and enhancing the calming effect. But you can imagine over time as you're taking it, it's like putting the brakes on your brain. As your brain gets used to that, you have to take more and more to get the effects, and that's the addiction part of it."

Dr. Gong says the show gets it “pretty close”. Victoria’s casual reliance on the drug suggests long-term use, and her tendency to pair it with alcohol raises red flags.

"Victoria's taking it probably for social anxiety from the looks of things, and that's kind of an indication for Lorazepam, it's sort of well-known as a treatment for anxiety, but usually only in the short-term. You don't really know how long she's been on it, but it's funny even in the first episode you're like, what's this lady on? She's just a little bit lost.

"From the looks of it, she's mixing it with alcohol which is a no-no, because both alcohol and Lorazepam work together to enhance that sedation, that sort of calmness, but probably for her it's more like hypnosis. You can see that in the show, she's falling asleep at dinner."

Dr. Gong points to an interaction in the second episode that highlights one of Lorazepam’s potential side effects: memory loss, particularly when taken in high doses over an extended period.

"There's lots of times where it's suggested she's been on it for ages, like in episode two, Kate (Leslie Bibb) goes up to Victoria to say, 'Hey, we met at this baby shower in Austin 10 years ago, we spent this whole weekend together,' and she's like, 'I don't know what you're talking about'.

"And that could also be down to Lorazepam, memory loss is kind of part of it. It portrays a lot of those known side-effects of benzos [benzodiazepines] which I thought was really interesting."

"I don't know what people are thinking about Lorazepam in terms of him taking it, obviously we shouldn't be sharing medication, especially medication that's abusable," Dr Gong says.

"The short-term effect is, it's probably gonna make you feel calmer, which is what he's taking it for, obviously he's being investigated for his money-laundering, so he's trying to calm himself down, and people take it for that sedating effect to go to sleep.

"But you can definitely get addicted to benzodiazepines, and over time your body starts craving more of it, which is a telltale sign to watch out for. If patients are needing it more and more every week, it's a sign to see if other treatments are available, because you might be on that train of developing dependence."

Lorazepam use in The White Lotus has mostly been depicted through two characters seemingly adrift in a medicated haze. But as the season nears its finale, could things take a more dangerous turn?

Dr. Gong says misusing the drug can have a wide range of effects - some of them quite serious.

"In terms of The White Lotus, this kind of portrays someone who's on that road of dependence, relying on it, taking it throughout the day and not thinking much about it. But in some patients, you can even get sort of paradoxical effects, where they get really hyperactive.

"If you take too much, you can also get what we call respiratory failure, where you basically stop breathing because it's a depressant drug across the body. It can be very dangerous at high doses."

The White Lotus season three finale airs Monday, 7 April on Neon.