Effects of lorazepam on mood and cognition
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Lorazepam and Cognitive Effects: Memory, Attention, and Psychomotor Performance
Research consistently shows that lorazepam impairs several aspects of cognition, especially memory and psychomotor performance. Both short-term and long-term users experience significant difficulties with memory recall and slowed psychomotor speed after taking lorazepam, with these effects being particularly pronounced in elderly individuals and those at higher risk for cognitive decline, such as APOE-epsilon4 carriers 110. Lorazepam’s impact on memory is mainly anterograde, meaning it affects the ability to form new memories after taking the drug, while retrieval of information learned before administration is less affected . These cognitive impairments are not solely due to sedation, as lorazepam can cause memory, attention, and visual perception deficits even at doses that produce similar sedative effects as other benzodiazepines 45.
Lorazepam also impairs concentration and executive functioning, with some studies suggesting it has a greater negative effect on information processing and concentration than other benzodiazepines like clobazam . The degree of cognitive impairment can vary depending on the dose, with higher doses causing more severe memory problems . Notably, lorazepam’s cognitive effects may differ from other benzodiazepines, indicating that not all drugs in this class have the same impact on cognitive functions 45.
Lorazepam and Mood: Anxiolytic and Sedative Effects
Lorazepam is well-known for its anxiolytic (anxiety-reducing) and sedative properties. In studies comparing lorazepam to other drugs, it consistently produces increased ratings of sedation and subjective drug effects, such as feeling the drug’s presence and liking its effects . Lorazepam can reduce anxiety and has a calming effect, which is why it is often prescribed for panic attacks and anxiety disorders 29. However, in elderly long-term users, acute administration of lorazepam did not significantly change self-ratings of mood, sedation, or anxiety for the group as a whole, though some individuals with generalized anxiety disorder showed different responses .
While lorazepam can improve mood by reducing anxiety, its positive mood effects are often accompanied by cognitive and psychomotor impairments 26. In some cases, lorazepam’s mood-stabilizing benefits are offset by a return of anxiety after a short period, leading to the need for alternative medications .
Individual Differences and Special Populations
The cognitive effects of lorazepam can be more pronounced in certain populations. For example, healthy late-middle-aged individuals who carry the APOE-epsilon4 allele, a genetic risk factor for Alzheimer’s disease, experience greater declines in verbal and visuospatial memory after lorazepam compared to noncarriers . Elderly individuals, especially those on long-term lorazepam therapy, are also at higher risk for cognitive side effects, with little evidence of therapeutic benefit in terms of mood or anxiety reduction .
Summary
Lorazepam is effective at reducing anxiety and producing sedation, but it consistently impairs memory, attention, and psychomotor performance, with these effects being more severe at higher doses and in vulnerable populations such as the elderly and those at genetic risk for cognitive decline 1245+3 MORE. While it can improve mood by reducing anxiety, these benefits are often accompanied by significant cognitive side effects. Clinicians should carefully weigh the risks and benefits of lorazepam, especially in populations at risk for cognitive impairment.
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