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The paradoxical effect is the name used to describe instances when, instead of decreasing anxiety and manic episodes, it actually increases them. While this can happen in some patients with the first dose, in a sense, it happens to virtually all patients who have become addicted. The difference is simply, when the effect happens in relation to when the medication is taken.

In the case of a simple side effect, the symptoms are usually apparent within minutes of taking Ativan. The patient will become agitated and difficult to deal with. The paradoxical effect will cause or worsen a panic attack.

In the case of Ativan abuse and addiction, the paradoxical effect is one of the primary withdrawal symptoms and may occur hours after the last dosage.

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