Beer for anxiety

Alcohol and anxiety: Panic Attacks After Drinking

What is anxiety?

Anxiety is a feeling of worry or fear about what’s going to happen.¹ It can be mild or severe and affect your thoughts, the way you feel, and often has physical symptoms like increasing your heart rate, making you sweat or tremble.²

Most people feel anxious from time to time. It’s a natural human response and usually passes once the situation is over - for example around a job interview. But if you have feelings of anxiety that are constant, overwhelming, or affect your daily life, there are things you can do, and support that is available to help you manage.

This page explains more about anxiety, why alcohol can trigger it or make it worse, and steps you can take to feel better.

Types of anxiety and symptoms

Anxiety can become a health problem if it affects your ability to live your life as fully as you want to.

Several medical categories relating to anxiety are used by doctors – these include generalised anxiety disorder (GAD), social anxiety, panic attacks and phobias.³ One thing they have in common is they cause your body to go into ‘fight or flight’ mode, releasing hormones into your bloodstream to prepare you to react or run away.⁴

It can cause symptoms like feeling tired, having trouble concentrating or sleeping, headaches or tummy aches - as well as many others.⁵

And because of the way alcohol interferes with your ‘fight or flight’ response,⁶ drinking can make you more vulnerable to these anxiety disorders,^7,8 and make symptoms worse.⁹

Find out more about different types of anxiety on the Mind website

How alcohol affects anxiety

Alcohol is a depressant. It slows down processes in your brain and central nervous system, and can initially make you feel less inhibited. ^10,11 In the short-term, you might feel more relaxed - but these effects wear off quickly.

In fact, if you’re experiencing anxiety, drinking alcohol could be making things worse.

Over time, if you regularly drink heavily, the central nervous system gets used to the supressing effect of the alcohol, which means your brain is affected if the alcohol level suddenly drops. You can go straight into ’fight or flight’ mode as the alcohol leaves your system – the same reaction as an anxiety disorder.¹²

Find out more about alcohol withdrawal

Alcohol and anxiety – the vicious circle

If you suffer from anxiety, it’s important not to be tricked by the temporary feeling of relaxation from drinking alcohol, to avoid being trapped in a vicious circle:

You drink alcohol
You initially feel calm as the alcohol affects the brain
You feel anxious as a symptom of alcohol withdrawal

You may want to drink again to try to relieve your anxiety

But the last step only starts the process again from the beginning. As the initial calm feeling fades you can feel anxiety as the effects of the alcohol wear off.

The more you drink the greater your tolerance for alcohol - meaning you need to drink more alcohol to get the same feeling. If you rely on alcohol to mask anxiety, you may find you become reliant on it to relax – putting you at risk of alcohol dependence.

Alcohol and panic attacks

If you experience sudden, intense anxiety and fear, it might be the symptoms of a panic attack.¹³ Other symptoms may include a racing heartbeat, or feeling faint, dizzy, lightheaded, or sick.

A panic attack usually lasts 5 to 30 minutes. They can be frightening, but they're not dangerous and shouldn’t harm you.

If you suffer from panic attacks, cut right down on your alcohol consumption, if you drink.

Alcohol has an effect on brain chemistry - it can induce panic because of its effects on GABA, a chemical in the brain that normally has a relaxing effect. Small amounts of alcohol can stimulate GABA and cause feelings of relaxation, but heavy drinking can deplete GABA, causing increased tension and feelings of panic.^14,15Panic attacks can occur due to alcohol withdrawal.

NHS advice on getting help for panic attacks

How to prevent alcohol causing or worsening anxiety

If you feel like you’re struggling with anxiety, try cutting back on the amount of alcohol you drink. Try this four-step guide, to get started:

Track

Track how much you’re drinking to help spot patterns so you can avoid triggers – the MyDrinkaware app can help.

Download the app

Reduce

If you’re drinking more than the UK low risk drinking guidelines (no more than 14 units a week for both men and women) try to cut down. It’s safer to make gradual, small reductions (not sudden large changes).
We have advice on how to take a break from alcohol, but if you’re worried you are dependent on alcohol talk to your GP surgery or contact an alcohol support service.

Take a break

Maintain

Once you’ve cut down your drinking (or stopped drinking altogether), keep going like this for a couple of weeks. Most people can expect to see an improvement in their anxiety symptoms in this time as the brain’s balance of chemicals and processes start to return to normal and you experience better quality sleep⁶.

Better sleep

Review

If you’re still feeling anxious after a few weeks, contact your GP surgery. Talking therapies like CBT (cognitive behavioural therapy), can help you learn to spot unhelpful patterns of behaviour and help you to develop coping strategies. Your GP should be able to tell you about local services.

Alcohol support

Anxiety and depression

Anxiety is different to depression, but they can sometimes go together – feeling anxious and worrying constantly can make you feel low. And depression is affected by alcohol too - find out more on our alcohol and depression webpage.

Alcohol and depression

Get help

The NHS website, Every Mind Matters, has advice on how to access support and treatment for anxiety in England. This includes options for NHS support, links to charities, helplines and communities, and tips on self-care.

NHS Every Mind Matters – support and treatment for anxiety

if you are in Scotland, Wales or Northern Ireland, there is separate advice on getting help with anxiety.

Scotland – NHS inform
Wales – NHS mental health and wellbeing
Northern Ireland – NI Direct, mental health

Specific support is also available if you need help with your drinking.

Find out more about alcohol support services

Alcohol support services

If you are concerned that you or someone you care about has a problem with alcohol there is a lot of help available. Here you can find useful links and phone numbers to get the support you need.

Support services

What to expect when you stop drinking The benefits of drinking less Alcohol and depression How to reduce your drinking

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References

[1] Mind website. What is anxiety? (Accessed 20 April 2022). Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/about-anxiety/

[2] NHS website, Every mind matters. What is anxiety? (Accessed 20 April 2022) https://www.nhs.uk/every-mind-matters/mental-health-issues/anxiety/#what-is-anxiety

[3] Mind website. What are anxiety disorders? (Accessed 20 April 2022) Available at: https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/anxiety-disorders/

[4] NHS website, Every mind matters. What causes anxiety? (Accessed 20 April 2022) Available at: https://www. nhs.uk/every-mind-matters/mental-health-issues/anxiety/#causes

[5] ibid

[6] Day, E., & Daly, C. (2021). Clinical management of the alcohol withdrawal syndrome. Addiction.

[7] Holmes, A., Fitzgerald, P. J., MacPherson, K. P., DeBrouse, L., Colacicco, G., Flynn, S. M., Masneuf, S., Pleil, K. E., Li, C., Marcinkiewcz, C. A., Kash, T. L., Gunduz-Cinar, O., & Camp, M. (2012). Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding. Nature neuroscience, 15(10), 1359–1361. https://doi.org/10.1038/nn.3204

[8] Anker, J. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging the Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Research: Current Reviews, 40(1), arcr.v40.1.03. https://doi.org/10.35946/arcr.v40.1.03

[9] Gorka, S. M., & Phan, K. L. (2017). Impact of anxiety symptoms and problematic alcohol use on error-related brain activity. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 118, 32–39. https://doi.org/10.1016/j.ijpsycho.2017.05.011

[10] Gan, G., Guevara, A., Marxen, M., Neumann, M., Jünger, E., Kobiella, A., Mennigen, E., Pilhatsch, M., Schwarz, D., Zimmermann, U.S. and Smolka, M.N., 2014. Alcohol-induced impairment of inhibitory control is linked to attenuated brain responses in right fronto-temporal cortex. Biological psychiatry, 76(9), pp.698-707. Available at: biologicalpsychiatryjournal.com/article/S0006-3223(14)00015-8/abstract. [Accessed 23 February 2017].

[11] Klenowski, P. M. (2018). Emerging role for the medial prefrontal cortex in alcohol-seeking behaviors. Addictive Behaviors, 77, 102–106. https://doi.org/10.1016/j.addbeh.2017.09.024

[12] Day, E., & Daly, C. (2021). Clinical management of the alcohol withdrawal syndrome. Addiction.

[13] NHS website. Panic disorder. (Accessed 18 May 2022). Available at: https://www.nhs.uk/mental-health/conditions/panic-disorder/

[14] Cosci, F. , Schruers, K. R., Abrams, K., & Griez, E. J. (2007). Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship. The Journal of Clinical Psychiatry, 68(6)

[15] Gimeno, C., Dorado, M. L., Roncero, C., Szerman, N., Vega, P., Balanzá-Martínez, V., & Alvarez, F. J. (2017). Treatment of Comorbid Alcohol Dependence and Anxiety Disorder: Review of the Scientific Evidence and Recommendations for Treatment. Frontiers in Psychiatry, 8, 173. https://doi.org/10.3389/fpsyt.2017.00173

[16] Driessen, M., Meier, S., Hill, A., Wetterling, T., Lange, W. and Junghanns, K. (2001). The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders. Alcohol and Alcoholism, 36(3), 249-255.

Last Reviewed: 1st July 2022

Next Review due: 1st July 2025

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Tips to change your relationship with alcohol

Alcohol and Anxiety: Causes, Risks and Treatment

Understanding anxiety

When dealing with stressful days or nervous situations, you may be tempted to have a glass of wine or a beer to calm your nerves. However, drinking alcohol, especially heavily and over a long period of time, can actually increase your anxiety.

Drinking alcohol can have serious consequences if you’re being treated for anxiety. Having a drink might seem like a good way to ease anxiety, but you may be doing more harm than good.

There’s some truth to the idea that alcohol can reduce stress. Alcohol is a sedative and a depressant that affects the central nervous system.

At first, drinking can reduce fears and take your mind off of your troubles. It can help you feel less shy, give you a boost in mood, and make you feel generally relaxed. In fact, alcohol’s effects can be similar to those of antianxiety medications.

Occasionally unwinding with alcohol isn’t necessarily dangerous if your doctor approves. But once you start drinking, you can build a tolerance to the de-stressing effects of alcohol. This can make anxiety and stress even more difficult to cope with.

Drinking excessive amounts of alcohol can also have noticeable physical and mental consequences. Over time, consuming too much alcohol can lead to blackouts, loss of memory, and even brain damage (especially if it causes other health problems, such as liver damage). These issues can create more anxiety as you cope with their symptoms.

Learn more: Alcohol-related liver disease »

The sense of relaxation you feel when you drink can often be attributed to your blood alcohol content (BAC). A rise in BAC levels leads to temporary feelings of excitement, but feelings of depression occur as BAC levels fall. As a result, it’s possible that having a few drinks that make your BAC rise and then fall back to normal again can make you more anxious than you were before.

Alcohol changes levels of serotonin and other neurotransmitters in the brain, which can worsen anxiety. In fact, you may feel more anxious after the alcohol wears off.

Alcohol-induced anxiety can last for several hours, or even for an entire day after drinking.

Using alcohol to cope with social anxiety disorder can be dangerous. According to the Anxiety and Depression Association of America (ADAA), about 7 percent of Americans have this form of anxiety.

With social anxiety, you may find social situations unbearable. It’s common for people with social anxiety disorder to drink alcohol to cope with social interactions. Doing this can lead to a dependence on alcohol during socializing, which can make anxiety symptoms worse.

About 20 percent of people with social anxiety disorder also suffer from alcohol dependence.

Besides needing alcohol to feel comfortable when socializing, other signs of dependence include:

needing a drink to get going in the morning
drinking heavily four or more days per week
requiring a drink at every get-together
an inability to stop drinking
drinking five or more alcoholic beverages in one day

Read more: Alcohol addiction »

Overconsumption of alcohol can also lead to hangovers. A hangover can cause symptoms that make you feel more anxious than you were, including:

headaches
dizziness
nausea
dehydration
low blood glucose (sugar)

The long-term consequences of alcohol abuse can be a variety of health problems, including mental health disorders.

Research shows that people with alcoholism find it difficult to recover from traumatic events. This is possibly because of the effects of alcohol abuse, which can actually change brain activity.

Long-term heavy drinkers may be predisposed to developing an anxiety disorder. However, there is no evidence that moderate drinking will cause anxiety.

Increased anxiety is also a symptom of alcohol withdrawal. If you’ve consumed alcohol in large amounts for a long period of time and suddenly stop drinking, your anxiety can be aggravated by the side effects of alcohol withdrawal. Other symptoms of alcohol withdrawal include:

trembling hands
sweating
heart rate above 100 beats per minute
hallucinations
nausea
vomiting
seizures

Moderate drinking is not the same for all genders and age groups. In the United States, “moderate” typically refers to two drinks a day for adult men and one for women. Older adults metabolize alcohol faster, so if you’re in this age group, limit yourself to one alcoholic beverage per day. Ask your doctor if moderate alcohol consumption is suitable for you.

The benefits of alcohol consumption can sometimes be outweighed by the risks, which include:

depression
obesity
liver disease
cardiovascular damage

Alcohol affects everyone differently. It can cheer you up after a rough day or make you feel more sedated. Discuss these concerns with your doctor first to see if alcohol is safe for you.

Keep in mind that you may not safely drink alcohol if you have:

a low tolerance for drinking
anxious or aggressive tendencies
a mental health disorder

Alcohol isn’t an anxiety treatment. Seek help from a mental health professional if you have anxiety. If you think you have a problem with alcohol, seek help from your doctor right away.

Many treatment options exist for anxiety.

Treatment may depend on the type of anxiety you have. If you have social anxiety or a social phobia, therapy may work best to reduce your levels of anxiety (combined with a medication such as sertraline, or Zoloft). If you have generalized anxiety disorder (GAD), an ongoing feeling of worry or stress without a specific cause, your doctor may recommend learning behaviors or skills to help you stop avoiding activities because of anxiety (known as cognitive behavioral therapy, or CBT), or talking about your anxiety with a therapist.

Your doctor may also prescribe medications.

Each type of medication treats anxiety in a different way. Antidepressants may be taken every day to help treat anxiety, while benzodiazepines are generally used for temporary relief from uncontrollable feelings of anxiety. Talk to your doctor to decide which type of medication is best for you.

Some of these medications may interact with alcohol. Talk to your doctor about alcohol consumption before taking any of these medications, as side effects can be harmful or fatal.

Online therapy options

Read our review of the best online therapy options to find the right fit for you.

Anxiety can be treated, but it isn’t always curable. However, you can make lifestyle changes to help you reduce your anxiety as well as learn to cope with it.

There are some daily changes you can make to reduce your anxiety.

Reduce anxiety

Sleep regularly and consistently, around 6 to 8 hours a night, depending on your age.
Limit the amount of caffeine and alcohol you consume, as both can increase your level of anxiety.
Eat consistent and healthy meals every day.
Set aside time every day to focus on relaxation techniques, such as meditation or yoga.
Make time each day to engage in a relaxing hobby, such as listening to music or painting.

You can also learn to cope with your anxiety by slowing it and preventing it from increasing and causing panic attacks:

Slowly breathe in and breathe out to calm yourself down when you begin to feel anxious.
Think positive thoughts when you feel your thoughts becoming too negative or overwhelming.
Slowly count from 1 to 10 or higher until feelings of anxiety begin to fade.
Focus on something that makes you laugh or feel positive emotions until your anxiety starts to fade.

Why hangover anxiety occurs and what to do about it

January 3, 2020 Health

If after the next party you suffer from anxiety and memory lapses, this article is for you.

Alcohol calms the brain. It acts on gamma-aminobutyric acid (GABA) receptors, and they give a signal to slow down the activity of nerve cells. “So you become joyful and relaxed when you drink,” explains David Nutt, professor of neuropsychopharmacology at Imperial College London.

The first two drinks of alcohol put you in a blissful state of calm caused by GABA. When you get to your third or fourth drink, another brain-slowing process kicks in. Substances in alcohol reduce the activity of glutamate, the main excitatory neurotransmitter in the brain.

The less glutamate, the less anxiety, and vice versa. So when people get drunk, they don't worry about anything. In this state, it seems that life is beautiful, but do not rush to conclusions.

Soon the body fixes the imbalance of chemicals in the brain and tries to correct the situation. This is similar to the processes that occur when you eat a lot of sweets. To normalize blood sugar levels, the body produces a lot of insulin. But as soon as the sweetness eaten is digested, the accumulated hormone causes a sharp drop in glucose levels, which makes you want to eat.

The situation is similar with alcohol. The body tries to normalize the levels of GABA and glutamate.

Therefore, after heavy drinking, you will find an extremely low content of GABA and a jump in glutamate. This is what leads to anxiety. And also to convulsions, which often occur with a hangover. The brain needs a couple of days to return to normal. “If you've been drinking a lot for a long time, it can take weeks to recover,” Nutt says. “And in alcoholics, changes in GABA levels are observed for years.”

These processes usually run while you are trying to sleep. “People who are drunk fall asleep quickly,” Nutt continues. “Their sleep is deeper than when they are sober, which explains the cases of involuntary urination and nightmares. After about four hours, breaking begins. The person wakes up trembling and nervous.”

However, GABA and glutamate imbalances are not the only problem. Alcohol also causes a small increase in norepinephrine. This hormone is involved in the fight-or-flight response. At first it suppresses stress, but then, on the contrary, increases it. So increased anxiety is a sign of norepinephrine release.

Another cause of hangover anxiety is the inability to remember what you said and did while you were drunk.

This is caused by an abnormal glutamate level. We need it to form memories. After the sixth or seventh glass of alcohol, glutamate receptors are blocked by ethanol, so you won't remember anything in the morning.

However, hangover anxiety does not affect everyone equally. The researchers asked healthy young adults how anxious they felt before and during drinking, as well as the morning after.

According to psychopharmacologist Celia Morgan, shy people are much more anxious the next morning. Perhaps this comes from the fact that their GABA levels are initially low. But it could also be a matter of psychology. Anxious people are usually more prone to obsessive thoughts about the past.

Unfortunately, there's not much you can do about it other than drink less. Take a painkiller in the morning so that your head does not bother you. And in any case, do not treat hangover anxiety with a new portion of alcohol. This is the path to addiction.

Try to get out of the vicious circle. “Before you drink in company, to feel more confident, imagine a hangover the next day,” says Morgan. "If you can't socialize without alcohol, you'll be stuck in this circle, and your hangover anxiety will only increase. "

7 reasons not to "treat" anxiety with alcohol

It's no secret that there is a connection between alcohol and anxiety. But a recent study found that alcohol exacerbates symptoms of anxiety and fear. Experts talk about this in detail and explain how to improve the situation.

Vita Zorina

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1. At first, alcohol gives confidence

But this effect is short-lived. Many people loosen up under the influence of alcohol and stop experiencing social anxiety for a while. This is due to the fact that alcohol upsets the chemical balance in the brain, but pretty soon the pleasant sensations end.

2. The level of serotonin decreases

Since alcohol is a depressant, it negatively affects the level of serotonin, the "happiness hormone". As a result, anxiety rises.

3. You have to drink more and more

Alas, the body gradually becomes more tolerant to alcohol, more and more alcohol is required to achieve the same effect. It turns out a vicious circle, and if you constantly do this, the consequences will be devastating for mental health.

4. And then comes a disturbing hangover

You may not have a headache or nausea, but the sensations are very unpleasant. Heart palpitations, dizziness, trembling hands - all this can provoke an attack. You can also start to worry that these are symptoms of something more than a hangover. Dehydration and low levels of serotonin add their share to the unhealthy state.

5. Short-term memory may deteriorate

Has it ever happened that after the next party you barely remember what you were doing? If an anxiety disorder is added to this, you feel even worse. Meanwhile, alcohol really impairs memory, and “here I remember, here I don’t remember” is a symptom that manifests itself in very many people.

5. Increased risk of developing alcohol addiction

A study in the United States showed that 20% of people with social anxiety have an alcohol addiction.

7. Sleep worsens

Alcohol changes the sleep pattern, which affects mood and vitality. As a result, a person often feels anxiety, it becomes more and more difficult for him to cope with everyday activities.

What to do with this unpleasant phenomenon?

1.

Learn more