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While research on alcohol is evolving, the Centers for Disease Control and Prevention (CDC) says drinking less or not at all is better for your health. You may have seen plenty of on-screen characters sip whisky or wine to calm their nerves, but if you have an anxiety disorder, you may wonder if this habit really helps. While these drinks may calm anxiety at first, the alcohol in them can cause a rebound effect once the initial effects wear off, making you even more anxious than you were before.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292a588d30-f4e3-4796-96c4-456408e007ee Mixing alcohol and anxiety can also increase your risk for alcohol use disorder (alcohol addiction), which in turn can make your anxiety symptoms worse.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9bc624e-78ba-4320-aae5-dd36f2673d33 That’s because the two have a bidirectional relationship, says Sharon Batista, MD , a psychiatrist in private practice in New York City and an assistant clinical professor of psychiatry at Mount Sinai Hospital. “Alcohol can worsen anxiety, and anxiety can drive problematic alcohol use.”
Alcohol and Anxiety How Alcohol Affects Anxiety Disorders Alcohol acts on two chemical messengers ( neurotransmitters ) in your brain: glutamate and γ-aminobutyric acid (GABA) and glutamate.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c26c76d4-e077-4a0d-b52c-382e748aec68 When you drink, GABA activity essentially dampens anxiety, like the mute button on a remote. Your brain doesn’t understand why it got so quiet, so it tries to turn up the “volume” by making you more sensitive to glutamate, which increases excitability.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c26c76d4-e077-4a0d-b52c-382e748aec68 As your body processes alcohol, GABA decreases, but glutamate stays active at its new, increased level, which leaves you more anxious when not drinking, says Dr. Batista. “Alcohol also affects serotonin and dopamine pathways, both of which are implicated in mood and anxiety regulation,” she says. Not only does alcohol worsen anxiety, but your anxiety level can stay high for a long time after you stop drinking. “It is not until 12 or more hours after our last drink that the glutamate receptors start to decrease,” says Ashvin Sood, MD , a psychiatrist in private practice in Washington, DC. Because of the changes in brain activity prompted by alcohol, says Batista, drinking can worsen anxiety symptoms in the following ways.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290263eedc-f1c8-4be1-8a24-aee4dde7adcd Rebound Anxiety As mentioned, anxiety can increase as blood alcohol levels fall, especially after heavy or chronic use.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9bc624e-78ba-4320-aae5-dd36f2673d33 Sleep Disruption Alcohol interferes with the typical stages of sleep, leading to poor sleep quality, which can also affect anxiety. Withdrawal Even short-term withdrawal after moderate drinking can trigger anxiety symptoms in susceptible individuals. Neuroadaptation Chronic drinking leads to changes in brain chemistry that can make anxiety symptoms more persistent and severe.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 Dehydration Alcohol dehydrates you, and even mild dehydration can increase irritability and anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299cc476ab-8d60-4190-ab42-bd0ebe5dc8bb Alcohol can also lower your inhibitions, which may encourage you to do or say things you wouldn’t ordinarily do that leave you feeling embarrassed the next day. This can also increase feelings of anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290263eedc-f1c8-4be1-8a24-aee4dde7adcd
Drinking When Not Anxious Is It Safe to Drink When I Don’t Feel Anxious? Whether you experience bouts of anxiety occasionally or you have a diagnosed anxiety disorder, alcohol can make symptoms worse and can even prompt anxiety when you don’t often have it.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 “Current public-health consensus has shifted away from ‘a little is good for you,’” says Dr. Sood. “No level is safe for health.” Batista agrees, adding that even small amounts of alcohol can have negative consequences for people with anxiety, even when they don’t feel anxious before they drink.
Alcohol and Medication Does Alcohol Interact With Anxiety Medications? Alcohol can interact with anxiety medications, which can have dangerous effects.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e2f551b-094d-433f-9e5f-360790f2c85c The following anxiety medications are known to interact dangerously with alcohol and can lead to the following side effects.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d5402dd2-c36f-4ac9-8f9e-f735e9e1600b Benzodiazepines like alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan): respiratory depression, overdose, higher risk of accidents, and injury Sedating antidepressants like mirtazapine (Remeron): drowsiness and dizzinesse60dc2a1-f33c-4a05-9b50-8e3e8e597629e5cbfdaf-df60-4bd1-8c92-c1df5d6d44e0 Monoamine oxidase inhibitors like tranylcypromine (Parnate) and phenelzine (Nardil): dangerous blood pressure increase Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta): increased sedation “Basically, [the effects of any medication] that causes you to be tired and decreases your rate of breathing will be supercharged with alcohol,” says Sood.
Before You Drink Are Some Alcoholic Drinks Safer for Anxiety Disorders Than Others? No amount of alcohol is completely safe for people with anxiety disorders, and no research has found that one type of alcohol is better than another if you have these conditions.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 “Our culture often downplays the harms of alcohol, but the reality is that no amount of alcohol is entirely without risk — either for the general population or for those with anxiety disorders,” says Batista. But heavier drinking can have a stronger impact on anxiety symptoms than lighter drinking, so if you choose to drink, it may help to limit how much you have.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9bc624e-78ba-4320-aae5-dd36f2673d33 Sood recommends tracking drink equivalents so you know exactly how much you’re having. “Know the numbers,” says Sood. “One U.S. standard drink equals about 14 grams (g) of alcohol — the amount in 12 ounces (oz) of 5 percent beer, 5 oz of wine, and 1.5 oz of spirits.” Some drinks have more alcohol than others. Drinks with lower concentrations of alcohol include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762909d7b45a-0146-4a6f-80b2-1f9fb5bf4689 Beer (4 to 8 percent, or 8 to 12 percent for craft beer) Wine (14 to 16 percent) Champagne (12.5 percent) Hard seltzer (4 to 12 percent) Kombucha (0.5 to 2.5 percent)
Safe Drinking Practices for People With Anxiety Disorders If you don’t want to say a permanent goodbye to alcohol, you can practice certain habits to keep you safer. Batista recommends these strategies.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954db32b1-5fc6-4dd3-bc0f-cd1ad2d0553d Set clear limits on how much and how often you drink. Avoid alcohol when you’re feeling anxious or when taking sedating medications. Never use alcohol as a coping strategy for anxiety symptoms. Eat a nutritious diet and stay hydrated. Monitor any increase in anxiety symptoms after drinking and adjust your drinking habits accordingly. Seek professional help if alcohol use becomes difficult to control. Timing also matters, says Sood. He recommends no alcohol within four to six hours of bedtime to protect deep sleep and prevent sleep disruptions and next-day anxiety. Sood also suggests writing down your drink limit for the day before your first sip and scheduling alcohol-free days when you don’t drink at all. Sood always encourages his patients to tell their doctor or therapist if alcohol has become a problem for them. “Most of us have shame when sharing our relationship with alcohol and anxiety,” says Sood. “[But] stigma is slowly going down, and we often will approach with empathy and patience, and can point you to the right resources.” The Takeaway Alcohol may ease anxiety symptoms at first, but anxiety often returns to the same level or worse once your drink wears off. There is no safe level of alcohol when you have anxiety, which can worsen symptoms and interact with anxiety medications. If lowering your alcohol intake feels like a challenge, let your healthcare provider know. They can help you develop safe drinking strategies and other anxiety coping techniques.
Resources We Trust Mayo Clinic: 11 Tips for Coping With an Anxiety DisorderCleveland Clinic: Anxiety and Alcohol: Does Drinking Worsen Symptoms?American Addiction Centers: Alcohol and Anxiety: Does Alcohol Cause Anxiety and Panic Attacks?Anxiety and Depression Association of America: Social Anxiety Disorder and Alcohol AbuseAmerican Psychological Association: Understanding Alcohol Use Disorders and Their Treatment
Alcohol and Anxiety How Alcohol Affects Anxiety Disorders Alcohol acts on two chemical messengers ( neurotransmitters ) in your brain: glutamate and γ-aminobutyric acid (GABA) and glutamate.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c26c76d4-e077-4a0d-b52c-382e748aec68 When you drink, GABA activity essentially dampens anxiety, like the mute button on a remote. Your brain doesn’t understand why it got so quiet, so it tries to turn up the “volume” by making you more sensitive to glutamate, which increases excitability.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c26c76d4-e077-4a0d-b52c-382e748aec68 As your body processes alcohol, GABA decreases, but glutamate stays active at its new, increased level, which leaves you more anxious when not drinking, says Dr. Batista. “Alcohol also affects serotonin and dopamine pathways, both of which are implicated in mood and anxiety regulation,” she says. Not only does alcohol worsen anxiety, but your anxiety level can stay high for a long time after you stop drinking. “It is not until 12 or more hours after our last drink that the glutamate receptors start to decrease,” says Ashvin Sood, MD , a psychiatrist in private practice in Washington, DC. Because of the changes in brain activity prompted by alcohol, says Batista, drinking can worsen anxiety symptoms in the following ways.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290263eedc-f1c8-4be1-8a24-aee4dde7adcd Rebound Anxiety As mentioned, anxiety can increase as blood alcohol levels fall, especially after heavy or chronic use.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9bc624e-78ba-4320-aae5-dd36f2673d33 Sleep Disruption Alcohol interferes with the typical stages of sleep, leading to poor sleep quality, which can also affect anxiety. Withdrawal Even short-term withdrawal after moderate drinking can trigger anxiety symptoms in susceptible individuals. Neuroadaptation Chronic drinking leads to changes in brain chemistry that can make anxiety symptoms more persistent and severe.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 Dehydration Alcohol dehydrates you, and even mild dehydration can increase irritability and anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299cc476ab-8d60-4190-ab42-bd0ebe5dc8bb Alcohol can also lower your inhibitions, which may encourage you to do or say things you wouldn’t ordinarily do that leave you feeling embarrassed the next day. This can also increase feelings of anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290263eedc-f1c8-4be1-8a24-aee4dde7adcd
Drinking When Not Anxious Is It Safe to Drink When I Don’t Feel Anxious? Whether you experience bouts of anxiety occasionally or you have a diagnosed anxiety disorder, alcohol can make symptoms worse and can even prompt anxiety when you don’t often have it.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 “Current public-health consensus has shifted away from ‘a little is good for you,’” says Dr. Sood. “No level is safe for health.” Batista agrees, adding that even small amounts of alcohol can have negative consequences for people with anxiety, even when they don’t feel anxious before they drink.
Alcohol and Medication Does Alcohol Interact With Anxiety Medications? Alcohol can interact with anxiety medications, which can have dangerous effects.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e2f551b-094d-433f-9e5f-360790f2c85c The following anxiety medications are known to interact dangerously with alcohol and can lead to the following side effects.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d5402dd2-c36f-4ac9-8f9e-f735e9e1600b Benzodiazepines like alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan): respiratory depression, overdose, higher risk of accidents, and injury Sedating antidepressants like mirtazapine (Remeron): drowsiness and dizzinesse60dc2a1-f33c-4a05-9b50-8e3e8e597629e5cbfdaf-df60-4bd1-8c92-c1df5d6d44e0 Monoamine oxidase inhibitors like tranylcypromine (Parnate) and phenelzine (Nardil): dangerous blood pressure increase Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta): increased sedation “Basically, [the effects of any medication] that causes you to be tired and decreases your rate of breathing will be supercharged with alcohol,” says Sood.
Before You Drink Are Some Alcoholic Drinks Safer for Anxiety Disorders Than Others? No amount of alcohol is completely safe for people with anxiety disorders, and no research has found that one type of alcohol is better than another if you have these conditions.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8563df-19e8-42d9-87d1-a356fcd75fb9 “Our culture often downplays the harms of alcohol, but the reality is that no amount of alcohol is entirely without risk — either for the general population or for those with anxiety disorders,” says Batista. But heavier drinking can have a stronger impact on anxiety symptoms than lighter drinking, so if you choose to drink, it may help to limit how much you have.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e9bc624e-78ba-4320-aae5-dd36f2673d33 Sood recommends tracking drink equivalents so you know exactly how much you’re having. “Know the numbers,” says Sood. “One U.S. standard drink equals about 14 grams (g) of alcohol — the amount in 12 ounces (oz) of 5 percent beer, 5 oz of wine, and 1.5 oz of spirits.” Some drinks have more alcohol than others. Drinks with lower concentrations of alcohol include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762909d7b45a-0146-4a6f-80b2-1f9fb5bf4689 Beer (4 to 8 percent, or 8 to 12 percent for craft beer) Wine (14 to 16 percent) Champagne (12.5 percent) Hard seltzer (4 to 12 percent) Kombucha (0.5 to 2.5 percent)
Safe Drinking Practices for People With Anxiety Disorders If you don’t want to say a permanent goodbye to alcohol, you can practice certain habits to keep you safer. Batista recommends these strategies.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954db32b1-5fc6-4dd3-bc0f-cd1ad2d0553d Set clear limits on how much and how often you drink. Avoid alcohol when you’re feeling anxious or when taking sedating medications. Never use alcohol as a coping strategy for anxiety symptoms. Eat a nutritious diet and stay hydrated. Monitor any increase in anxiety symptoms after drinking and adjust your drinking habits accordingly. Seek professional help if alcohol use becomes difficult to control. Timing also matters, says Sood. He recommends no alcohol within four to six hours of bedtime to protect deep sleep and prevent sleep disruptions and next-day anxiety. Sood also suggests writing down your drink limit for the day before your first sip and scheduling alcohol-free days when you don’t drink at all. Sood always encourages his patients to tell their doctor or therapist if alcohol has become a problem for them. “Most of us have shame when sharing our relationship with alcohol and anxiety,” says Sood. “[But] stigma is slowly going down, and we often will approach with empathy and patience, and can point you to the right resources.” The Takeaway Alcohol may ease anxiety symptoms at first, but anxiety often returns to the same level or worse once your drink wears off. There is no safe level of alcohol when you have anxiety, which can worsen symptoms and interact with anxiety medications. If lowering your alcohol intake feels like a challenge, let your healthcare provider know. They can help you develop safe drinking strategies and other anxiety coping techniques.
Resources We Trust Mayo Clinic: 11 Tips for Coping With an Anxiety DisorderCleveland Clinic: Anxiety and Alcohol: Does Drinking Worsen Symptoms?American Addiction Centers: Alcohol and Anxiety: Does Alcohol Cause Anxiety and Panic Attacks?Anxiety and Depression Association of America: Social Anxiety Disorder and Alcohol AbuseAmerican Psychological Association: Understanding Alcohol Use Disorders and Their Treatment
