Q: Sometimes I feel really anxious the day after I drink. Can alcohol cause a panic attack?
The short answer is yes.
Panic attacks — sudden waves of overwhelming fear and apprehension, along with physical symptoms like chest pain and tightness, sweating, a racing heartbeat, nausea, difficulty breathing, feeling faint or numbness in the arms and hands — are intense episodes of anxiety.
And alcohol and anxiety are considered “two sides of the same coin,” said Dr. Alëna Balasanova, an associate professor of psychiatry and the director of addiction psychiatry education at the University of Nebraska Medical Center.
While drinking is often used as a social lubricant or a way to relax and unwind, scientists have found that alcohol can ramp up feelings of anxiety. These feelings can result when alcohol is metabolized by the body, a process that can take a day or longer to complete. Regular, heavy drinkers may experience higher levels of anxiety, particularly after the alcohol wears off.
“I don’t want to scare people to think that if you go out and you have a few glasses of wine, that you’re going to have a panic attack,” Dr. Balasanova said. “But certainly the risk is always there.”
And that risk is higher if you already have an anxiety disorder.
Ideally, “people who are prone to anxiety should avoid heavy drinking, or drinking at all, even if alcohol seems to alleviate anxiety in the short term,” said Jennifer E. Merrill, an associate professor of behavioral and social sciences at Brown University.
The Vicious Cycle of Alcohol and Anxiety
Scientists don’t fully understand how alcohol and anxiety are linked, but they do know that people with alcohol use disorder, a pattern of frequent drinking that is difficult to control and persists despite distress or problems functioning, have higher risks of developing anxiety disorders and vice versa.
When you drink alcohol, the brain ramps up the release of a chemical called gamma-aminobutyric acid, or GABA, which helps us feel calm. Alcohol also inhibits the release of a neurotransmitter called glutamate, which is associated with anxiety. These disruptions can make people feel more relaxed.
But if you become physically dependent on alcohol — after years of drinking heavily, for example — the constant ramping up of GABA can cause the brain to produce less of it, and glutamate becomes more dominant. The brain then becomes “hyperexcitable,” which can lead to symptoms like panic attacks, said Dr. Kathleen Brady, an addiction expert and professor of psychiatry at the Medical University of South Carolina.
Federal health officials define heavy drinking as consuming five or more drinks per day (or 15 or more per week) for men, and four or more per day (or eight or more per week) for women.
But, Dr. Brady added, even those who drink moderately — two or fewer drinks in a day for men and no more than one drink in a day for women — can experience alcohol-induced panic attacks, particularly if they have an anxiety disorder or have had a panic attack in the past.
Alcohol can also cause you to become dehydrated or to sleep poorly, which might make someone feel more anxious than usual, Dr. Balasanova said. Using alcohol to self-soothe and cope with anxiety may only create more anxiety in the long run, she added, perpetuating a vicious cycle.
How to Handle an Alcohol-Induced Panic Attack
There are ways to cope with a panic attack, regardless of whether it’s caused by alcohol or something else. It is counterproductive to try to fight it or distract yourself, said David Carbonell, a psychologist in Chicago who helps patients with anxiety disorders.
You can, however, take steps to better understand what’s happening in your body and help yourself feel more comfortable. Dr. Carbonell advises his patients to try the AWARE method.
AWARE is an acronym that involves acknowledging and accepting that the panic attack is happening: Recognize that you are afraid but not in danger. Then, wait and observe how you feel. You can try actions like belly breathing, but it is important to acknowledge that it isn’t your responsibility to make the panic attack end. Repeat the steps as needed. Regardless of how you respond, a panic attack will generally end in under 15 minutes.
It’s freeing when you realize you don’t have to work to stop the panic, Dr. Carbonell said. “In fact, the harder I try to make it end, the more I’m going to be aggravating myself,” he added.
If you’re concerned about your alcohol use or anxiety, Dr. Balasanova said, talking through those worries with a primary care doctor or another health care professional like a therapist is a good place to start.