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September 26, 2019
Hangover Anxiety: Causes and Remedies
For some drinkers, it’s almost as reliable as the pounding headache and queasy stomach: the feeling of dread that follows a night of heavy imbibing. Your mind races as you frantically scroll through your text messages and Instagrams, replaying what you can remember from the night before. Did I say anything embarrassing? Did I offend anyone? Do my friends hate me now?
For some, these doubts are just fleeting, run-of-the-mill nerves from letting their guard down after a few too many drinks the night before. But for others, these all-encompassing thoughts aren’t just regret from drinking too much or your mind’s effort to piece together a hazy night. The overwhelming feeling of nervousness after drinking too much is an experience common enough that Reddit has devoted threads to the term: “hangxiety.”
Even model Chrissy Teigen, who is known for her silly, alcohol-fueled antics on social media, revealed that she's planning on cutting back on booze after “making kind of an ass” out of herself after drinking too much. “That feeling, there's just nothing like that. You feel horrible,” she told Cosmopolitan.
“I think of a hangover as, more or less, a mini-withdrawal from alcohol, and anxiety is one of the components,” George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), tells SELF. Although not everyone experiences anxiety when they're hungover—some people feel just achy or have an upset stomach—Koob says it’s a relatively common symptom of a hangover. And for people who are already prone to anxiety, it’s even worse, sometimes lasting all day and disrupting your ability to function.
It’s the flip side of what happens the night before, when you’re having fun with your friends and everyone is in a good mood. When the alcohol buzz hits, your brain gets a rush of dopamine in its reward center, explains Aparna Iyer, M.D., a psychiatrist and assistant professor at University of Texas Southwestern Medical Center. That rush is the same thing that happens when you hang out with your romantic partner, win big at the casino, or get a notification on social media: You feel great, and you want to drink more to keep that feeling going. The problem is, that dopamine rush is short-lived with alcohol, Dr. Iyer says. When your dopamine levels come back down, it impacts your mood and anxiety levels for the worse.
As alcohol increases feel-good dopamine, it interrupts other neurotransmitters, including serotonin, which influence your mood, Dr. Iyer explains. “The feelings that you have after you drink alcohol, or even the day after, can result in a whole range of feelings and moods and anxiety symptoms,” she says. “It can range from panic to feeling depressed to feeling impulsive to feeling agitated and irritable.”
Alcohol also increases effects related to GABA (gamma aminobutyric acid), the principal inhibitory neurotransmitter, she says David Kareken, Ph.D., a neuropsychologist at Indiana University Health. This slows down energy levels and has an overall calming effect. In fact, a number of medications used to treat anxiety, including benzodiazepines, also target GABA in the brain. “This is one reason why alcohol intoxication can be perceived as relaxing,” says Dr. Kareken.
Hangxiety is more prevalent for people who are prone to anxiety, especially those who use alcohol as a social lubricant to quell their nerves.
As alcohol binds to the GABA receptors in your brain and dampens feelings of anxiety, it’s only temporary, Dr. Iyer explains. “People who already have a pre-existing anxiety disorder, even if it's a small one and kind of underlying everything, whatever they have quieted by drinking the alcohol, that can come back full force or even worse,” she says.
This rebound effect also impacts your sleep cycle, which is key to managing anxiety, according to the Anxiety and Depression Association of America. A 2016 meta-analysis published in the journal Sleep Medicine found that even acute sleep deprivation increased symptoms of anxiety and depression. And although drinking makes you drowsy, it affects your quality of sleep.
“The amount of REM sleep that somebody experiences, which is part of the normal sleep cycle, is diminished. As a result, people can wake up feeling unrested in various ways,” Nasir H. Naqvi, M.D., an assistant professor of clinical psychiatry at Columbia University Medical Center, tells SELF. “Some of the anxiety and general emotional effects of alcohol withdrawal may be due to poor sleep."
For someone who frequently experiences hangxiety, it could be an indicator of a bigger problem.
The DSM-5 lists 11 criteria that could lead to a diagnosis of alcohol use disorder, or AUD, defined by the NIAAA as “problem drinking that becomes severe”. One of those is continuing to drink even though it made you feel depressed or anxious. According to the DSM-5, AUD can be classified as mild, moderate, or severe depending on how many symptoms you've checked off.
A red flag for someone who may be wondering whether or not they have an alcohol use disorder, Koob says, is if he or she self-medicates anxiety with more alcohol. “[People] who drink and then get anxious, and then start using the anxiety as an excuse for drinking…you're beginning to get in trouble in my view,” Koob says. “When you start drinking to fix the problem the drinking itself caused, then you're moving into the zone of what I would consider a major alcohol use disorder.”
Alcohol use disorder is addressed with a number of behavioral treatments, he explains, including a therapeutic technique called motivational interviewing, cognitive behavioral therapy, psychotherapy, group therapy, family therapy, and 12-step programs. Treatment can be administered by certified counselors, clinical psychologists, psychiatrists, or medical specialists who specialize in addiction medicine. There are also three FDA-approved medications that are available in outpatient and inpatient facilities to treat AUD: disulfiram, naltrexone, and acamprosate, according to the journal American Family Physician.
It's also possible that prolonged drinking can bring on an anxiety disorder.
Since alcohol is a GABA antagonist, it makes brain neurons less excitable. Over time, the brain will need more GABA to function at a normal level, and that’s when an anxiety disorder can set in, Dr. Naqvi explains. It’s something he sees in his practice “all the time,” he says. “It’s very common.” Especially for chronic drinkers, the withdrawal period from alcohol before the next drink can trigger feelings of anxiety.
“It feels like you have generalized anxiety or even panic attacks, but in fact, it's the chronic effect of alcohol on the brain that puts the brain into a persistent withdrawal state from alcohol—and anxiety is one of the cardinal features of alcohol withdrawal,” Dr. Naqvi says.
And while an AUD doesn’t necessarily mean you'll have an alcohol-induced anxiety disorder, the opposite could be true. “If you have enough alcohol-induced anxiety that it affects your functioning, and you continue to drink despite knowledge of this effect, then it does become a basis for being diagnosed with alcohol use disorder,” Dr. Naqvi explains. In addition to stopping drinking, Dr. Naqvi says alcohol-induced anxiety is often treated with medication such as a sedative to alleviate the temporary surge in anxiety that comes with alcohol cessation.
So, how do you deal with that urge to both apologize to everyone you know and hide in bed for the next 12 hours?
Even if you don’t have an alcohol use disorder or binge drink regularly, you can still experience hangxiety after a night of heavy drinking. If you wake up the next morning incredibly anxious and paranoid, take a breather before you text everyone in your phone with profuse apologies. Odds are, it’s more likely a physical reaction from the booze than a humiliating scenario where you happened to offend your entire group of friends.
Deep breathing, mindful meditation, and exercise can all help you to relax and reduce symptoms of anxiety. If it’s something that persists for days, or happens even when you cut back on drinking, then visit a mental health professional. After all, alcohol has become so ingrained in our culture, from boozy brunches to company happy hours to late night bar crawls. If your good time turns into a nightmare the next morning, it might be time to cut back on the booze—and make your mental health a priority.
DHM may be the answer to hangxiety
In a controlled study conducted with animals, researchers found that an ingredient called dihydromyricetin (DHM) blocked alcohol tolerance and prevented signs of withdrawal when taken during alcohol consumption.
How’d they come this conclusion? Researchers gave mice alcohol along with either placebo or DHM. After, they measured various behaviors and brain functions related to intoxication. Mice were placed on their backs in a V-shaped cradle and researchers measured the time it took the rats to turn over or the loss of righting reflex (LORR).
Mice who were given DHM significantly reduced LORR (or the time it took them to turn over).1 The effectiveness of DHM, however, was lost when the mice were also administered flumazenil, which acts on the GABA receptors in the brain. This suggests that DHM’s affect on the brain is mediated through the GABA receptors and in doing so, helps impact the way alcohol is processed in the brain.
Researchers also observed that DHM helped reduce the anxiety and hyperexcitability caused by alcohol exposure and withdrawal.