Alcohol and anxiety: Panic attacks after drinking

Alcohol and anxiety: Panic attacks after drinking

Reviewed by:
Austin Lin, MD
Staff Psychiatrist
at Talkiatry
July 5, 2023
In this article

It’s no secret that alcohol has a profound impact on the brain—even a casual drinker can experience a mood shift after a beer or two. It’s also no secret that drinking—especially heavy drinking—can bring on feelings of regret the next day.

But what about full-blown panic attacks? We turned to our staff of board-certified psychiatrists for everything you need to know about the connection between alcohol and anxiety, including when it's time to seek help.

How are alcohol and anxiety related?

Researchers have long studied the connection between alcohol consumption and anxiety. We know that many people with alcohol use disorders also experience anxiety disorders. So why the overlap, and can alcohol actually cause anxiety? Research points to both physiological and psychological causes of these co-occurring disorders, including changes in brain chemistry caused by drinking, as well as the regret often felt after heavy drinking—aka “hangxiety.”

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What is “hangxiety”?

“Hangxiety” describes the regret, worry, and levels of anxiety felt after a night of heavy drinking. While the term may be informal, the science isn’t—there’s plenty of data to explain this experience.

Drinking alcohol disrupts the body’s natural production of cortisol, a stress hormone that helps regulate many of your body’s systems (think: metabolism, heart rate, immune system, cognitive function).

Studies have found that heavy drinkers have increased cortisol levels due to alcohol’s effects on the body. Elevated cortisol levels can lead to feelings of anxiety or restlessness.

Additionally, alcohol affects neurotransmitter levels in the brain—the chemical messengers responsible for how we think, feel, and behave. Over time, these changes can make it harder for you to relax when you aren’t drinking and may lead to persistent worries, intrusive thoughts, and other anxiety symptoms.

Waking up after a night of heavy drinking can sometimes come with a fuzzy memory or uncertainty about what exactly happened when you were under the influence. “Blacking out,” or experiencing mild to complete memory loss after heavy drinking, can also occur. It’s not uncommon or unexpected to feel regret when this happens—you may feel regretful about what you said or did to others, or nervous that they will judge you for your behavior. These feelings can naturally increase overall feelings of anxiety in daily life.

Can alcohol cause panic attacks?

Yes, alcohol can cause panic attacks. To understand exactly why this happens, chemically, it’s important to understand the role of GABA—a neurotransmitter—in the brain and body.

GABA’s main role is to help regulate the nervous system. It does so by binding to GABA receptors in the brain—which helps your body to relax and your mind to feel calm. Alcohol is believed to mimic this effect by also binding to GABA receptors. That’s why drinking can help you feel relaxed in the short-term, especially in social situations.

Your body, however, is always looking to establish equilibrium, or balance. A heavy influx of alcohol can lead to your body blocking its own GABA receptors in an attempt to re-establish this equilibrium. With fewer GABA receptors available, your body can naturally absorb less GABA, which inhibits your ability to naturally calm down and can lead to panic attacks.

How can you prevent panic attacks after drinking?

The more you drink, the more likely you are to induce chemical changes that can trigger panic attacks and other health problems. As a result, the best way to prevent panic attacks after drinking is to know your limits and avoid drinking to excess.

But remember, if you’re already prone to anxiety or have been diagnosed with an anxiety disorder, consuming even a small amount of alcohol can trigger your symptoms, including panic attacks. If you’re worried about having a panic attack after drinking, the best strategy is to abstain.

Is hangxiety a sign of alcohol dependence?

Anyone can experience anxiety—or “hangxiety”—after drinking, even if you aren’t dealing with alcohol dependence. However, if you find yourself frequently experiencing anxiety and regret after drinking, particularly after heavy drinking, it may be a sign of a more serious problem.

Other symptoms of alcohol dependence or alcohol use disorder may include:

  • Being unable to limit how much you drink
  • Devoting a lot of time to drinking or recovering from drinking
  • Experiencing alcohol withdrawal symptoms—such as shaking, sweating, or nausea—when you don’t drink, or drinking to avoid those symptoms
  • Drinking in unsafe situations, like when driving
  • Developing a tolerance to alcohol—that is, needing to drink more to feel the effects of alcohol
  • Continuing to drink despite knowing it’s causing problems in your social, work, or family life
  • Turning to alcohol as a coping mechanism

When is it time to seek professional help?

If you’re regularly experiencing some or all the symptoms listed above, it’s important to seek professional help immediately.

Similarly, if you find yourself regularly experiencing the symptoms of an anxiety disorder—including panic attacks—it's important to seek help.

Other symptoms of an anxiety disorder, like generalized anxiety disorder or social anxiety disorder, include:

  • Feelings of restlessness or irritability
  • Excessive worry or fear that is difficult to control
  • Pounding or racing heart; chest pain from anxiety
  • Sweating or shaking
  • Gastrointestinal distress
  • Headaches
  • Sleep problems, including insomnia

Only a qualified healthcare professional can diagnose an alcohol use disorder or an anxiety disorder. Although it may be tempting to ignore your symptoms, or to self-diagnose, the only way to access the resources you need to recover is by getting a clinical diagnosis.

Managing anxiety with Talkiatry

Treatment for anxiety disorders and alcohol use disorders varies depending on the individual and the symptoms, so it’s critical to work with a professional to get the help that you need. About 30% of people who experience substance use disorder also experience another mental health condition.

At Talkiatry, our psychiatrists can treat patients with mental health conditions such as anxiety or depression and substance use disorders that occur at the same time. Treating these conditions is a critical part of treating substance use disorder.

With Talkiatry, you can see a psychiatrist from the comfort of your home and you can schedule your first appointment in a matter of days. To get started and learn about your treatment options, take our free online assessment, to see if Talkiatry is right for you and get matched with a psychiatrist.

About Talkiatry

Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 60 insurance partners, and first visits available in days. We treat patients with anxiety, depression, trauma, ADHD, and more. Get started with a short online assessment.

The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.


Alcoholism and the Brain: An Overview | PMC

Co-Occurring Alcohol Use Disorder and Anxiety | PMC

Alcoholism and its effects on the central nervous system | NCBI

Shyness, alcohol use disorders and ‘hangxiety’: A naturalistic study of social drinkers | ScienceDirect

Why Alcohol Causes Hangover Anxiety (i.e., Hangxiety) | American Addiction Centers

The Effects of Alcohol on the Brain | Scripps

Stress and the HPA Axis | PMC

GABA and Alcohol: How Drinking Leads to Anxiety | Georgetown Behavioral

Alcohol use disorder - Symptoms and causes | Mayo Clinic

Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.

Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.

Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.

Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.

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