Substance-Induced Anxiety Disorder: Causes, Symptoms, and Treatment

Introduction

Substance/medication-induced anxiety disorder is a form of anxiety that develops as a direct result of using or withdrawing from certain substances, including medications, recreational drugs, or alcohol. Although this condition has been recognized for many years, its prevalence has grown with the increasing use of prescription medications and recreational substances. The anxiety experienced can be intense, significantly disrupting daily life and causing considerable distress. Understanding this condition is essential for those affected, as it can lead to more effective treatment and management strategies.

This article offers a thorough overview of substance/medication-induced anxiety disorder, addressing its definition, risk factors, symptoms, diagnostic tests, treatment options, and home management strategies. By the end, you will have a clearer understanding of the condition and how to seek help if you or a loved one is experiencing anxiety related to substance use or medication.

Definition of Substance/Medication-Induced Anxiety Disorder

Substance/medication-induced anxiety disorder occurs when anxiety symptoms are triggered by the use, misuse, or withdrawal from certain substances or medications. This article will explore the risk factors, symptoms, diagnostic tests, medications, procedures, and home remedies that can help manage the condition.

Description of Substance/Medication-Induced Anxiety Disorder

Substance/medication-induced anxiety disorder is characterized by anxiety symptoms that are directly caused by the use of a substance or medication. This includes both legal substances, such as prescription medications or alcohol, and illegal substances, like recreational drugs. The severity of anxiety can vary, ranging from mild unease to severe panic attacks or excessive worry.

The progression of the disorder often depends on the specific substance involved. Anxiety may arise during substance use or develop during withdrawal when the substance is no longer present in the body. In some cases, anxiety may persist even after discontinuing the substance, requiring further treatment.

Research indicates that substance/medication-induced anxiety disorder is relatively common, particularly among individuals using substances like alcohol, stimulants (e.g., cocaine or amphetamines), or certain prescription medications (e.g., corticosteroids or benzodiazepines). Studies suggest that up to 30% of individuals with anxiety disorders may have symptoms related to substance use or withdrawal, underscoring the importance of recognizing the role substances play in triggering anxiety.

Risk Factors for Developing Substance/Medication-Induced Anxiety Disorder

Lifestyle Risk Factors

Certain lifestyle factors can increase the likelihood of developing substance/medication-induced anxiety disorder. One significant risk factor is the use of recreational drugs, such as cocaine, methamphetamines, or marijuana. These substances can alter brain chemistry, leading to heightened anxiety, especially when used in large amounts or over extended periods.

Alcohol use is another common factor. While alcohol may initially have a calming effect, chronic use or withdrawal can lead to significant anxiety. Additionally, individuals who frequently consume large amounts of caffeine, through coffee or energy drinks, may experience increased anxiety, as caffeine is a stimulant that can trigger anxious feelings.

People with high-stress lifestyles or poor coping mechanisms may also be more likely to turn to substances to manage stress, increasing their risk of developing anxiety related to substance use.

Medical Risk Factors

Certain medical conditions and treatments can elevate the risk of substance/medication-induced anxiety disorder. For example, individuals prescribed medications like corticosteroids, stimulants (for ADHD), or benzodiazepines (for anxiety or insomnia) may develop anxiety as a side effect.

Withdrawal from medications, especially those affecting the central nervous system, can also lead to anxiety. For instance, individuals discontinuing benzodiazepines after long-term use may experience withdrawal symptoms, including severe anxiety and panic attacks.

Patients with chronic pain who are prescribed opioid medications may also be at risk, as these drugs can lead to dependence and withdrawal-related anxiety. Additionally, individuals with a history of substance abuse or mental health disorders, such as depression or generalized anxiety disorder, are more likely to develop this condition.

Genetic and Age-Related Risk Factors

Genetics can play a role in the development of substance/medication-induced anxiety disorder. Individuals with a family history of anxiety disorders or substance abuse may be more prone to experiencing anxiety related to substance use. This genetic predisposition increases the likelihood of developing anxiety when exposed to specific substances or medications.

Age is another factor. Younger individuals, particularly adolescents and young adults, may be more susceptible to the effects of recreational drugs and alcohol, which can lead to anxiety. Conversely, older adults prescribed multiple medications may experience anxiety due to drug interactions or withdrawal from certain medications.

In summary, a combination of lifestyle choices, medical conditions, genetic predisposition, and age-related factors can contribute to the risk of developing substance/medication-induced anxiety disorder. Recognizing these risk factors can help individuals make informed decisions about substance use and seek appropriate treatment if anxiety symptoms develop.

Clinical Manifestations of Substance/Medication-Induced Anxiety Disorder

Palpitations

Palpitations, or the sensation of a racing or pounding heart, occur in approximately 70% of patients with substance/medication-induced anxiety disorder. These sensations are often caused by overstimulation of the sympathetic nervous system, triggered by substances like stimulants, caffeine, or alcohol withdrawal. Palpitations are more common in the early stages of substance use or withdrawal, particularly with stimulants like amphetamines or cocaine. Patients may feel their heart beating irregularly or faster than usual, which can intensify anxiety and create a cycle of increasing worry about their physical health.

Sweating

Excessive sweating is reported in about 60% of individuals with this disorder. Sweating is a common response to anxiety, as it is part of the body’s “fight or flight” response. Substances like alcohol, caffeine, or certain medications can disrupt the body’s normal stress response, leading to increased perspiration. This symptom is especially common during withdrawal from substances like alcohol or opioids. Sweating may occur alongside other physical symptoms, such as palpitations and trembling, leading to discomfort and self-consciousness in social situations.

Trembling

Trembling or shaking affects around 50% of patients with substance/medication-induced anxiety disorder. This symptom is often linked to nervous system activation due to substance use or withdrawal, such as from stimulants, alcohol, or benzodiazepines. Trembling can manifest as noticeable shaking in the hands or legs and may worsen in stressful situations. Patients withdrawing from alcohol or benzodiazepines may experience more severe tremors, especially in the early stages of withdrawal. This symptom can be distressing and contribute to a sense of anxiety and loss of control.

Restlessness

Restlessness is present in about 65% of individuals with this disorder. It is characterized by an inability to sit still or relax, often accompanied by a sense of unease or agitation. Restlessness is commonly seen in patients withdrawing from stimulants or experiencing side effects of certain medications, such as antidepressants or corticosteroids. This symptom can make it difficult to focus on tasks or engage in daily activities, further contributing to anxiety and frustration.

Fatigue

Fatigue affects approximately 55% of patients with substance/medication-induced anxiety disorder. This symptom may result from the body’s overexertion during periods of heightened anxiety or from the physical toll of withdrawal from substances like alcohol, opioids, or stimulants. Fatigue can also be a side effect of certain medications, such as antihistamines or beta-blockers. Patients may feel physically and mentally drained, which can worsen anxiety and make it harder to cope with daily stressors.

Difficulty Concentrating

Difficulty concentrating is reported in about 60% of patients. This cognitive symptom is often linked to overwhelming worry and physical discomfort caused by anxiety. Substances like stimulants, alcohol, and certain medications can disrupt normal brain function, making it harder to focus or retain information. This symptom may be more pronounced during withdrawal or in individuals using high doses of certain medications. Difficulty concentrating can interfere with work, school, and personal responsibilities, leading to further stress and anxiety.

Irritability

Irritability is experienced by around 50% of individuals with this disorder. It often results from the emotional and physical strain caused by anxiety and substance use. Irritability may be more pronounced during withdrawal from substances like alcohol, nicotine, or stimulants, as the body adjusts to the absence of the substance. Patients may become easily frustrated or angry, which can strain relationships and contribute to a sense of isolation.

Muscle Tension

Muscle tension occurs in about 45% of patients. This symptom is a physical manifestation of anxiety, as the body’s muscles tighten in response to stress. Substance use, particularly stimulants or alcohol, can exacerbate muscle tension, making it difficult to relax. This tension can lead to headaches, neck pain, or back pain, further contributing to discomfort and anxiety. Muscle tension may be more pronounced during withdrawal or in individuals with chronic substance use.

Sleep Disturbances

Sleep disturbances, including difficulty falling asleep, staying asleep, or experiencing restless sleep, are reported in approximately 70% of patients with this disorder. Substances like stimulants, alcohol, or certain medications can disrupt the body’s natural sleep-wake cycle, leading to insomnia or poor-quality sleep. Withdrawal from substances like alcohol or benzodiazepines can also cause significant sleep disturbances. Lack of sleep can worsen anxiety symptoms, creating a vicious cycle of poor sleep and increased anxiety.

Excessive Worry

Excessive worry is a hallmark symptom of anxiety disorders and is present in nearly 80% of patients with substance/medication-induced anxiety disorder. This symptom involves persistent and uncontrollable thoughts about potential dangers or negative outcomes, often related to health or substance use. Excessive worry can be triggered by the effects of certain substances, such as stimulants or hallucinogens, or by withdrawal from substances like alcohol or opioids. This symptom can be particularly distressing, as patients may feel overwhelmed by their thoughts and unable to find relief.

html

Health Conditions with Similar Symptoms to Substance/Medication-Induced Anxiety Disorder

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) is marked by excessive, uncontrollable worry about various aspects of life, such as work, health, or relationships. People with GAD often experience persistent anxiety that interferes with daily activities and may have physical symptoms like restlessness, fatigue, and muscle tension.

How to Know if You Might Have Generalized Anxiety Disorder vs. Substance/Medication-Induced Anxiety Disorder

Both GAD and substance/medication-induced anxiety disorder involve excessive worry and anxiety. However, GAD is typically not linked to substance use or medication. In GAD, the anxiety is more generalized and persistent, often lasting six months or more, and is not directly triggered by a specific substance. In contrast, substance/medication-induced anxiety disorder is directly related to substance use or withdrawal.

Your healthcare provider may ask about your history of substance use, including prescription medications, recreational drugs, or alcohol. If your anxiety symptoms started after beginning a new medication or using a substance, this could indicate substance/medication-induced anxiety disorder. Blood or urine tests may also be used to detect substances in your system.

In GAD, the anxiety is often more diffuse and not tied to a specific event or substance. Additionally, GAD tends to be more chronic, whereas substance/medication-induced anxiety disorder may resolve once the substance is discontinued or metabolized.

Panic Disorder

Panic disorder is characterized by recurrent, unexpected panic attacks—sudden episodes of intense fear or discomfort that peak within minutes. These attacks are often accompanied by physical symptoms like heart palpitations, sweating, shaking, and shortness of breath. People with panic disorder may worry about having more attacks and avoid situations where they fear an attack might occur.

How to Know if You Might Have Panic Disorder vs. Substance/Medication-Induced Anxiety Disorder

Panic attacks can occur in both panic disorder and substance/medication-induced anxiety disorder. However, in panic disorder, the attacks are typically spontaneous and not triggered by substance use. In contrast, panic attacks in substance/medication-induced anxiety disorder are usually linked to substance use or withdrawal.

If your panic attacks started after using a new medication or substance, or if they occur primarily during substance use or withdrawal, this may suggest substance/medication-induced anxiety disorder. A detailed history of your substance use can help your healthcare provider make this distinction. Lab tests may also be used to detect substances in your system.

Panic disorder is diagnosed when panic attacks occur repeatedly and are not associated with substance use. People with panic disorder often develop a fear of having more attacks, leading to avoidance behaviors, whereas in substance/medication-induced anxiety disorder, the panic attacks typically resolve once the substance is discontinued.

Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, involves intense fear or anxiety in social situations. People with social anxiety disorder often worry about being judged, embarrassed, or humiliated in front of others. This can lead to avoidance of social interactions, which can interfere with work, school, and relationships.

How to Know if You Might Have Social Anxiety Disorder vs. Substance/Medication-Induced Anxiety Disorder

Both social anxiety disorder and substance/medication-induced anxiety disorder can involve anxiety in social situations. However, in social anxiety disorder, the anxiety is specifically related to social interactions and fear of judgment. In contrast, substance/medication-induced anxiety disorder is directly related to substance use or withdrawal, and the anxiety may not be limited to social situations.

If your anxiety occurs primarily in social settings and you have a long-standing fear of being judged or embarrassed, this may suggest social anxiety disorder. On the other hand, if your anxiety started after using a substance or medication, or if it occurs in situations unrelated to social interactions, substance/medication-induced anxiety disorder may be more likely.

Your healthcare provider may ask about your history of social anxiety and substance use to help differentiate between the two. In social anxiety disorder, the anxiety is usually specific to social situations and persists even in the absence of substance use, whereas in substance/medication-induced anxiety disorder, the anxiety is more likely to resolve once the substance is discontinued.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) develops after a person experiences or witnesses a traumatic event, such as a serious accident, natural disaster, or assault. People with PTSD may have flashbacks, nightmares, and severe anxiety related to the trauma, and they may avoid situations that remind them of the event.

How to Know if You Might Have PTSD vs. Substance/Medication-Induced Anxiety Disorder

Both PTSD and substance/medication-induced anxiety disorder can involve anxiety, but PTSD is specifically triggered by a traumatic event, whereas substance/medication-induced anxiety disorder is triggered by substance use or withdrawal. In PTSD, the anxiety is often accompanied by flashbacks, nightmares, and avoidance of trauma-related situations, which are not typically seen in substance/medication-induced anxiety disorder.

If your anxiety is linked to a past traumatic event and you experience flashbacks or nightmares about the trauma, this may suggest PTSD. In contrast, if your anxiety started after using a substance or medication, or if it occurs during withdrawal, substance/medication-induced anxiety disorder may be more likely.

Your healthcare provider may ask about your history of trauma and substance use to help differentiate between the two conditions. In PTSD, the anxiety is often accompanied by trauma-related symptoms, whereas in substance/medication-induced anxiety disorder, the anxiety is more likely to resolve once the substance is discontinued.

Major Depressive Disorder (MDD)

Major depressive disorder (MDD) is characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. People with MDD may also experience changes in appetite, sleep disturbances, and difficulty concentrating. MDD can interfere with daily functioning and significantly impact a person’s quality of life.

How to Know if You Might Have Major Depressive Disorder vs. Substance/Medication-Induced Anxiety Disorder

Both MDD and substance/medication-induced anxiety disorder can involve feelings of distress and mood changes. However, in MDD, the primary symptoms are related to depression, such as persistent sadness, loss of interest in activities, and feelings of hopelessness. In contrast, substance/medication-induced anxiety disorder is primarily characterized by anxiety, with mood changes directly related to substance use or withdrawal.

If your symptoms are primarily related to sadness, loss of interest, and difficulty functioning, this may suggest MDD. On the other hand, if your symptoms started after using a substance or medication, or if they occur during withdrawal, substance/medication-induced anxiety disorder may be more likely.

Your healthcare provider may ask about your mood, substance use, and the timing of your symptoms to help differentiate between the two. In MDD, depressive symptoms are usually persistent and not directly linked to substance use, whereas in substance/medication-induced anxiety disorder, the anxiety and mood changes are more likely to resolve once the substance is discontinued.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone, leading to symptoms such as rapid heartbeat, weight loss, sweating, and anxiety. The thyroid hormone plays a key role in regulating metabolism, and when too much is produced, it can cause the body to speed up in ways that mimic anxiety.

How to Know if You Might Have Hyperthyroidism vs. Substance/Medication-Induced Anxiety Disorder

Both hyperthyroidism and substance/medication-induced anxiety disorder can cause symptoms of anxiety, such as nervousness, restlessness, and rapid heartbeat. However, hyperthyroidism is caused by an overactive thyroid gland, whereas substance/medication-induced anxiety disorder is caused by substance use or withdrawal.

If your anxiety is accompanied by other symptoms of hyperthyroidism, such as unexplained weight loss, increased sweating, or a rapid heartbeat, this may suggest hyperthyroidism. Blood tests that measure thyroid hormone levels can help confirm the diagnosis. In contrast, if your anxiety started after using a substance or medication, or if it occurs during withdrawal, substance/medication-induced anxiety disorder may be more likely.

Your healthcare provider may order blood tests to check your thyroid hormone levels. If your thyroid hormone levels are elevated, this may suggest hyperthyroidism. In substance/medication-induced anxiety disorder, thyroid hormone levels are usually normal, and the anxiety is more likely to resolve once the substance is discontinued.

Treatment Options

Medications

SSRIs (Selective Serotonin Reuptake Inhibitors)

SSRIs are a class of antidepressants that work by increasing serotonin levels in the brain. They are commonly used to treat anxiety disorders, including substance/medication-induced anxiety disorder.

SSRIs are often considered a first-line treatment for anxiety disorders. They are typically prescribed when anxiety symptoms are persistent and significantly impact daily life. Common SSRIs include fluoxetine, sertraline, and escitalopram.

Patients can expect to see improvements in anxiety symptoms within 4 to 6 weeks of starting SSRIs. However, it may take several months to experience the full benefits. Side effects can include nausea, headaches, and sexual dysfunction, but these often subside over time.

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

SNRIs are another class of antidepressants that affect both serotonin and norepinephrine levels in the brain. Like SSRIs, they are used to treat anxiety disorders.

SNRIs, such as venlafaxine and duloxetine, are typically prescribed when SSRIs are not effective or if a patient has both anxiety and depression. They are also considered a first-line treatment for anxiety disorders.

Improvements in anxiety symptoms usually occur within 4 to 6 weeks. SNRIs may cause side effects like increased blood pressure, dizziness, and dry mouth, but these often diminish with time.

Benzodiazepines

Benzodiazepines enhance the effect of the neurotransmitter GABA, which has calming effects on the brain. They are used to provide quick relief from acute anxiety symptoms.

Benzodiazepines, such as alprazolam, lorazepam, and diazepam, are typically used for short-term management of severe anxiety symptoms. They are not recommended for long-term use due to the risk of dependence and withdrawal symptoms.

Patients can expect immediate relief from anxiety symptoms, usually within 30 minutes to an hour. However, due to the potential for addiction, these medications are used cautiously and for the shortest duration possible.

Buspirone

Buspirone is an anti-anxiety medication that works by affecting serotonin and dopamine receptors in the brain. It is used to treat chronic anxiety but does not have the sedative effects of benzodiazepines.

Buspirone is typically prescribed for patients with generalized anxiety disorder or those who cannot tolerate the side effects of SSRIs or SNRIs. It is considered a second-line treatment for anxiety.

Patients may begin to notice improvements in anxiety symptoms within 2 to 4 weeks. Buspirone is generally well-tolerated, with fewer side effects than other anti-anxiety medications.

Beta-blockers

Beta-blockers reduce the physical symptoms of anxiety, such as rapid heart rate and trembling, by blocking the effects of adrenaline. They are not used to treat the emotional symptoms of anxiety.

Beta-blockers, such as propranolol, are often used for situational anxiety, such as performance anxiety or anxiety before a specific event. They are not typically used for long-term treatment of anxiety disorders.

Patients can expect quick relief from physical symptoms of anxiety, usually within an hour of taking the medication. Beta-blockers are generally well-tolerated, but side effects can include fatigue and dizziness.

Antipsychotics

Antipsychotics alter the effects of neurotransmitters in the brain, particularly dopamine. They are sometimes used to treat severe anxiety symptoms that do not respond to other treatments.

Antipsychotics, such as quetiapine or olanzapine, are typically reserved for patients with treatment-resistant anxiety or those with co-occurring mental health conditions, such as psychosis. They are not a first-line treatment for anxiety disorders.

Patients may experience a reduction in anxiety symptoms within a few weeks of starting antipsychotics. However, these medications can have significant side effects, including weight gain, drowsiness, and metabolic changes.

Trazodone

Trazodone is an antidepressant often used off-label to treat anxiety and insomnia. It works by affecting serotonin levels in the brain.

Trazodone is typically prescribed for patients who experience both anxiety and sleep disturbances. It is often used when other medications are not effective or cause intolerable side effects.

Patients may notice improvements in anxiety and sleep within a few days to weeks. Trazodone is generally well-tolerated, but side effects can include drowsiness and dry mouth.

Gabapentin

Gabapentin is primarily used to treat seizures and nerve pain but is sometimes used off-label to treat anxiety. It works by affecting the way nerves send messages to the brain.

Gabapentin is typically prescribed for patients who have not responded to other anxiety treatments or who have co-occurring conditions like chronic pain. It is not a first-line treatment for anxiety disorders.

Patients may experience a reduction in anxiety symptoms within a few weeks of starting gabapentin. Side effects can include dizziness, fatigue, and coordination problems.

Clonidine

Clonidine reduces anxiety by lowering blood pressure and decreasing the body’s stress response. It is often used to treat anxiety-related physical symptoms.

Clonidine is typically prescribed for patients with anxiety who also have high blood pressure or for those who experience physical symptoms like sweating and shaking. It is not a first-line treatment for anxiety.

Patients can expect to see a reduction in physical symptoms of anxiety within a few hours of taking clonidine. Side effects can include drowsiness, dry mouth, and low blood pressure.

Hydroxyzine

Hydroxyzine is an antihistamine used to treat anxiety by reducing activity in the central nervous system. It is often used as a short-term treatment for anxiety.

Hydroxyzine is typically prescribed for patients who need quick relief from anxiety symptoms but want to avoid the sedative effects of benzodiazepines. It is often used for short-term or situational anxiety.

Patients can expect to feel relief from anxiety symptoms within 30 minutes to an hour of taking hydroxyzine. Side effects can include drowsiness and dry mouth.

Improving Substance/Medication-Induced Anxiety Disorder and Seeking Medical Help

In addition to medications, several home remedies can help improve symptoms of substance/medication-induced anxiety disorder. These include:

1. Deep breathing exercises: Regular practice can help calm the nervous system and reduce anxiety.
2. Regular physical activity: Exercise releases endorphins, which can improve mood and reduce anxiety.
3. Mindfulness meditation: This practice helps individuals stay present and manage anxious thoughts.
4. Yoga: Combining physical movement with mindfulness can help reduce stress and anxiety.
5. Adequate sleep: Ensuring 7-9 hours of sleep each night can help regulate mood and reduce anxiety.
6. Balanced diet: Eating a nutritious diet can support overall mental health.
7. Limiting caffeine: Reducing caffeine intake can help prevent anxiety symptoms from worsening.
8. Staying hydrated: Proper hydration supports brain function and mood regulation.
9. Journaling: Writing down thoughts and feelings can help manage anxiety.
10. Social support: Connecting with friends, family, or support groups can provide emotional relief.

While these remedies can help manage anxiety, it’s important to seek medical help if symptoms persist or worsen. Telemedicine offers a convenient way to consult with healthcare providers from the comfort of your home, ensuring timely and accessible care.

Living with Substance/Medication-Induced Anxiety Disorder: Tips for Better Quality of Life

Living with substance/medication-induced anxiety disorder can be challenging, but there are steps you can take to improve your quality of life:

1. Follow your treatment plan: Take medications as prescribed and attend follow-up appointments with your healthcare provider.
2. Practice stress management techniques: Incorporate relaxation exercises, mindfulness, and physical activity into your daily routine.
3. Build a support network: Stay connected with friends, family, or support groups who can provide emotional support.
4. Limit substances that can worsen anxiety: Avoid alcohol, recreational drugs, and excessive caffeine.
5. Maintain a healthy lifestyle: Eat a balanced diet, get enough sleep, and stay physically active to support your mental health.

Conclusion

Substance/medication-induced anxiety disorder arises from the use or withdrawal of certain substances. It can cause significant distress and impact daily functioning, but with the right treatment and lifestyle adjustments, symptoms can be managed effectively.

Early diagnosis and treatment are essential for managing this condition and preventing it from worsening. If you or a loved one are experiencing symptoms of anxiety, our primary care telemedicine practice can provide the support and guidance you need. Reach out to us today to schedule a consultation and take the first step toward better mental health.

James Kingsley

Learn More