Which drug can cause anxiety and panic? Unpacking medication-induced symptoms

According to research, a significant number of patients prescribed corticosteroids experience psychiatric reactions, including anxiety, with the risk increasing at higher doses. Knowing which drug can cause anxiety and panic is vital, as a wide range of medications and substances can trigger or worsen these distressing symptoms.

Quick Summary

This article explores various drugs and medications that can induce anxiety and panic symptoms. It covers common culprits, such as stimulants, corticosteroids, and antidepressants, and details how withdrawal from certain substances can also trigger these reactions. Understanding these triggers is essential for proper management.

Key Points

• Stimulants can cause anxiety: Medications for ADHD (e.g., Adderall) and substances like caffeine and illicit drugs can increase nervous system activity, causing anxiety and panic.

• Corticosteroids mimic stress: Steroids like prednisone can trigger psychiatric side effects, including anxiety, by affecting the body's stress hormone system, particularly at high doses.

• Withdrawal can provoke panic: Stopping certain drugs, such as benzodiazepines, opioids, or alcohol, can cause severe rebound anxiety and panic attacks as a withdrawal symptom.

• Initial antidepressant anxiety: When starting some antidepressants (like SSRIs), some people may experience a temporary increase in anxiety, agitation, or restlessness as the body adjusts.

• Communicate with a healthcare provider: It is crucial to discuss any new or worsening anxiety symptoms with a doctor, rather than stopping a medication abruptly, to determine the safest and most effective course of action.

• Over-the-counter culprits: Some common products, like decongestants (pseudoephedrine) and certain pain relievers containing caffeine, can also cause anxiety-like side effects.

Introduction

For many, anxiety and panic attacks can feel unprovoked and overwhelming. However, in some cases, these episodes are not a symptom of an underlying mental health condition but a side effect of medication or substance use, a phenomenon known as substance- or medication-induced anxiety disorder. This can occur during intoxication, while the medication is being taken, or during the withdrawal phase. Identifying the connection between a drug and anxiety symptoms is the first step toward effective management and relief. It's crucial to discuss any concerns with a healthcare provider before making changes to a treatment plan.

Common Medication Culprits

Several classes of prescription drugs are known to have anxiety-inducing properties due to their effects on the central nervous system, hormonal pathways, or neurotransmitter levels.

Stimulants

Stimulants increase the activity of the central nervous system. While this effect is therapeutic for conditions like ADHD, it can lead to nervousness, jitters, and heightened anxiety in many individuals.

• ADHD Medications: Drugs such as amphetamine/dextroamphetamine (Adderall) and methylphenidate (Ritalin) can cause restlessness and anxiety, especially at higher doses. For individuals without ADHD, the stimulating effects may be even more pronounced and distressing.
• Caffeine: Found in headache medications (e.g., Excedrin Migraine) and widely consumed drinks, caffeine can rev up the heart and blood pressure, making a person feel jittery, nervous, and anxious.
• Illicit Stimulants: Recreational drugs like cocaine and methamphetamine are powerful stimulants known to trigger severe anxiety and panic attacks during use.

Corticosteroids

Corticosteroids, which include drugs like prednisone and dexamethasone, are powerful anti-inflammatory medications used for a variety of conditions. However, they are synthetic versions of the body's stress hormone, cortisol. Their psychiatric side effects are well-documented, with anxiety and mood disturbances being common, particularly at higher doses.

Antidepressants

Ironically, while used to treat anxiety disorders, some antidepressants can cause or worsen anxiety, especially when treatment is first initiated. The initial fluctuation of serotonin levels is believed to be the reason for heightened anxiety, agitation, or restlessness in some individuals. This initial increase in anxiety often subsides with continued use, but if it doesn't, a dosage adjustment or different medication may be necessary.

Other Medications

• Decongestants: Many over-the-counter cold and allergy remedies contain decongestants like pseudoephedrine, which can cause nervousness, jitters, and a rapid heartbeat.
• Thyroid Medications: An overactive thyroid can cause anxiety-like symptoms, including a rapid heart rate and tremors. If a patient is on too high a dose of thyroid medication, such as levothyroxine, it can mimic these symptoms.
• Asthma Inhalers: Some rescue inhalers, which contain beta-agonists like albuterol, work by expanding airways. These drugs can also activate receptors in the heart, leading to side effects like shaking and anxious feelings.

Withdrawal-Induced Anxiety and Panic

For some substances, anxiety and panic are not a side effect of intoxication but a prominent symptom of withdrawal. The body becomes physically dependent on the substance and experiences a rebound effect when it is removed, disrupting the normal balance of brain chemicals.

• Benzodiazepines: Used to treat anxiety, benzodiazepines can cause intense rebound anxiety and panic attacks if they are stopped abruptly after prolonged use. This is why a healthcare provider must carefully manage discontinuation.
• Opioids: Both prescription painkillers and illicit opioids can lead to significant anxiety during withdrawal, alongside other symptoms like muscle aches and nausea.
• Alcohol: Chronic alcohol use suppresses the central nervous system. When consumption ceases, the nervous system overcompensates, leading to severe anxiety, agitation, and even seizures.
• Stimulants: Withdrawal from stimulants can also cause anxiety, often accompanied by depression and fatigue.

How to Manage Medication-Induced Anxiety

1. Do Not Stop Abruptly: Never stop taking a prescribed medication suddenly without consulting a doctor. For many drugs, including antidepressants and benzodiazepines, abrupt discontinuation can be dangerous and worsen anxiety.
2. Communicate with Your Provider: Discuss your symptoms openly with your healthcare provider. They can help determine if your medication is the cause and recommend a dosage adjustment, a different medication, or a slow tapering plan.
3. Explore Lifestyle Changes: Reducing or eliminating caffeine, avoiding alcohol, getting regular exercise, and practicing mindfulness can help manage symptoms.

Comparison Table: Common Anxiety-Inducing Medications and Effects

Drug Class	Examples	Mechanism for Anxiety	Onset of Anxiety	Management Strategy
Stimulants	Amphetamine, Caffeine	Increases CNS activity, heart rate, and blood pressure.	During use/Intoxication.	Dose adjustment or discontinuation under medical supervision.
Corticosteroids	Prednisone, Dexamethasone	Mimics stress hormone cortisol, disrupts HPA axis.	During use, especially at high doses.	Tapering dosage under medical guidance.
Antidepressants (SSRIs)	Sertraline, Fluoxetine	Initial fluctuations in serotonin levels, withdrawal.	Initial use or sudden discontinuation.	Wait for adjustment, dose change, or controlled taper.
Benzodiazepines	Alprazolam, Lorazepam	Rebound anxiety due to dependency and withdrawal.	Sudden discontinuation.	Gradual tapering process overseen by a doctor.
Decongestants	Pseudoephedrine	CNS stimulation, restlessness.	During use.	Opt for a non-stimulant alternative if possible.
Thyroid Hormones	Levothyroxine	Over-medication causing increased metabolism and heart rate.	During use (over-medication).	Dosage adjustment based on blood work.

Conclusion

While medications are invaluable for treating many health conditions, they can sometimes come with unwanted side effects, including anxiety and panic. The specific drug, dosage, and an individual's unique biology all play a role in determining the risk and severity of these symptoms. The key takeaway is the importance of open communication with healthcare providers. Never assume new anxiety symptoms are simply a personal issue; consider if they are medication-induced. Proper diagnosis and a collaborative approach with your doctor can ensure effective treatment while minimizing negative side effects.

For more in-depth information, the National Institutes of Health (NIH) offers various resources on drug-induced psychiatric conditions. One study focused specifically on iatrogenic panic attacks.

Frequently Asked Questions

Can starting an antidepressant cause anxiety or panic attacks?

Yes, it is possible. Many people experience a temporary increase in anxiety, agitation, or restlessness when they first start taking an antidepressant, especially SSRIs. This is believed to be due to the initial fluctuations in serotonin levels and usually improves as your body adjusts to the medication.

Do ADHD medications cause anxiety?

Stimulant ADHD medications, such as Adderall and Ritalin, increase central nervous system activity. This can lead to side effects like restlessness, nervousness, and anxiety, particularly if the dosage is too high or in individuals who are sensitive to stimulants.

Can corticosteroids cause anxiety?

Yes. Corticosteroids like prednisone are known to cause a range of psychiatric side effects, including anxiety and other mood disturbances. The risk is often dose-dependent, and the symptoms typically resolve after the medication is discontinued.

Is anxiety a common symptom of drug withdrawal?

Yes, anxiety is a very common and sometimes severe symptom of withdrawing from many substances. This includes prescription medications like benzodiazepines and opioids, as well as alcohol and illicit stimulants.

Can over-the-counter medication cause anxiety?

Yes. Some over-the-counter products, including certain cold medicines with decongestants like pseudoephedrine and pain relievers containing caffeine, can stimulate the central nervous system and cause anxiety-like symptoms.

What should I do if I think my medication is causing anxiety or panic attacks?

You should contact your healthcare provider immediately to discuss your symptoms. Never stop taking a prescribed medication on your own, as sudden discontinuation can be dangerous and could make your symptoms worse.

How long does medication-induced anxiety last?

The duration of medication-induced anxiety varies. It may be temporary as your body adjusts to a new medication, resolve quickly after stopping an over-the-counter drug, or persist longer during a withdrawal process. Always consult a doctor for personalized advice.

Are there non-drug-related reasons for substance-induced anxiety?

Yes, while medication and drug use are key triggers, withdrawal symptoms from alcohol, for example, can also cause severe anxiety and panic. The body’s chemical balance is disrupted, leading to rebound effects.