Why Is Your Anxiety So Much Worse During A Hangover?

Photographed by Ashley Armitage.
If you've ever woken up after a night of having one-too-many drinks, panicked over any texts or Instagram DMs you may have sent while intoxicated, you might be someone who suffers from "hangxiety" — which, as you probably guessed, is being in a state of anxiety when you're hungover.
Nasir Naqvi, MD, PhD, assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons, says that hangovers can cause a lot of unpleasant reactions, one of which can be anxiety.
It's not uncommon: According to a 2012 study of over 1,400 Dutch students, about half of them reported having a hangover the day after drinking, and 7% of those who experienced hangovers said that they also experienced anxiety. And a 2006 study from Ulster University of 48 students found that a majority of them experienced increased anxiety while hungover.
Sally Winston, PsyD, a clinical psychologist and member of the Anxiety and Depression Association of America, says this happens because hangovers can make you way more sensitive to everything that's happened or is going on around you.
"You may find yourself reviewing everything you said and did, or wondering what you said and did [the night before] if you drank too much," Dr. Winston says. "You might be thinking about what other people think about you, and the retrospective review of your own behaviour can cause a lot of anxiety depending on how much you remember, on how you behaved, and how much anxiety you had to start with."
That goes double if you've blacked out, she adds.
"If you’ve had a blackout, that means you’ve had a lot of alcohol, and your imagination can take off," she says. "You start with 'what if,' and you fill in all the blanks, and it can get pretty scary."
Dr. Naqvi says that "hangxiety" could also have something to do with how alcohol affects the GABA (gamma aminobutyric acid) receptor in your brain, which is the system that helps send messages from your brain to your nervous system. Drinking alcohol tends to have a calming effect on that part of the brain (some anti-anxiety meds, including benzodiazepines like Xanax, also target GABA receptors), but once that buzz wears off, you might realise that the relief was only temporary.
Another culprit for hangover anxiety? A lack of proper sleep. Sure, a few drinks might put you to sleep, but Dr. Naqvi says that it also can disturb your sleep, both because you're likely getting up to pee at night. But, also because it decreases the amount of REM sleep you get, causing you to to wake up more irritable and anxious.
Dr. Naqvi adds that anxiety during a hangover could affect people who don't necessarily have an anxiety disorder, but that those who do suffer from generalised anxiety are definitely more sensitive to it.
And, as for why hangxiety affects some, but not others? "Some people metabolise alcohol faster than others. Other people have more buildup of the toxic metabolites of alcohol because of how they metabolise alcohol, and some may have more sensitivity in the brain to these effects," he says.
But on the flipside, Dr. Naqvi says that alcohol can also cause an anxiety disorder over time, which can happen when alcohol's prolonged effect on the brain causes someone to constantly feel withdrawal (and anxiety is one of the main features of alcohol withdrawal).
"If people drink heavily and regularly, they can develop an anxiety disorder that feels like generalised anxiety or panic disorder, one that's alcohol-induced," he says. "The tricky part about it is every time they drink, [the anxiety] gets better, but what happens is that in between [the drinking events], it gets worse."
But, no matter how alcohol may or may not make you feel, if you're frequently experiencing hangovers (like, say, every single weekend), Dr. Winston says that might be a sign that you need to cut back on drinking.
"A hangover should be something that happens accidentally once a year," she says. "If that’s a regular part of your life, you are drinking too much."
If you do find yourself in the midst of hangover anxiety, Dr. Winston says to remember that your brain is feeling overly sensitive, and it's sending you "hyperaware," exaggerated thoughts that you have to weed out.
In the meantime, there may not be a single proven way to "cure" hangovers, but drinking water can help — and hey, don't discount any weird trick you've personally found to quell the effects of nausea and a pounding headache.
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