Substance-Induced Anxiety Disorder

What is substance-induced anxiety disorder?

Suppose you’ve begun taking a stimulant medication to treat ADHD. Once you start taking the drug (e.g., Ritalin), you notice that you’re feeling anxious, nervous, or panicked. What you’re experiencing might be a substance-induced anxiety disorder.

This disorder is a direct result of the substance you’ve taken. Therefore, if your nervousness or anxiety can be better attributed to something else (e.g., an upcoming event like getting married), substance-induced anxiety disorder isn’t an appropriate diagnosis.^[1]

While some people experience substance induced anxiety shortly after taking a drug, others develop symptoms during withdrawal, when they stop taking the drug. In either case, the culprit of the symptoms is the substance being taken. Symptoms range widely, from anxiety and nervousness, to loss of appetite, to feeling like you’re out of control. ^[1]

Though substance abuse and anxiety are prevalent and often co-occur, substance-induced anxiety disorder is not common in comorbid situations. In fact, only about 0.2% of people with a substance use disorder and an anxiety disorder have substance-induced anxiety disorder.^[2]

The incidence of substance induced anxiety disorder is even rarer in the general population. The 12-month occurrence of this disorder is estimated to be 0.002%^[3], though that figure could be significantly higher due to misdiagnoses and underreporting.

Symptoms of substance-induced anxiety disorder

As noted earlier, the symptomatology of substance-induced anxiety disorder includes hallmark symptoms of anxiety and panic disorders. More specifically, you might experience symptoms that include:^[1][3]

• Difficulty concentrating on tasks, such as an inability to focus on school or work activities
• Feelings of dread, such as a feeling of being out of control and that you might die
• General feelings of restlessness and nervousness that may or may not lead to physical tics, like pacing or tapping fingers
• Feelings of tension or extreme alertness that make you jumpy or feel on edge
• Increased heart rate, heart palpitations, sweatiness, and other signs of physiological arousal, like being in fight or flight mode
• Chest pain, shortness of breath, or feeling dizzy
• Nausea, feeling faint, or abdominal pain

Additionally, you might experience panic attacks during which you have extreme anxiety or fear, in addition to some of the symptoms outlined above.

Remember, these symptoms must occur shortly after taking a drug, while on the drug, or during withdrawal. Moreover, the substance you’ve taken must be able to induce the symptoms you’re experiencing.

Which drugs can cause substance-induced anxiety disorder?

A variety of substances and medications are identified as having the potential to cause substance induced anxiety. Below are lists of some of the most common culprits.

Substances

Several types and classes of substances might cause anxiety symptoms.

Hallucinogens like LSD, Ketamine, MDMA, and PCP can do so, particularly during withdrawal.^[3] Cannabis and alcohol, both of which have stimulant and depressant properties, can also lead to substance-induced anxiety disorder.^[4][5]

Stimulants like cocaine and amphetamines might induce anxiety during or after use. Even caffeine can bring about anxiety symptoms if enough of it is ingested. Inhalants used for huffing (e.g., fuel, spray paint) may also produce anxiety symptoms.^[3]

Medications

Sedatives, hypnotics, and anxiolytics like opioids, benzodiazepines, and barbiturates can cause substance induced anxiety.

Opioids like morphine and codeine are commonly prescribed for their sedative and pain-killing characteristics. Typically, medication induced anxiety occurs once these substances are no longer used.^[6]

Benzodiazepines have sedative powers that are useful for treating anxiety and sleep-related problems. However, some patients might need higher and higher doses to achieve the same effect. Moreover, anxiety levels might spike once the drug's effect wears off. In either case, taking benzodiazepines might have a paradoxical effect of increasing anxiety, even when they are prescribed to treat anxiety.^[7]

Barbiturates are a type of depressant used as a sedative. They can also be used for their hypnotic, anesthetic, and anticonvulsant properties. However, tolerance develops quickly with these drugs, and, like benzodiazepines, they can induce anxiety.^[8]

Non-prescription medications, like some decongestants and antihistamines, also possess anxiety-inducing features.^[3]

Diagnosing substance-induced anxiety disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines specific criteria that must be met for a diagnosis of substance-induced anxiety disorder. These criteria are as follows:^[3]

• Panic attacks or anxiety are prevalent
  • Symptoms develop shortly after taking a drug, while on the drug, or during withdrawal
  • The drug in question must be able to produce panic and anxiety symptoms
• The symptoms cannot be better explained by an independent anxiety disorder, as evidenced by the following:
  • Symptomatology that precedes the use of the substance in question
  • The symptoms last one month or longer after severe intoxication or the completion of acute withdrawal
  • Other evidence of an independent anxiety disorder, such as a history of panic or anxiety attacks
• The symptoms do not occur only during a delirious episode
• The symptoms cause clinically significant distress or impairment in critical areas of functioning

Your doctor or mental health provider will use these DSM-5 criteria to guide their evaluation of your condition. As part of that process, they might ask you questions about substances you’ve taken, such as prescription medications, over-the-counter drugs, and illicit drugs.

Likewise, you might be asked about specific symptoms. For example, if you’re experiencing shortness of breath, your doctor might ask you about the conditions under which you experience this symptom, how long the shortness of breath lasts, how intense it is, and so forth.

Other questions will be asked to rule out other potential causes of your symptoms. This might include questions about your use of substances like alcohol, if you have a history of panic attacks or feelings of anxiety, and if you’ve been diagnosed with any mental health disorders in the past.

These questions and the DSM-5 diagnostic criteria help rule out other causes and aid in making an informed diagnosis. This is a critical step, as arriving at the proper diagnosis helps determine a course of treatment.

Treatment for substance-induced anxiety disorder

Fortunately, there are many effective treatments for substance induced anxiety and medication induced anxiety. These treatments range from therapy to medications to self-help strategies, as outlined below.

However, the first course of action is to discuss your anxiety with your doctor or mental health provider. If it’s determined that a substance or medication is causing anxiety symptoms, an adjustment to the dosage might be all that’s needed to ease the anxiety.

Therapy

Therapy is especially beneficial for people with substance abuse and anxiety problems. Individual therapy (e.g., cognitive-behavioral therapy) is especially helpful in treating anxiety and substance-related issues. Group therapies and support groups are also highly effective in treating substance-induced anxiety disorder.^[9]

Medication

In some cases, antidepressants (e.g., Zoloft, Effexor) or anxiolytics (e.g., Xanax, Wellbutrin) might be prescribed to help reduce anxiety symptoms. However, if the connection between anxiety symptoms and substances or medications is unclear, using additional medications might come with increased risks.

In particular, using medication to treat a medication induced anxiety disorder might lead to unwanted side effects, dangerous interactions, or increased potential for tolerance or abuse. As such, using medications to treat this condition should be done with great care and with the input of your medical doctor, mental health provider, and other treatment providers.^[10]

Self-Help

Feelings of anxiety can often be reduced through self-help techniques like exercise, meditation, and mindfulness training. Furthermore, eating right, avoiding substances like caffeine and alcohol, and getting plenty of rest can combat substance-induced anxiety.

Relaxation techniques are also effective in managing anxiety. Breathing exercises, yoga, and Pilates are low-impact activities you might try if you feel anxious. Of course, as noted earlier, if you suspect your anxiety results from a substance or medication, talk to your doctor immediately. The best self-help might be picking up the phone and making that call.