6 Medications that Induce Anxiety and Stress

6 Medications that Induce Anxiety and Stress

Feb 1, 2024 | Written by Priyanka Puranik, MSc | Reviewed by Scott Sherr, MD and Marion Hall

We often turn to medication for relief, seeking respite from ailments that burden our minds and bodies. But what if the very pills meant to heal end up exacerbating one of our most common woes: anxiety? Yes, it's a paradox indeed, but the truth is, some widely prescribed medications can unwittingly trigger or worsen anxiety and stress.

In this article, we will look at six common medications and their potential to fuel anxiety. The medications discussed here range from beta-blockers, often used for cardiovascular conditions, to hormonal contraceptives, prescribed for birth control and other hormonal imbalances. Each of these medications interacts with the body's biochemical pathways in unique ways, potentially triggering or worsening symptoms of anxiety and stress. The exploration of these mechanisms is not just an academic exercise. It also has practical implications for millions who rely on these medications daily.

As we embark on this exploration, it's crucial to remember that the response to medication is highly individualistic. The same drug that causes anxiety in one person may have no such effect in another. This variability underscores the complexity of our biological systems and the importance of personalized medicine.

Get ready to unpack the fascinating complexities of the human body and mind, where sometimes, the cure can indeed feel like a curse.

Let's begin with a familiar friend turned foe: benzodiazepines.

1. Rebound & Reactions: Why Benzodiazepines Can Worsen Anxiety

Benzodiazepines, including well-known tranquilizers like Xanax and Valium, are widely prescribed for their immediate calming effects, particularly in treating anxiety and insomnia. They operate by enhancing the action of gamma-aminobutyric acid (GABA), a key neurotransmitter in the brain that inhibits nerve signals, thereby inducing relaxation and reducing anxiety. However, this initial relief is just one side of the story.

The Paradox of Long-Term Use: Tolerance and Rebound Anxiety

While benzodiazepines are effective in the short term, their prolonged use harbors the risk of worsening anxiety. This ironic twist stems from the body's adaptation to the drug. Over time, the brain requires higher doses to achieve the same calming effect due to increased tolerance. This dependence can lead to “rebound anxiety,” a phenomenon where anxiety symptoms resurface, often more intensely than before, once the medication's effects diminish [1]. Studies have shown that patients with panic disorder treated with benzodiazepines for extended periods experience higher rates of anxiety during withdrawal compared to those on a placebo [2].

Complicating the picture further, some individuals, especially those prone to anxiety, experience paradoxical reactions to benzodiazepines. In these cases, the drugs can unexpectedly induce panic attacks or exacerbate existing anxiety symptoms. Research indicates that a significant minority of patients with panic disorder may report worsening symptoms or new-onset panic attacks upon benzodiazepine use [3,4].

Neuropharmacological Changes and Withdrawal Management

The long-term use of benzodiazepines can lead to a complex set of neuropharmacological changes, particularly affecting neurotransmitter balance. With extended use, there's a decrease in GABA function and overall neurotransmitter activity. This imbalance reduces the brain's natural ability to manage stress and anxiety, potentially intensifying these symptoms over time [1].

The management of benzodiazepine withdrawal is multifaceted, involving strategies to prevent dependence, gradual dosage reduction, and psychological interventions. Addressing underlying medical conditions and providing ongoing support to tackle psychosocial stressors are also crucial in preventing relapse [3].

While these findings might seem alarming, remember that it's crucial to weigh the potential risks against the individual's specific needs and the severity of their anxiety. Under close medical supervision, benzodiazepines can still be valuable tools for managing acute anxiety and panic attacks. However, understanding the potential for anxiety-worsening effects is essential for both patients and healthcare providers to make informed decisions about treatment plans and consider alternative, safer options when at all possible.

2. Balancing Hearts and Minds: The Beta-Blocker Paradox

Beta-blockers, known for their role in managing cardiovascular conditions such as hypertension and heart failure, also impact psychological states due to their mechanism of action. These medications function by blocking the effects of adrenaline, a hormone integral to the body's “fight or flight” response, thus reducing heart rate and blood pressure. However, their influence extends beyond physical symptoms, sometimes affecting mental health [5].

Neurochemical Impact and Central Nervous System Penetration

Beta-blockers, by design, interfere with the sympathetic nervous system. This interference, while beneficial for cardiovascular health, and often helpful in mitigating anxiety too, can paradoxically lead to feelings of anxiety in rare cases. This is because the suppression of adrenaline might cause a compensatory response in the body, manifesting as psychological stress or anxiety. Some beta-blockers, particularly those that are lipophilic, like propranolol, can cross the blood-brain barrier and directly affect the central nervous system, leading to various psychological effects. This is usually calming but in a small proportion of people, it can have the opposite effect [5].

Physical Side Effects and Psychological Distress

The physical side effects of beta-blockers, such as fatigue and sexual dysfunction, can also contribute to anxiety and stress. These side effects, impacting an individual's lifestyle and well-being, might exacerbate psychological distress [5].

Thus, while beta-blockers are crucial for treating various cardiovascular conditions and social anxiety, their impact on psychological health is complex and varies among individuals. The findings suggest that while beta-blockers can manage physical symptoms effectively, their influence on psychological well-being, particularly regarding anxiety disorders, needs careful consideration, especially with long-term use. The use of beta-blockers, especially in the context of mental health, should be closely monitored, and a personalized approach to treatment is essential.

3. The Unwinding Coil: Antidepressants and the Anxiety Tango

Next in our exploration of anxiety-inducing medications, we encounter a class often perceived as an antidote to anxiety itself: antidepressants. While primarily prescribed for depression, these medications are frequently used off-label to manage anxiety disorders as well. However, the relationship between antidepressants and anxiety isn't always straightforward.

Antidepressants, particularly SSRIs and tricyclics, play a pivotal role in treating depression and anxiety disorders. Despite their effectiveness, they sometimes have paradoxical effects on anxiety and stress, especially during early treatment stages. This phenomenon, often temporary, is known as jitteriness/anxiety syndrome or activation syndrome. It's characterized by an early worsening of anxiety and stress symptoms due to the brain's adjustment to changes in neurotransmitter levels. A systematic review in the British Journal of Psychiatry highlights this, noting a wide variation in the reported incidence of this syndrome, ranging from 4 to 65% of patients starting antidepressant treatment [6].

Serotonin syndrome, primarily associated with SSRIs, although extremely rare, poses a risk of excessive serotonin, leading to symptoms like anxiety, agitation, and restlessness. This condition was thoroughly explored in a review article published in 2005, emphasizing the importance of careful dosage management and patient education about this potential side effect [7].

Discontinuation syndrome is another important aspect. Stopping or reducing the dose of antidepressants abruptly can lead to withdrawal-like symptoms, including heightened anxiety and stress. This underscores the need for tapering off these medications under medical guidance.

In conclusion, while antidepressants are invaluable for mood disorder management, their interaction with anxiety is complex, requiring careful dosage management, patient education, and a gradual approach to medication changes.

4. The Buzz and the Jitters: Stimulants and the Anxiety Loop

Our journey through the labyrinth of medication-induced anxiety now brings us face-to-face with a class often associated with focus and energy: stimulants. These medications, like Ritalin and Adderall, are primarily prescribed for attention deficit hyperactivity disorder (ADHD) but are sometimes used off-label to manage fatigue and narcolepsy. However, beneath their energizing facade, stimulants can harbor a hidden potential to trigger or worsen anxiety.

The overstimulation of neurotransmitters, especially dopamine and norepinephrine, is a primary factor in how stimulants can exacerbate anxiety and stress. This overstimulation can lead to increased anxiety and stress by creating a heightened state of arousal and alertness. A 2007 study found a significant correlation between stimulant use and increased anxiety symptoms in children with ADHD, highlighting the delicate balance between treating ADHD symptoms and managing anxiety [8].

Furthermore, the rebound effects of stimulants, where symptoms of anxiety and stress increase as the drug's effects wear off, illustrate the challenges in managing medication schedules. This effect was examined in a 1995 study that noted an increase in anxiety-related symptoms among stimulant users, particularly those with pre-existing anxiety disorders [9].

Additionally, individual sensitivity to stimulants can vary greatly, with some people being more prone to experiencing anxiety and stress-related side effects. This sensitivity is influenced by genetic factors and pre-existing mental health conditions.

5. Hormonal Contraceptives: Beyond Birth Control

Hormonal contraceptives, such as pills, patches, and injections, are commonly used for birth control and regulating menstrual cycles by altering estrogen and progesterone levels. Beyond their primary function, these contraceptives can influence mood and emotional well-being, potentially impacting anxiety and stress levels.

The manipulation of reproductive hormones can significantly affect mood-regulating chemicals in the brain, like serotonin. Fluctuations in estrogen and progesterone may contribute to increased vulnerability to anxiety and stress. A 2013 study reported that some women using hormonal contraceptives experienced mood swings and increased anxiety, suggesting a link between contraceptive use and mood disturbances [10].

Individual sensitivity to hormonal changes also plays a critical role. This sensitivity varies, with some women more prone to experiencing anxiety and stress-related symptoms due to hormonal contraceptives. Moreover, psychosocial factors, such as concerns about side effects or stress about managing contraception, can contribute to overall anxiety and stress levels.

A 2016 study explored the relationship between hormonal contraceptive use and mental health. The research highlighted the variation in individual responses and the potential for increased anxiety and depressive symptoms in some users [11].

6. The Calming Storm: Corticosteroids and the Anxiety Paradox

We now arrive at the final stop in our exploration of medication-induced anxiety: corticosteroids, a class of steroid hormones widely prescribed for their anti-inflammatory and immunosuppressive properties in conditions like asthma, allergies, rheumatoid arthritis, and autoimmune diseases. Despite their therapeutic effectiveness, corticosteroids have a notable history of psychological side effects, including the potential to induce or exacerbate anxiety and stress.

Mechanism of Corticosteroids in Contributing to Anxiety and Stress

The disruption of the hypothalamic-pituitary-adrenal (HPA) axis by corticosteroids is a key factor in their ability to induce anxiety and stress. This class of medications can interfere with the normal functioning of this crucial stress response system, leading to an imbalance in stress hormones, notably cortisol. Such imbalances can precipitate anxiety and stress-like symptoms. A study corroborated this by reporting a significant association between corticosteroid use and the development of anxiety disorders [12,13].

Additionally, corticosteroids can affect neurotransmitter balance, particularly serotonin and dopamine, which are vital in mood regulation. Alterations in these levels can contribute to heightened anxiety and stress responses. Further compounding this issue, the physical side effects of corticosteroids, such as weight gain and insomnia, can also contribute to psychological distress.

Treatment and Management of Medication-Induced Anxiety

Addressing and managing medication-induced anxiety involves a multifaceted approach that may include changes in medication, psychotherapy, lifestyle modifications, and exploring natural remedies.

Treatment and Management of Medication-Induced Anxiety

Addressing and managing medication-induced anxiety involves a multifaceted approach that may include changes in medication, psychotherapy, lifestyle modifications, and exploring natural remedies.

Adjusting Medications

  • Review and Modify: The first step often involves reviewing the current medication regimen. If a medication is identified as a potential cause of anxiety, a healthcare provider might adjust the dosage or switch to an alternative with fewer anxiety-inducing side effects.
  • Gradual Tapering: For medications that cause withdrawal symptoms, gradually tapering off instead of abrupt cessation can help reduce anxiety.

Psychotherapy

  • Cognitive Behavioral Therapy (CBT): This form of therapy is effective in managing anxiety by helping individuals understand and change their thought patterns and behaviors.
  • Stress Management Techniques: Techniques like mindfulness, relaxation training, and stress reduction strategies can be beneficial.

Lifestyle Changes

  • Regular Exercise: Physical activity is known to reduce stress and anxiety. Even moderate exercise like walking can have significant benefits.
  • Healthy Diet: A balanced diet, rich in vegetables, fruits, whole grains, and lean proteins, can support overall mental health.
  • Adequate Sleep: Ensuring sufficient and quality sleep can help in managing anxiety.

Natural Remedies and Supplements

  • Herbal Supplements: Some natural supplements like valerian root, chamomile, and lavender have been used for their calming effects.
  • Mind-Body Practices: Yoga, tai chi, and meditation can help in reducing stress and anxiety.
  • Omega-3 Fatty Acids: Found in fish oil and flaxseeds, they may have a beneficial impact on mood and anxiety.
  • Tro Calm: For calm on demand, Tro Calm works its magic using a combination of kava, CBD, CBD, and N-nicotinoyl-GABA. It is a precision-dosed, pharmaceutical-grade, and physician-formulated buccal troche that can help you de-stress and completely relax.

Consultation and Monitoring

  • Regular Medical Consultation: Regular check-ups with healthcare providers are important for monitoring the effects of any changes in medication and overall mental health.
  • Therapeutic Support: Seeking support from mental health professionals can provide additional strategies for managing anxiety.

It's crucial for individuals experiencing medication-induced anxiety to consult with healthcare professionals before making any changes to their medication or starting new treatments. Personalized care tailored to individual needs is the key to effectively managing anxiety and stress.

 

References

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  2. Otto, M. W., McHugh, R. K., Simon, N. M., Farach, F. J., Worthington, J. J., & Pollack, M. H. (2010). Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation. Behavior research and therapy, 48(8), 720–727. https://doi.org/10.1016/j.brat.2010.04.002
  3. Lim, B., Sproule, B. A., Zahra, Z., Sunderji, N., Kennedy, S. H., & Rizvi, S. J. (2020). Understanding the effects of chronic benzodiazepine use in depression: a focus on neuropharmacology. International clinical psychopharmacology, 35(5), 243–253. https://doi.org/10.1097/YIC.0000000000000316
  4. Lader, M., & Kyriacou, A. (2016). Withdrawing Benzodiazepines in Patients With Anxiety Disorders. Current psychiatry reports, 18(1), 8. https://doi.org/10.1007/s11920-015-0642-5
  5. Steenen, S. A., van Wijk, A. J., van der Heijden, G. J., van Westrhenen, R., de Lange, J., & de Jongh, A. (2016). Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis. Journal of Psychopharmacology (Oxford, England), 30(2), 128–139. https://doi.org/10.1177/0269881115612236
  6. Sinclair, L. I., Christmas, D. M., Hood, S. D., Potokar, J. P., Robertson, A., Isaac, A., Srivastava, S., Nutt, D. J., & Davies, S. J. (2009). Antidepressant-induced jitteriness/anxiety syndrome: systematic review. The British journal of psychiatry: the journal of mental science, 194(6), 483–490. https://doi.org/10.1192/bjp.bp.107.048371
  7. Boyer, E. W., & Shannon, M. (2005). The serotonin syndrome. The New England journal of medicine, 352(11), 1112–1120. https://doi.org/10.1056/NEJMra041867
  8. Pliszka S. R. (2007). Pharmacologic treatment of attention-deficit/hyperactivity disorder: efficacy, safety, and mechanisms of action. Neuropsychology Review, 17(1), 61–72. https://doi.org/10.1007/s11065-006-9017-3
  9. Tannock, R., Schachar, R., & Logan, G. (1995). Methylphenidate and cognitive flexibility: dissociated dose effects in hyperactive children. Journal of Abnormal Child Psychology, 23(2), 235–266. https://doi.org/10.1007/BF01447091
  10. Keyes, K. M., Cheslack-Postava, K., Westhoff, C., Heim, C. M., Haloossim, M., Walsh, K., & Koenen, K. (2013). Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States. American journal of epidemiology, 178(9), 1378–1388. https://doi.org/10.1093/aje/kwt188
  11. Skovlund, C. W., Mørch, L. S., Kessing, L. V., & Lidegaard, Ø. (2016). Association of Hormonal Contraception With Depression. JAMA psychiatry, 73(11), 1154–1162. https://doi.org/10.1001/jamapsychiatry.2016.2387
  12. Brown, E. S., & Suppes, T. (1998). Mood symptoms during corticosteroid therapy: a review. Harvard review of psychiatry, 5(5), 239–246. https://doi.org/10.3109/10673229809000307
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Authors

Priyanka Puranik, a passionate biotechnology scholar, earned her first master's degree from the Institute of Bioinformatics and Biotechnology (IBB), Savitribai Phule Pune University, India, in 2019. During her rigorous five-year Integrated Master of Science (MSc) program, Priyanka immersed herself in intricate research projects, spanning Molecular and Cell Biology, Nanotechnology, and Cancer Biology. Her master's thesis involved synthesizing 3D multicellular tumor spheroids from mammalian cancer cell lines, unraveling in-vitro growth complexities.

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