Alcohol and Panic Attacks: Understanding the Link and Finding Help

Five percent of all American adults (more women than men) suffer a panic attack at least once during their lifetime. Although this is worrying, it is unsurprising, because an estimated 52.9 million adult Americans struggle with mental health disorders. 

Of these, 9.7% report using alcohol to help with their symptoms, a choice that sets off a vicious cycle. In this article, we dissect the link between alcohol, panic attacks, and mental health disorders. 

What Is a Panic Attack? 

The Diagnostic and Statistical Manual of Mental Health Disorders (DSM) defines a panic attack as “an abrupt surge of intense fear or discomfort” that manifests as physical symptoms without any real danger or apparent cause. 

The Science Behind Panic Attacks

Predisposition to panic attacks is a result of many factors, including:

• Structural brain changes
• The amygdala, thalamus, and hypothalamus are key brain areas involved in panic attacks. Studies show that the amygdala (which interprets external stimulus) is 8% smaller in patients who experience panic attacks. In other words, the amygdalas in these patients are more likely to misinterpret real-world situations and trigger panic attacks.  
• The hypothalamic-pituitary-adrenal (HPA) axis controls the body’s hormone production. In patients that experience panic attacks, this axis is impaired, leading to excess production of the fight-or-flight hormones (i.e., noradrenaline).
• Decreased neurochemical sensitivity. Research shows that individuals who experience panic attacks have:
• Lower levels of endorphins, which are feel-good hormones that relieve anxiety and promote feelings of well-being. 
• A lower sensitivity to calming hormones such as:
• Serotonin, due to genetic mutations
• Gamma-aminobutyric acid (GABA), also due to genetic changes
• An increased sensitivity to carbon dioxide, which sets off a hormonal cascade that can induce a panic attack. 
• Genes. Data shows that people with a family history of panic attacks are more likely to experience them. The largest study on this subject compared 1,000 twins and found that 30-46% of individuals had a positive family history of experiencing panic attacks. Researchers believe that there are many genes (such as the COMT gene) responsible for this. 

Panic Attack Symptoms

The DSM lists 13 symptoms for panic attacks that are consequences of the body’s fight-or-flight response. These are listed below along with their frequency in brackets:

1. Shortness of breath (90%)
2. Trembling or shaking (85.7%)
3. Palpitations (80%) 
4. Feeling dizzy or fainting (71-76%)
5. Excessive sweating (66.6%)
6. Tingling/numbness (54.3%)
7. Fear of dying (46.2%, of which 25.5% tried to take their own life) 
8. Choking (35%)
9. Chest pain (28.5%)
10. Feeling unreal or detached(27%)
11. Hot flashes/chills (7-20%)
12. Nausea (12.5%)
13. Losing control (undetermined frequency, but could be as high as 100%)

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What Triggers a Panic Attack?

• Stress:Stress triggers the release of stress hormones (such as epinephrine and cortisol). This causes physical symptoms, including increased heart and breathing rates, which can trigger a panic attack. Common stressors include the death of a loved one, financial anxiety, conflicts, or arguments. 
• Social anxiety: Research shows that people with social anxiety tend to have panic attacks 13% more frequently than the normal population. This is because of the associated dysregulation of neurotransmitter systems. 
• Dietary factors
• Alcohol: Alcohol inhibits the gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex that normally calms the brain. Understandably, this can lead to a panic attack. 
• Caffeine:51.1 % of caffeine users experience panic attacksdue to its stimulant effect. 
• Monosodium glutamate (MSG): MSG, a common ingredient in processed foods, increases risk of panic attacks. This is because it disturbs the normal excitatory/inhibitory chemical balance in the brain. 
• Refined sugar: Refined sugar causes sudden spikes and drops in blood sugar levels. This triggers the release of stress hormones (such as adrenaline and cortisol), which can lead to panic attacks.
• Pre-existing mental health disorders: Individuals with depression, anxiety, or other mental illnesses are more prone to panic attacks due to structural brain changes and hormonal imbalances. 
• Post-Traumatic Stress Disorder (PTSD): 35.4% of PTSD patients experience panic attacks. While scientists don’t completely understand this co-occurrence, they believe increased cortisol (a stress hormone) levels are responsible. 
• Pre-existing physical conditions

1. Asthma: Asthma (and the use of asthma medication) can directly exacerbate panic symptoms.
2. Hyperthyroidism:Increased levels of thyroid hormones activate the sympathetic nervous system via epinephrine release. As discussed, this can lead to panic attacks.
3. Vestibular dysfunction: The vestibular system, which provides the brain with information about the body's position, relies on serotonin to function. Thus, vestibular dysfunction can lower serotonin (a feel-good hormone) levels, predisposing individuals to panic attacks.
4. Mitral valve prolapse (MVP): 57% of patients with MVP (a valvular heart defect) suffer from panic disorders. This is because MVP patients frequently experience palpitations and chest pain, both of which can lead to panic attacks. 
5. Hypoglycemia (low blood sugar levels):Hypoglycemia triggers the abrupt release of epinephrine to boost sugar levels, which leads to anxiety and panic.

• Substance misuse
• Marijuana: Tetrahydrocannabinol (THC), a part of marijuana, overwhelms the brain's endocannabinoid (feel-good) system. Understandably, this raises the risk of panic attacks. 
• Nicotine:Nicotine causes the release of norepinephrine and epinephrine. These fight-or-flight hormones induce anxiety, which may evolve into a panic attack.
• Cocaine:Cocaine (like nicotine) stimulates the sympathetic system and (like marijuana) suppresses the feel-good network. Understandably, this predisposes users to panic attacks.
• Amphetamines: Amphetamine (like nicotine) triggers epinephrine release.
• Ecstasy (3,4-methylenedioxymethamphetamine, MDMA): Ecstasy damages the brain's serotonergic (relaxation) system. Low levels of serotonin increase excitability, predisposing users to panic attacks. 
• Medications 
• Steroids:Studies show that anabolic steroids lead to anxiety and mood instability due to their effect on the brain’s serotonin and dopamine system.
• Asthma treatment: Common asthma medications such as albuterol and salmeterol can lead to panic attacks. This is because these drugs trigger epinephrine release.
• Levothyroxine: Studies show that levothyroxine-treated hypothyroid patients are likely to experience anxiety. This is because the drug indirectly raises epinephrine levels by increasing thyroid hormones levels.

Alcoholism and Panic Attacks - A Vicious Cycle

Drinking small amounts of alcohol can be relaxing because it triggers the release of calming hormones serotonin and GABA. However, it sets off a cycle that alternates between relaxation and alcohol-induced anxiety (known as “hangxiety”). 

This is because alcohol's relaxing effect is temporary. When alcohol's effect wears off, serotonin levels drop, which leads to anxiety (due to adrenaline release). This prompts users to consume more significant quantities of alcohol. Thus, the cycle repeats.

Alcohol-Induced Panic Attacks

Research links alcohol use to anxiety and panic attacks. In one study, 35.8% of alcohol-dependent men (and 60.7% of women) reported feeling anxious. This is because, as users increase the quantities of alcohol they drink to ease anxiety symptoms, it creates structural brain changes, depleting the reserves of GABA (a calming hormone). 

Alcohol and Panic Attack FAQs

Why Is Alcohol an Unhealthy Coping Mechanism for Panic Attacks? 

Alcohol alters the brain’s neurochemistry (in particular, its serotonin and GABA levels), which can worsen anxiety and lead to panic attacks.

Can You Get Panic Attacks When You Stop Drinking? 

Yes, abruptly stopping (or reducing) alcohol intake after prolonged use can lead to panic attacks.

Can You Get a Panic Attack When Intoxicated?

Yes, heavy drinking can deplete GABA reserves, which can lead to panic attacks.

How Long Does It Take for Anxiety to Go Away After Quitting Drinking? 

For most users, it may take 3-7 days for symptoms to go away. 

How to Help Someone Experiencing a Panic Attack 

A panic attack can be unnerving for both the patient and the observer. Luckily, witnesses can help the affected by following a few simple principles:

• Stay calm. It’s crucial to NOT let the situation overwhelm you. Your calmness serves as a signal to the patient that everything is going to be fine and helps them calm them down. 
• Stick around. Staying beside someone having a panic attack can be reassuring for them. 
• Encourage them to breathe slowly and deeply. Slowing down the breathing rate centers the individual. Examples of effective breathing techniques include: 
• Square breathing, which involves inhaling, holding the breath, exhaling, and pausing (each for four seconds) before the next breath.  
• Slow diaphragmatic or abdominal breathing, which involves placing one hand on the chest and the other on the abdomen and focusing on their rise and fall while breathing deeply. 
• Move the patient to a quiet place where they can focus on their breathing.
• Do your best to be understanding, positive, and encouraging. Ask them about what may have triggered the panic attack and encourage them to think about the situation more rationally.  
• Speak to the affected individual in short, simple sentences. Saying the following things can help: 
• "You can get through this." 
• "I'm proud of you. Good job." 
• "Tell me what you need now." 
• "Concentrate on your breathing. Stay in the present." 
• "It's not the place that is bothering you; it's the thought." 
• "What you are feeling is scary, but it's not dangerous."
• Ask the patient to repeat a simple, physically tiring task such as raising his or her arms over the head. This helps divert their attention and calms them down.

Panic Attack Treatment

Panic attack treatment ranges from lifestyle changes to psychotherapy and various medical interventions. 

Lifestyle Changes That Can Help Treat (and Prevent) Panic Attacks

• Exercise: Moderate-intensity exercise triggers the release of endorphins (feel-good hormones) such as serotonin, GABA and endocannabinoids. These boost mood and lower the frequency of panic attacks. 
• 86% of patients with panic disorder reported reduced panic attack frequency (at a 6-month follow-up) following a 23-week exercise program. 
• A healthy diet: An unhealthy diet rich in processed foods raises cortisol levels (a stress hormone), which can lead to anxiety and panic attacks. 
• A large cross-sectional analysis on Norwegian adults found a healthy diet (consisting of vegetables, fruits, wholegrains, fish, and unprocessed meats) reduces risk of anxiety. 
• Nutritional supplements: Studies show inositol can reduce the frequency and severity of panic attacks by increasing GABA levels and activity. 
• In 21 diagnosed panic attack patients, inositol reduced panic attack frequency and severity over a four-week trial.
• Another study including 20 patients found inositol to be more effective than the antidepressant fluvoxamine in reducing weekly panic attacks. 
• Drink plenty of water: Studies show that water has a natural calming effect, likely because it restores the brain's electrolyte balance, which reduces anxiety. 
• Mindfulness techniques such as yoga. Mindfulness refers to focusing (non-judgmentally) on the present moment. This triggers the release of serotonin which, as discussed, soothes the nervous system and relieves anxiety. 
• Patients in a study reported significant improvement in panic symptoms following an eight-week mindfulness program. 
• Similarly, participants of a two-month, once-weekly yoga study reported improvements in all anxiety indexes. 

Psychotherapy as Panic Attack Treatment: Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing the thoughts and feelings that affect mental health. Studies show that 80% of people with a panic disorder who complete a course of CBT are panic-free at the end of treatment.

CBT for panic attacks combines relaxation techniques with breathing training. This is because studies show that five sessions of breathing training over the course of four weeks reduces the severity of panic attacks. 

Panic Attack Medications

Doctors turn to panic attack medications when the measures detailed above fail to abate symptoms. Examples of panic attack medications include:

• Selective serotonin reuptake inhibitors (SSRIs) — first line treatment. These antidepressants are a first-line treatment that works by increasing serotonin levels to relieve anxiety. Drugs in this category include:
• Fluvoxamine
• Paroxetine. A 22-week study showed decreased panic attack frequency (when compared to placebo) in patients using paroxetine
• Sertraline. In a large, 80-week study, sertraline users reported 44% reduction in panic attacks and a 46% reduction in anxiety symptoms.
• Benzodiazepines. These are another class of antidepressants. They work by increasing GABA levels in the brain. Examples include:
• Alprazolam
• Clonazepam
• Propranolol. This off-label option is a beta blocker, which means it counteracts the panic-attack-induced surge in epinephrine. Up to 80% patients report immediate relief in panic attack symptoms after using the medication. However, it is only effective during the event itself, with limited long-term efficacy. 

Quit Alcohol Once and for All with Confidant Health!

Alcohol is not the solution to your anxiety. Luckily, the experts at Confidant Health can help you overcome your alcohol use and break free from the hangxiety cycle. Get in touch today!