Too often, people who struggle with undiagnosed mental health disorders, like depression and anxiety, abuse drugs or alcohol to ease the symptoms of their mental illness. People who struggle with untreated or undiagnosed anxiety may experience symptoms of this condition during withdrawal, especially if medical professionals do not monitor them during detox.
Untreated rebound anxiety can lead to relapse very quickly. This rebound effect requires treatment.
Drug Withdrawal Syndrome
Ending an addiction to alcohol or drugs requires help with detoxing from these substances to reach homeostasis or equilibrium of your brain chemistry. This can take time, depending on the substance that was abused, how long it was abused, and how large each dose was.
Some drugs, like alcohol and opioids, have medications that can ease withdrawal symptoms. This is called medication-assisted treatment (MAT). Other substances, like cocaine or marijuana, do not have prescription medications to ease withdrawal directly, but people who struggle with addiction to these drugs still benefit from working with medical professionals to ease off chemical dependence.
Without help from doctors, nurses, and therapists, some withdrawal symptoms can be physically dangerous. Most symptoms, such as rebound anxiety, are not dangerous. They can be so uncomfortable that the person relapses back into substance abuse. Rebound anxiety can also be dangerous if the person takes harmful actions as a result of their anxiety.
A plan that is carefully created and administered, using medical research and evidence on best treatment practices, is the best foundation to end the body’s dependence on intoxicating substances. This reduces the risk of relapse.
What is Rebound Anxiety?
The rebound effect occurs when a drug that has a contrary impact on the disorder is discontinued, which makes the original condition harder to treat due to serious health effects. Rebound symptoms are not common, as they manifest in a small number of people going through chemical withdrawal. They can lead to relapse, overdose, and death if not diagnosed and treated accordingly.
Withdrawal symptoms are seen with prescription medications like antidepressants as well as substances of abuse like alcohol. Even large, regular doses of over-the-counter (OTC) medications can cause rebound symptoms when you stop taking them as often.
For example, people who have chronic migraines may take a large dose of a nonsteroidal anti-inflammatory drug (NSAID) to combat the problem. If they quit without tapering the dose, they are more likely to develop frequent, painful headaches. Quitting caffeine can lead to headaches, tiredness, and sluggishness when you do not drink it.
Similarly, more potent drugs lead to rebound symptoms when you quit them, especially if you do so suddenly. Drugs that lead to rebound anxiety are most likely to be sedatives or to interact with dopamine and serotonin to reduce panic or nervousness. These drugs include:
- Alcohol
- Nicotine
- Opioids
- Benzodiazepines
- Antidepressants
These drugs are all sedatives to a certain extent, so people who struggle with anxiety are likely to consume them. Benzodiazepines and antidepressants are both prescription medications given to people with anxiety to help them in various ways. Opioids and alcohol are also sedatives, but they are not prescribed to treat anxiety.
Opioids, alcohol, and benzodiazepines are very addictive. Antidepressants are not considered addictive, as they do not cause euphoria, but withdrawing from these medications can be uncomfortable and requires medical oversight.
Anxiety Disorder and Substance Abuse
The limbic system in the brain is involved in the fight-or-flight response, and it is also associated with anxiety and panic disorders. Substance abuse can also impact the limbic system, which is involved in regulating mood, attention, some memory functions, rage, and sexual drive.
People who struggle with anxiety are more likely to struggle with substance abuse compared to the general population. This is a form of self-medication because symptoms of anxiety can be intense and uncomfortable, especially when the condition is undiagnosed and untreated.
However, a person with anxiety may realize they are self-medicating and attempt to quit. This leads to rebound anxiety, which could be more intense than the initial anxiety symptoms. This struggle may lead to relapse back into drug or alcohol abuse.
Drugs like alcohol, benzodiazepines, and nicotine lead to physical dependence and tolerance. The body needs the presence of the drug to feel normal (dependence) while also needing larger and larger doses to produce the original, calming effects (tolerance).
Symptoms of Rebound Anxiety
When a person abuses sedative-like alcohol or opioids, rebound anxiety can be uncomfortable. Symptoms of rebound anxiety include:
- Nervousness and restlessness
- Irritability and mood swings
- Panic attacks
- Extreme overactivity in the brain, which may lead to seizures
Types of Withdrawal Prone to Rebound Anxiety
Alcohol
Withdrawal symptoms associated with alcohol use disorder (AUD) typically peak within 24 to 72 hours (one to three days). Mood swings, insomnia, panic, sweating, and increased heart and breathing rates are all likely symptoms during withdrawal, and these can be unnerving and uncomfortable.
With medical oversight, they can be managed, but if you try to quit drinking by yourself, these may cause you to go back to drinking. If you drank a lot of alcohol for a decade or more, you are at risk of delirium tremens (DTs), a physically dangerous condition that includes a high risk of seizures.
Benzodiazepines
These drugs were initially designed to manage anxiety and insomnia. They are still prescribed for this purpose today, but doctors typically prescribe them for short-term treatment, often less than two weeks. Benzodiazepines include medications like:
- Valium
- Klonopin
- Xanax
- Ativan
These drugs calm brain signals, but this process can quickly lead to dependence and tolerance. If you take benzodiazepines consistently for more than two weeks, you are more likely to need to taper off the substance when you no longer need it. You are also at risk of feeling as though you need the medication to feel normal, which is a symptom of addiction.
Benzodiazepine withdrawal is more likely when:
- You try to quit suddenly.
- You take a short-acting version.
- You take a large dose.
Withdrawing from benzodiazepines often triggers rebound anxiety and insomnia. Withdrawal after high-dose abuse can also cause seizures.
Antidepressants
Because benzodiazepines are not a good consistent prescription treatment for anxiety, people who are diagnosed with a generalized anxiety disorder (GAD), social anxiety, and other related conditions are increasingly being prescribed antidepressants. It can take several weeks for antidepressants to build up in the brain and ease anxiety. Many people take antidepressants for years without needing to take a larger dose or taper off the drugs.
Sometimes, a person no longer needs or wants to be on antidepressants. Trying to quit these drugs can be time-consuming and uncomfortable. People who quit antidepressants report various symptoms such as:
- Quasi-mania
- Rebound anxiety
- Aggression
- Insomnia
- Periodic “brain zaps”
- Loss of sex drive
Although antidepressants slowly increase the amount of serotonin in the brain so that the person does not feel euphoric after taking one dose, this increase can lead to physical dependence on antidepressants; even trying to taper off these drugs can be difficult if the taper is too fast.
In each case, it is crucial to work with a medical professional to end the body’s dependence on these substances. This can help to manage any rebound anxiety that does occur.
Proven Evidence-Based Treatment
Detox helps the brain return to a state of equilibrium on its own, but the process takes time. Staying in detox for long enough to produce neurotransmitters without the help from substances allows for medical intervention from doctors, nurses, and counselors.
In some instances, people who have abused sedatives for a long time may develop protracted withdrawal, especially if they do not receive appropriate medical treatment to ease withdrawal symptoms. Psychological conditions like anxiety are more likely to be exacerbated with protracted withdrawal, and this increases the risk of relapse.
Prescription medications taken as ordered by your doctor may require a taper if you want to stop taking them. Always speak with your doctor before quitting any medication you have received. A medical professional can guide you to the safest way to stop taking it.
Substances of abuse require detox that includes medical oversight to diagnose and ease symptoms. Some drugs, like opioids, have medications that can help you safely taper off physical dependence. Others, like benzodiazepines, may not have associated MAT options, but a supervising physician can still keep you safe during the detox process.
Medical supervision is the best way to reduce the likelihood of rebound anxiety. If it does occur, this medical assistance can help to manage it well.
