Can You Drink Alcohol With an Anxiety Disorder?

While research on alcohol is evolving, the Centers for Disease Control and Prevention (CDC) says drinking less or not at all is better for your health.

You may have seen plenty of on-screen characters sip whisky or wine to calm their nerves, but if you have an anxiety disorder, you may wonder if this habit really helps.

That’s because the two have a bidirectional relationship, says Sharon Batista, MD, a psychiatrist in private practice in New York City and an assistant clinical professor of psychiatry at Mount Sinai Hospital. “Alcohol can worsen anxiety, and anxiety can drive problematic alcohol use.”

How Alcohol Affects Anxiety Disorders

As your body processes alcohol, GABA decreases, but glutamate stays active at its new, increased level, which leaves you more anxious when not drinking, says Dr. Batista. “Alcohol also affects serotonin and dopamine pathways, both of which are implicated in mood and anxiety regulation,” she says.

Not only does alcohol worsen anxiety, but your anxiety level can stay high for a long time after you stop drinking. “It is not until 12 or more hours after our last drink that the glutamate receptors start to decrease,” says Ashvin Sood, MD, a psychiatrist in private practice in Washington, DC.

• Rebound Anxiety As mentioned, anxiety can increase as blood alcohol levels fall, especially after heavy or chronic use.

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• Sleep Disruption Alcohol interferes with the typical stages of sleep, leading to poor sleep quality, which can also affect anxiety.
• Withdrawal Even short-term withdrawal after moderate drinking can trigger anxiety symptoms in susceptible individuals.
• Neuroadaptation Chronic drinking leads to changes in brain chemistry that can make anxiety symptoms more persistent and severe.

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• Dehydration Alcohol dehydrates you, and even mild dehydration can increase irritability and anxiety.

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Is It Safe to Drink When I Don’t Feel Anxious?

Batista agrees, adding that even small amounts of alcohol can have negative consequences for people with anxiety, even when they don’t feel anxious before they drink.

Does Alcohol Interact With Anxiety Medications?

• Benzodiazepines like alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan): respiratory depression, overdose, higher risk of accidents, and injury
• Sedating antidepressants like mirtazapine (Remeron): drowsiness and dizziness

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• Monoamine oxidase inhibitors like tranylcypromine (Parnate) and phenelzine (Nardil): dangerous blood pressure increase
• Z-drugs like zolpidem (Ambien) and eszopiclone (Lunesta): increased sedation

“Basically, [the effects of any medication] that causes you to be tired and decreases your rate of breathing will be supercharged with alcohol,” says Sood.

Are Some Alcoholic Drinks Safer for Anxiety Disorders Than Others?

“Our culture often downplays the harms of alcohol, but the reality is that no amount of alcohol is entirely without risk — either for the general population or for those with anxiety disorders,” says Batista.

Sood recommends tracking drink equivalents so you know exactly how much you’re having. “Know the numbers,” says Sood. “One U.S. standard drink equals about 14 grams (g) of alcohol — the amount in 12 ounces (oz) of 5 percent beer, 5 oz of wine, and 1.5 oz of spirits.”

• Beer (4 to 8 percent, or 8 to 12 percent for craft beer)
• Wine (14 to 16 percent)
• Champagne (12.5 percent)
• Hard seltzer (4 to 12 percent)
• Kombucha (0.5 to 2.5 percent)

Safe Drinking Practices for People With Anxiety Disorders

• Set clear limits on how much and how often you drink.
• Avoid alcohol when you’re feeling anxious or when taking sedating medications.
• Never use alcohol as a coping strategy for anxiety symptoms.
• Eat a nutritious diet and stay hydrated.
• Monitor ‌any increase in anxiety symptoms after drinking and adjust your drinking habits accordingly.
• Seek professional help if alcohol use becomes difficult to control.

Timing also matters, says Sood. He recommends no alcohol within four to six hours of bedtime to protect deep sleep and prevent sleep disruptions and next-day anxiety. Sood also suggests writing down your drink limit for the day before your first sip and scheduling alcohol-free days when you don’t drink at all.

Sood always encourages his patients to tell their doctor or therapist if alcohol has become a problem for them. “Most of us have shame when sharing our relationship with alcohol and anxiety,” says Sood. “[But] stigma is slowly going down, and we often will approach with empathy and patience, and can point you to the right resources.”

The Takeaway

• Alcohol may ease anxiety symptoms at first, but anxiety often returns to the same level or worse once your drink wears off.
• There is no safe level of alcohol when you have anxiety, which can worsen symptoms and interact with anxiety medications.
• If lowering your alcohol intake feels like a challenge, let your healthcare provider know. They can help you develop safe drinking strategies and other anxiety coping techniques.