Why Alcohol Can Cause Anxiety the Day After Consumption

Many people report feeling anxious after excessive alcohol consumption, especially the morning after a binge. This phenomenon, sometimes called “hangxiety” (a combination of the words hangover and anxiety), refers to the feelings of unease, nervousness, and discomfort that occur during a hangover. In fact, a hangover includes not only physical symptoms (such as headache, nausea, fatigue) but also negative emotional and cognitive effects (1).

Anxiety and irritability are among the mood symptoms reported during a hangover, although they occur less frequently compared to physical symptoms. For example, in a study with 1,837 young adults, about 22.6% reported feeling anxious during a hangover (in comparison, 34.2% reported feeling depressed) (2). This "hangover anxiety" can worsen the discomfort of the following day and interfere with daily activities, making it important to understand why it happens and how to prevent it.

Biological Mechanisms Involved

Several biological mechanisms help explain why alcohol can leave the body in an anxious state. Initially, during intoxication, alcohol acts as a depressant on the central nervous system (CNS), increasing the activity of the inhibitory neurotransmitter GABA and reducing the activity of the excitatory neurotransmitter glutamate. The body tries to compensate for this effect: after a period of repeated or intense consumption, it reduces the sensitivity/quantity of GABA receptors and increases the number of glutamate receptors to counterbalance the sedation caused by alcohol.

Thus, when alcohol leaves the bloodstream, a rebound effect occurs, with low GABAergic inhibitory signaling and excess glutamatergic excitatory activity, leaving the brain in a hyper-stimulated state. This state of "hyper-excitation" manifests in a manner similar to a mild withdrawal syndrome, activating the body's alert system and leading to symptoms such as tremors, sweating, increased heart rate, and anxiety. In other words, after the initial depressant effect of alcohol, the CNS "fires up," generating feelings of anxiety the next day due to the imbalance between inhibitory and excitatory neurotransmitters.

Another key factor involves the hypothalamic-pituitary-adrenal (HPA) axis, responsible for the stress response. High alcohol consumption can activate the HPA axis and elevate cortisol levels, the stress hormone. Normally, cortisol follows a daily rhythm (higher in the morning and decreasing in the evening), but alcohol disrupts this rhythm, and this misalignment can contribute to feelings of anxiety.

Recently, science has highlighted the role of the corticotropin-releasing factor (CRF) system, a neuropeptide central to the stress response, in modulating alcohol’s effects on mood. Specifically, two CRF receptors (known as CRF1 and CRF2) have opposite functions in the context of alcohol consumption. According to a study in an animal model of binge drinking, immediately after an intense drinking episode, animals showed anxiolytic (anxiety-reducing) and even antidepressant responses mediated by the activation of CRF2 receptors. However, after 24 hours, the same animals exhibited clear signs of anxiety and depression, this time related to the activation of CRF1 receptors (3).

Tips for Minimizing the Effects of Post-Alcohol Anxiety

Fortunately, it is possible to adopt strategies to reduce the chances of experiencing anxiety after drinking or at least lessen its intensity. Here are some practical tips:

• Take it easy on consumption: The most effective way to prevent hangover anxiety is to avoid excessive alcohol consumption. Know your limits and prefer to drink moderately, spacing the drinks over time.
• Stay hydrated and well-fed: Alcohol causes dehydration (it is diuretic) and can lead to low blood sugar and other imbalances that worsen discomfort. Alternate alcoholic drinks with water and avoid drinking on an empty stomach – have light meals before and during consumption.
• Don’t try to relieve symptoms with more alcohol: It may be tempting to have a drink when you wake up to alleviate the symptoms, but this is not recommended. While it may provide temporary relief (because alcohol will again activate GABA receptors, producing a sedative effect for a short period), this only masks the problem and can reinforce a dangerous cycle of consumption.
• Seek support if needed: If you find that you frequently experience intense anxiety after drinking or are using alcohol to cope with pre-existing anxiety, consider seeking professional help. A doctor or psychologist can guide you, whether to manage anxiety (with therapy or medication if indicated) or to adjust your drinking habits.

Feeling anxious the day after consuming alcohol is a relatively common experience, especially after episodes of excessive drinking. While intoxication may provide an apparent calming effect (anxiolytic), this is temporary – and even deceptive – because it will be followed by the discomfort of the hangover when alcohol is gone. Moderation or abstinence from alcohol consumption and simple health practices (hydration, rest) can make a significant difference in the quality of the following day and long-term mental well-being.

References:

1. Mackus, M., Loo, A. J. V., Garssen, J., Kraneveld, A. D., Scholey, A., & Verster, J. C. (2020). The Role of Alcohol Metabolism in the Pathology of Alcohol Hangover. Journal of clinical medicine, 9(11), 3421. https://doi.org/10.3390/jcm9113421 
2. van Schrojenstein Lantman, M., Mackus, M., van de Loo, A. J. A. E., & Verster, J. C. (2017). The impact of alcohol hangover symptoms on cognitive and physical functioning, and mood. Human psychopharmacology, 32(5), e2623. https://doi.org/10.1002/hup.2623 
3. Simon, B., Thury, A. Á., Török, L., Földesi, I., Csabafi, K., & Bagosi, Z. (2023). The effects of alcohol on anxiety-like, depression-like, and social behavior immediately and a day after binge drinking. Alcohol (Fayetteville, N.Y.), 112, 17–24. https://doi.org/10.1016/j.alcohol.2023.05.004