Mimosa, Bloody Marys, and Panic Attacks

Not long ago, I heard from an emergency room physician seeking to refer a patient for acute panic disorder. It seems this patient had shown up at the ER on a Sunday afternoon in a bit of frenzy, terrified that she was suffering a heart attack. She explained to the doc that she'd spent the previous day at her friend's wedding. After a long night of champagne and wine, she woke up with heart palpitations and nausea, which quickly spiraled into panic.

As a clinician, I've heard this story numerous times: Somebody has a panic attack, they go to the ER, the doctor gives them a clean bill of health and a prescription for Klonopin. They go home, and then they call me a few weeks later, when the panic symptoms haven't stopped. This is a very standard thing.

But in the past six months or so, I've noticed an uptick in people who report experiencing their first panic attack while they are hungover. Now, this is purely anecdotal; I don't know how common it really is. Although the links between anxiety disorders and substance abuse are well established, I couldn't find any research documenting  a link between first-time panic attacks and alcohol withdrawal. So, I can't say for certain that panic attacks really are more likely to occur, say, on the plane home from Vegas.

But from a theoretical perspective, it makes perfect sense. In therapy we talk about the Panic Cycle. In a panic attack, you experience unusual bodily sensations (like an elevated heart rate), which you misinterpret as harmful. So you focus on them and try to control them, which paradoxically just makes them intensify. This, in turn, makes you more anxious about them, and so it goes, until you are an anxious mess hiding in a bathroom stall. In therapy, we focus on breaking this cycle, so that you can experience anxiety without the whole anxious mess part.

During a hangover, two things are happening that can prime you to fall into the Panic Cycle. For one, you are experiencing symptoms that are identical to severe anxiety: shaky hands, sweating, headaches, insomnia. The other is that you probably aren't thinking so clearly, thanks to all the good sleep you didn't get last night. Because sleep deprivation has been shown to increase anxiety and to impede your cognitive functioning.So, when you do suddenly notice that your heart is racing, you're less able to reason out why that might be the case.

Again, I don't have the good scientific data on this. But it seems to me that heavy drinking, even once in a while, can set you up to have a panic attack the next morning. So keep this in mind next time you're planning a long night of celebrating.