Anxiety as a possible side effect of medication

Some medications can cause anxiety as a direct side effect, while others first trigger a panic attack, which subsequently leads to an anxiety state. Medical advice should be sought at the beginning and at the end of therapy. 

Anxiety disorders, fears and panic attacks can have numerous causes. In addition to physical illnesses and psychological conditions, medications can also trigger anxiety directly or as a result of their side effects.^1,2

Which medications can directly cause an anxiety or panic attack?  

If you take a look at the package inserts of some medications, you will find terms such as "panic attacks" and "anxiety" listed among the side effects. This is true for some preparations of the following groups of drugs ^1,2,3 :

• Drugs for the treatment of depression (antidepressants)  
• Substances for the therapy of some mental diseases (neuroleptics) 
• anti-Parkinson's drugs
• Drugs that act on brain function  
• Antibiotics, such as those from the group of fluoroquinolones  
• Medicines used to treat epilepsy (antiepileptic drugs)  
• Medicines for high blood pressure 
• Medicines for cardiac arrhythmias 
• asthma medicines 
• Substances used for hormone therapy, such as the contraceptive pill or preparations to treat hypothyroidism
• Appetite suppressants and energy drinks, especially from the group of sympathomimetics 
• Painkillers, especially opiates 

If you suspect that your anxiety is triggered by a medication, ask your doctor for advice. He or she can prescribe a more suitable medication; sometimes it is enough to change the dosage of the current medication. It is important to express your suspicions to the doctor treating you - as a first step towards improvement - and not to try things out on your own. 

Medications can have physical side effects that trigger anxiety

But anxiety can also be indirectly triggered by medications. If you don't directly find the terms "anxiety" or "panic attack" among the side effects, you should look for terms such as cardiac arrhythmia, tachycardia (rapid pulse), dizziness, shortness of breath or difficulty breathing. These can first cause an uncomfortable feeling, trigger anxiety about one's well-being, and eventually trigger an anxiety attack.^1,2 

Continued anxiety despite taking anti-anxiety medications or antidepressants?  

If anxiety, anxiety states and panic attacks persist during the first weeks of therapy with an antianxiety medication or an antidepressant, this should not immediately be declared as therapy failure or ineffectiveness, since in this case it is a case of the onset of action not yet having occurred. Certain medications do not develop their full effect until after two weeks, and some, such as lithium, even after up to 6 months.⁷ 

Discontinuation of medications can also lead to side effects It is essential to read the package insert not only at the beginning, but also before discontinuing a medication. Abrupt discontinuation of some drugs can lead to the so-called "rebound phenomenon" or "discontinuation phenomenon". The abrupt discontinuation of medication can lead to an exaggerated counter-reaction, which gives the impression that the old disease has returned in a worse form than it was before treatment. The consequence of an abrupt end of therapy can also be withdrawal symptoms. For example, abrupt discontinuation of neuroleptics, antidepressants and psychotropic drugs can lead to anxiety and panic attacks, and in the case of drugs to reduce heart rate and blood pressure (beta-blockers) to an increased heart rate (tachycardia) and a crisis-like rise in blood pressure. Therefore, certain preparations may only be discontinued after consultation with and instruction from a physician. By gradually reducing the dosage and frequency of intake, which is called tapering, the body can better adapt to the change and the "rebound effect" can be prevented. ^4,5,6

If you are unsure under which category, if any, your symptoms should be classified, ask your doctor or pharmacist for advice.