Written by Clay M. Cooper, PharmD | Reviewed by Alyssa Billingsley, PharmD Published on July 2, 2021
Key takeaways:
- Anxiety conditions are common and can be treated with therapy, medication, or a combination of both.
- There are several common medication types that could be the cause of anxiety symptoms, including stimulants, antidepressants, and thyroid medications.
- Talk with your healthcare provider about the anxiety you’re experiencing and the medications you take to see if there’s a connection between the two.
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Everyone experiences stress and anxiety at some point in their lives. We get anxious about work or school. We worry about ourselves, our friends, and our families. We’re nervous about a meeting, an interview, or an appointment.
Feelings like these are normal. They are a natural process built in to help keep us safe. But, for some people, those feelings are constant and can cause problems in their everyday lives. In fact, around 40 million Americans are affected by some type of anxiety condition.
Identifying the causes of anxiety is an important part of treating these conditions. Some people may avoid certain situations or triggers. Others may change certain habits, seek out counseling, or take medication to relieve their symptoms.
Another important place to look is in the medicine cabinet. Certain medications can cause or worsen anxiety, especially if you have been diagnosed with an anxiety condition. If you’re having trouble with these symptoms and have ruled out other causes, it might be the medication you’re taking.
Let’s take a look at 10 different types of medications that can cause or worsen anxiety as a side effect.
Stimulants
The most effective medications for treating attention-deficit hyperactivity disorder (ADHD) and narcolepsy are a class known as stimulants. This group includes medications like amphetamine salts (Adderall), methylphenidate (Ritalin, Concerta), and dexmethylphenidate (Focalin).
These medications work by changing the levels of certain brain chemicals. This helps to improve focus, boost alertness, and relieve other ADHD or narcolepsy symptoms. However, anxiety can be a side effect when the dose is too high or the medication is not the right choice for you.
If you experience anxiety while taking a stimulant, your healthcare provider may need to adjust your dose or switch you to a different medication. Making a change can help relieve anxiety while still controlling your condition’s symptoms.
Corticosteroids
Corticosteroids — often referred to as steroids — are used for various conditions and infections that cause swelling (inflammation) or rashes. They are notorious for their long list of side effects, including things like stomach upset, high blood sugar, immune system effects, and cataracts.
One of these possible side effects is anxiety, and it’s often seen when taking high doses of steroids, when the dose is lowered too quickly, or when they are stopped suddenly. In fact, research suggests that the dosage you’re taking is the most important risk factor for developing mental health side effects, such as anxiety — with higher doses putting you most at risk.
Corticosteroids are found in several different dosage forms, such as tablets, liquids, inhalers, nasal sprays, eye drops, and ear drops. Anxiety symptoms are most often related to tablets, liquids, and inhalers because the doses are higher, and they are more likely to be absorbed into your bloodstream.
Examples of corticosteroids include:
- Hydrocortisone
- Prednisone
- Prednisolone
- Methylprednisolone
- Fluticasone inhaler (Flovent)
- Dexamethasone
Medications with caffeine
Caffeine is a stimulant. Sometimes, it can make us jittery. We experience this sensation when we drink too much soda, coffee, or energy drinks. Caffeine also boosts alertness, brain function, and heart rate. However, overdoing it can lead to anxious feelings.
Besides being found in multiple beverages, caffeine is also in several medications, including over-the-counter (OTC) diet pills and headache remedies, like Excedrin, BC Powder, and Goody’s Powder.
Prescription medications can also be combined with caffeine. A common example is Fioricet (butalbital/acetaminophen/caffeine), which is used for migraines. As with the drinks mentioned above, the caffeine in these OTC and prescription medications can cause anxiety as a side effect.
If caffeine is a concern for you, check your medication labels for an ingredient list or ask your pharmacist for more information about the medications you take. Be sure to consider your total daily caffeine intake from all sources — foods, drinks, and medications.
Decongestants
Nasal decongestants are medications we take for a stuffy nose, a sinus headache, or bad allergies. Two commonly-used decongestants are pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). These medications work great to clear nasal passages and help us breathe better. But to our bodies, they look very similar to the stimulants discussed earlier and can have the same side effects, including anxiety.
Decongestants can be found in a variety of OTC medications. Several cough and cold products contain a decongestant along with a cough suppressant, an antihistamine, or a pain reliever. Decongestants can also be found in OTC nasal sprays, such as oxymetazoline (Afrin).
This is another group of medications where it is important to check the label or ask your pharmacist for help selecting a medication.
Antihistamines
Antihistamines often go hand-in-hand with decongestants. These medications are used to dry up runny noses, calm itchy eyes and skin, and relieve other allergy symptoms. Several different types are available OTC, including:
- Diphenhydramine (Benadryl)
- Loratadine (Claritin)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Levocetirizine (Xyzal)
Antihistamines, like decongestants, can be found in many OTC cough and cold products and nasal sprays. Antihistamines are also combined with decongestants in products like Claritin D (loratadine/pseudoephedrine), Allegra-D (fexofenadine/pseudoephedrine), and Zyrtec-D (cetirizine/pseudoephedrine).
While most people expect antihistamines to cause drowsiness, this isn’t always the case. A small number of people who take diphenhydramine experience a faster heart rate, trouble sleeping, and restlessness.
One study also suggests cetirizine and hydroxyzine have a greater chance of causing anxiety and mood changes than other antihistamines. Hydroxyzine can also be used to treat anxiety conditions. So if you notice your symptoms worsen after starting this medication, contact your provider to discuss it further.
Anxiety caused by antihistamines should go away once you stop taking the medication. If you notice you feel more nervous in the hours following a dose of these allergy medications, speak with your provider about alternatives.
Rescue inhalers
Rescue inhalers — also called short-acting beta agonist inhalers — is a term that refers to an inhaler a person with a lung condition, such as asthma, uses when they experience trouble breathing. Most rescue inhalers like ProAir, Proventil, or Ventolin contain albuterol.
Albuterol works by expanding the lungs and airways to let in more air. The receptors albuterol activates in the lungs are also present in the heart and muscles. When albuterol attaches to those receptors outside of the lungs, it can cause side effects like tremors (shaking) and anxious feelings.
Even though these side effects are temporary, they can still be bothersome when they happen. The only way to prevent these effects is to limit how often you use your as-needed inhalers. Speak with your provider about how to best prevent your symptoms with maintenance medications to help you lower the number of times you are using rescue inhalers.
Thyroid medications
Levothyroxine (Synthroid) and liothyronine (Cytomel) are synthetic versions of thyroid hormones made by your body — hormones that play a large role in the body’s metabolism and overall function — that are taken when your levels are too low. Treating hypothyroidism (low thyroid hormone) improves symptoms, such as fatigue, weight gain, and depression.
But as with any other medication, too high of a dose can be a bad thing. If you’re taking a higher dose than needed of thyroid medications, you might experience trouble sleeping, a faster heart rate, and anxiety.
Your healthcare provider will order regular blood tests called thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) levels while you are taking these medications to watch for too much or too little thyroid hormone in your body. If needed, they will make adjustments to your dose to help relieve these side effects.
Antidepressants
Like stimulants, antidepressants also work in your brain to change the levels of chemical messengers called neurotransmitters. Many antidepressants focus on raising levels of serotonin — a neurotransmitter that affects multiple functions, including sleep, appetite, and mood.
Some examples of antidepressants include:
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
Antidepressants work well to treat both depression and anxiety, but for some people they can lead to nervousness or anxiety as a side effect. It may seem a little contradictory that a medication used to treat anxiety can also cause anxiety. However, because serotonin can attach to multiple receptors through the brain and body, there is a small risk of causing unintended mood changes.
Speak with your healthcare provider if you notice any mood or behavior changes after starting these medications. They may adjust your dose or switch you to a different medication if you’re experiencing anxiety from your antidepressant.
Recreational drugs
It’s well-known that illicit drugs come with many risks. Some people use recreational drugs as a way to cope with stress, self-medicate conditions like depression or anxiety, or simply to escape from the world. However, drugs like cocaine, lysergic acid diethylamide (LSD), methamphetamine, and phencyclidine (PCP) can sometimes have the opposite effect. They can cause hallucinations, fast heart rates, and other side effects that cause anxiety or worsen an anxiety condition.
If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline at 1-800-662-HELP (4357) to learn about resources in your area.
Tapering medications
Sometimes, it isn’t the medication that causes anxiety but the absence of it. Medications like stimulants, antidepressants, anti-anxiety medications, and even recreational drugs can cause rebound anxiety if they are stopped suddenly, or you taper off them too quickly. If a medication was being used to treat an anxiety condition, it’s also possible for symptoms of that condition to return once the medication is out of a person’s system.
To help avoid or limit withdrawal symptoms like anxiety, it’s important to work with your healthcare provider to come up with a plan to safely stop these types of medications.
The bottom line
Having anxiety from time to time is something we all experience, but it can affect some people more severely than others. There are many different causes of anxiety, and identifying a potential reason is the first step in understanding and controlling this symptom.
Certain medications can cause or worsen anxiety in some people. If you believe this symptom could be coming from a medication, it’s best to discuss this with your healthcare provider. Having this conversation can help treat or relieve your anxiety.
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