Alcohol consumption has an impact on several neurotransmitter systems. Neurotransmitters are molecules that neurons use to interact with one another. Today, we’re going to be concentrating on glutamate and gamma-aminobutyric acid (GABA).
According to John H. Krystal, MD, chair of psychiatry at Yale and co-director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Centre for the Translational Neuroscience of Alcohol, the primary regulator of the balance of excitation and inhibition in brain circuits is the balance of glutamate and GABA activity within the brain, he told IFLScience.
Let’s talk about GABA first. When this neurotransmitter attaches to GABA receptors, it inhibits a neuron’s response to stimuli or lowers its excitability. According to Dr. Krystal, it is the primary inhibitory chemical messenger in the cerebral cortex and is principally in charge of providing inhibitory tuning of glutamate cell activity.
It is believed that GABA signaling has a part in lowering anxiety and terror in the brain. GABA receptors are the target of some medications used to treat anxiety disorders, such as benzodiazepines. GABA is created when an enzyme transforms glutamate, which brings us to our next topic: glutamate.
Glutamate, in contrast to GABA, raises cell excitability. Approximately 90% of the synaptic contact between nerve cells is accounted for by glutamate, the primary excitatory transmitter for the cerebral cortex. According to Dr. Krystal, glutamate functions as the brain’s primary “information highway” in many respects. N-methyl-D-aspartate (NMDA) receptors are among the several receptors to which it interacts. Glutamate is essential for several processes, including memory and learning, pain signalling, and other processes. According to Dr. Krystal, excessive glutamate activation can cause panic attacks and elevated anxiety, as reported by IFLScience.
How then do these neurotransmitters react to alcohol?
Low-level alcohol intoxication has pro-glutamate and pro-GABA actions in equal measure. Dr. Krystal clarified that as intoxication levels rise, alcohol’s pro-GABA actions begin to work in tandem with its capacity to block NMDA receptors. When combined, these factors add to the depressive effects and cognitive decline linked to alcohol consumption. At even greater dosages, the suppression of excitement takes over, resulting in drowsiness and, at hazardous levels, a potentially fatal coma.
Why could having a hangover make you feel anxious?
According to the authors of a 2019 study, alcohol may lessen anxiety by preventing the body from reacting to cues that cause worry. It is believed that alcohol’s anxiolytic [anxiety-reducing] action mediates coping-motivated drinking and may have an impact on the SAD-AUD [social anxiety disorder-alcohol use disorder] relationship.
If you’ve spent any significant time around drunk people, you’ve probably witnessed (or even experienced yourself) that excessive GABA activation during intoxication can lead to a form of fearlessness that inappropriately disinhibits behavior, according to Dr. Krystal, who spoke with IFLScience.
Given that alcohol can alleviate anxiety during intoxication, what could be causing your severe mental distress the following morning?
The brain must somehow correct this imbalance after a time of higher GABA and lower glutamate signaling than usual. To do this, it must modify the populations of receptors on neurotransmitter systems and neurotransmitter systems themselves.
As Dr. Krystal explained, these neurological adjustments the brain makes in an attempt to regain balance can lead to tolerance to alcohol and the development of physical reliance on it following prolonged periods of excessive drinking. Following this, when a person quits drinking, their brain may experience some unpleasant side effects as it attempts to regain equilibrium.
Alcohol withdrawal causes the GABA receptors to become less functional, which reduces inhibition and increases excitement. Dr. Krystal clarified that similarly, the NMDA glutamate receptors adapt to the persistent blockage of alcohol by proliferating, which lowers the population’s sensitivity to alcohol.
When alcohol is removed and there is less GABA inhibition, more glutamate is released. This glutamate is more effective at causing anxiety, seizures, and, in extreme cases, damage to nerve cells because it is interacting with more NMDA receptors.
When someone who has been drinking frequently regularly abruptly quits or cuts back, they are said to be suffering from alcohol withdrawal syndrome (AWS), with symptoms appearing eight to twenty-four hours after the last drink. The more often you drink, the more likely you are to experience symptoms such as anxiety, a fast heartbeat, shakiness, mood swings, irritability, and nightmares, as well as more serious ones like seizures and delirium tremens.
In addition to the usual effects of alcohol intoxication, like dehydration, irritation of the stomach and intestines, and disturbed sleep, an individual who does not normally drink but has a large alcohol binge also experiences a very mild form of alcohol withdrawal syndrome, according to Dr. Krystal. Furthermore, alcohol metabolites such as acetone and acetaldehyde can also harm your mood.
He went on to say that the onset of moderate alcohol withdrawal symptoms after a binge may be responsible for symptoms like elevated anxiety, which is compatible with the amygdala’s increased excitability, and heightened responses to sensory stimuli, which are consistent with the cortical excitability. The idea that certain moderate kinds of GABA and glutamate adaptations to alcohol can happen in a single bout of heavy drinking is supported by these hangover signs and symptoms.
According to Dr. Krystal, some heavy drinkers have been using alcohol as a form of self-medication for anxiety issues that they already have. Furthermore, within a day or two after a binge, heavier drinkers are more likely to feel more severe withdrawal symptoms, and his clinical judgment is that hangxiety is more common in individuals who already experience anxiety.
What can be done to avoid hangxiety?
It may be a good idea for those whose drinking habits have a consistent, significant negative impact on their mental health to stand back and reevaluate.
The inability to limit drinking and continuing to drink despite it causing problems in one’s personal or professional life are two indicators of alcohol use disorder (AUD), according to the Centres for Disease Control and Prevention (CDC), even though 90 percent of excessive drinkers are not expected to meet the diagnostic criteria for AUD.
The greatest strategy to lower your risk of hangxiety is to drink less alcohol, as the Alcohol and Drug Foundation (ADF) explains.
No level of alcohol consumption is healthy for your health, according to the World Health Organisation. The UK’s National Health Service advises not consuming more than 14 units of alcohol a week, ideally spread out over three or more days (one shot of 40 percent ABV spirit equals one unit) to minimize the negative effects of alcohol consumption. Ten standard drinks per week, or no more than four per day, are recommended by Australian guidelines. The Dietary Guidelines for Americans suggest limiting alcohol consumption to one drink for women and two for men per day, or not drinking at all.
However, what can you do if it’s too late to heed that advice and you’ve already had one or more drinks—possibly too many—and anxiety is starting to set in?
Avoiding stimulants and, crucially, consuming more alcohol is advised. Increasing alcohol consumption can alleviate certain symptoms, but it can also prolong dependence. Many of my patients suffer from hangxiety. Dr. Niall Campbell, a specialist at UK-based independent mental healthcare provider Priory, stated on their website that some people attempt to “relieve” the unpleasant effects of their drinking by increasing their intake, but this can result in additional panic episodes and even seizures.
In addition to the traditional hangover remedies of resting, eating, and drinking plenty of water, the ADF suggests practicing mindfulness, reaching out to a friend, and, if possible, diverting your attention. However, as the NIAAA states on its website: You will most likely just need to wait until the previous night’s symptoms go away because there is no method to hasten the brain’s healing from alcohol consumption.