The anxiety hangover: Recovering from a panic attack takes time

Exhausted, nauseous, headachy, mentally drained, anxious and blurred are words I would use for how an anxiety hangover feels. Not the anxious hangover after a night of dancing, drinking and laughing where an unsettling nervousness seeps in with the headaches and spins, but the uniquely draining element of being suspended in fight or flight. Others would add fragile, shaky, out of sorts, and physically and mentally uncomfortable.

My anxiety is triggered by various things, including situations, people, even conversations, and while I know my limits, I don’t always manage an anxiety attack or the aftermath as well as I possibly could. The repercussion of anxiety can see my body delicately knitted up into tight knots, my shoulders and neck aching, my head a bundle of threads waiting to be unravelled with logical and conscious thought.

It's important we acknowledge that even if the threat is imagined such as worrying about the future or far away like the war on Ukraine, the emotion feels utterly real

But like a hangover, this is our bodies’ way of coming down, levelling out, after such an intense response from our nervous system. It is no wonder we can feel physically and mentally drained after anxiety hits, but many of us don’t recognise the aftershock as being part of anxiety.

Anxiety has continued to rise as our already complicated lives remain in a constant state of fear, worry, confusion and apprehension as we internally and externally battle, firefight and try to understand the difficult situations occurring in our minds, homes, communities and worldwide.

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Sally O'Reilly, counselling psychologist and psychotherapist, frames anxiety as a normal yet unpleasant physical expression of, or reaction to, a real or imagined threat. She says, "It's important that we acknowledge that even if the threat is imagined such as worrying about the future, or invisible like a virus, or minimal such as it being an unlikely outcome, or even far away like the war on Ukraine, the emotion aroused feels utterly real. Unmanaged anxiety and fear can destabilise or paralyse us. As with all animals, it is normal to behave out of character, become disorientated or to freeze under unduly stressful conditions. It is normal to find it exhausting."

The aftermath of anxiety is not as easy to come through as a hangover caused by one too many drinks or that cocktail you’ve forgotten the name of. The cause of an anxiety hangover can be difficult to pinpoint, making the recovery a much slower and more difficult process. The symptoms can be overwhelming, severe and last longer than expected.

“I’ve seen a general rise in ‘baseline’ anxiety since Covid-19 infected our collective psyche,” says O’Reilly. “We have endured a real existential threat and we have buried many loved ones. Our faith in our ability to control our environment has been deeply shaken. We have learned that we are not in control. That fear and realisation has led to changes in our behaviour. We are more withdrawn, more inclined to ‘snap’, to be adversarial, vigilant and judgmental. We are sad and we are tired.”

This exhaustion makes it even harder to align and manage our thoughts with the aftermath of an attack lasting anywhere from 10 minutes to up to a week. Our bodies have reacted to the perceived threat and experienced an enormous chemical and hormonal reaction with adrenaline and the stress hormone, cortisol, running through our bodies. The reaction is powerful and heightens the physical response. Once the panic subsides, our bodies crash after the intense hormonal spike leaving us drained physically and mentally.

“Right now,” says O’Reilly, “many of us find that management of anxiety and the physical and mental hangover is more challenging than before. There is a sense of, when do we get a break? How much more bad news can we take?”

The hangover of an anxiety attack can include fatigue and exhaustion, recurring or sudden bouts of anxiety, broken or poor sleep, feeling restless or agitated, shaking, trembling, headaches, changes in appetite, muscle tension or body aches, and brain fog or confusion.

“Understanding ourselves and our own process is crucial. Batting anxiety away and wondering why we’re so affected just won’t cut it. It is better to acknowledge that real things are happening and our reactions to them are largely normal, proportionate and indicative that we are healthy, functioning, compassionate, empathic human beings who find suffering and the witnessing of suffering difficult. Many of us have been traumatised over the last two years. Some of us have and are experiencing vicarious trauma which is painful in a different way as we are affected by what we see on the news and on social media or hear during conversations with each other. If none of this were to affect us, that would indicate a pathology not a strength.”

Once we can attach meaning to something it can begin to feel less scary and more under our control. We are responding normally to a series of abnormal events

Caring for ourselves after an anxiety attack includes looking after both our physical and emotional wellbeing. Recognising that our bodies and minds need regulating is the first step before allowing ourselves time to rest and recuperate. Anxiety is physical work, after all, as O’Reilly says.

“It affects our heart rate, respiration, blood pressure, sleep and ability to focus,” she says. “It is not simply a transient emotion. If we can be compassionate with ourselves in knowing that, our exhaustion, fatigue, mood swings, erratic behaviour, even insomnia, will make more sense. Judging it as annoying and questioning why it’s so hard will not help. If someone breaks their leg, we don’t question their pain and desire to rest up. Why question our own exhaustion right now when it’s utterly logical? To do so is to be dismissive at best and at worst, cruel.”

Creating calm space for our minds to realign can include mindfulness, meditation, reading, listening to your favourite music, and self-compassion in recognising the upset you have experienced. We are asking our minds to relax and to separate our thoughts from the negative thinking traps and obtrusive opinions we can get stuck in.

Alleviating the physical symptoms of anxiety can include getting some fresh air and regulating our breathing, gentle exercise or stepping into the familiarity of our routines. Listening to what our bodies need is important because we are all different in our responses to anxiety, so actively addressing what our bodies and minds need in that moment is to be compassionate towards ourselves.

“Generally speaking,” says O’Reilly, “we can mind ourselves in the aftermath of, or indeed during, an anxious period by attending to our basic psychological needs. This would mean asking ourselves, what can I do today to meet my needs for personal power, freedom, connection and fun? These are the needs that can suffer when we’re under duress. It is too easy to neglect oneself.”

O’Reilly is aware that self-compassion is not a way to make anxiety go away but she believes it might help contextualise it. “Once we can attach meaning to something,” she says, “it can begin to feel less scary and more under our control. We are responding normally to a series of abnormal events. We could do with easing off on the self-judgment, reducing our media exposure, getting as much rest as we can, and where possible, notice what’s going well.”