Opioids are a class of drugs prescribed for pain relief and sedation. Taking opioids long term may increase the risk of anxiety and depression as side effects.

Opioids can cause many side effects, including the onset of physical and mental health symptoms. This can occur with both prescription and illegal opioids. In particular, taking opioids may lead to developing depression and anxiety. Opioids may also worsen the symptoms of people who already have anxiety.

Opioids reduce norepinephrine levels. Norepinephrine is a neurotransmitter that controls blood pressure and alertness. When a person stops taking opioids, norepinephrine returns to its usual level. This can overwhelm the brain, causing several withdrawal symptoms, including anxiety.

This article reviews the link between opioids and anxiety, the signs, and opioid-induced anxiety. The article also addresses how people may help to prevent anxiety from happening, how opioid use disorder (OUD) may develop, and treatment options for this condition.

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Prolonged or chronic use of opioids can cause anxiety. People may experience anxiety as a withdrawal symptom when they stop taking these medications. Opioids can be addictive if taken inappropriately, and they can already cause withdrawal symptoms after a person takes them for 4–8 weeks.

Withdrawal symptoms typically start a few hours after taking the last dose of opioids and peak within about 72 hours. Withdrawal symptoms of opioids may include:

The onset and peak of these symptoms may depend on the type of opioid a person takes. It may also depend on whether the opioid is short-acting (prescribed for acute pain) or long-acting (prescribed for managing pain).

Opioids can reduce norepinephrine levels in the body. This is a neurotransmitter that controls alertness and blood pressure, often causing drowsiness and low blood pressure as a side effect. When a person stops taking opioids and the medication no longer affects their system, norepinephrine is no longer repressed.

This causes the brain to immediately release a significant quantity of norepinephrine in the body to bring blood pressure and energy levels to baseline levels. This can cause acute withdrawal symptoms, including anxiety.

Taking opioids long term can induce the brain to keep producing high quantities of norepinephrine to compensate for the suppressing effect of opioid medications. This can also cause people to feel nervous and anxious and promote the onset of depression.

Signs of opioid-induced anxiety may include:

  • panic attacks
  • phobias
  • obsessions
  • compulsions
  • free-floating anxiety (a sense of unease not connected to anything specific)

People can experience anxiety even when taking their medications as prescribed. However, depending on the dosage — the dose and frequency at which a person takes opioids — the severity of the anxiety may differ. Anxiety may also occur as a withdrawal symptom.

Withdrawal anxiety may last between 5 and 14 days from when a person stops taking their opioid medications.

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Steps that may help reduce the risk of opioid-induced anxiety include:

  • taking opioids only if prescribed and precisely following the doctor’s recommendation
  • avoiding increasing the dosage a doctor prescribes
  • avoiding taking opioids while using alcohol, illegal substances, or sleeping pills
  • speaking with a doctor in case of any unwanted side effects

Doctors can also recommend the most appropriate strategies to help prevent anxiety and other symptoms when taking opioid medications.

Over 60% of people with OUD experience anxiety or an anxiety-related condition at some point in their lives. People who develop OUD continue taking these medications despite experiencing adverse effects. Someone with OUD may also be unable to stop taking opioids when they try.

Having preexisting anxiety before starting to take opioids may also increase the risk of developing OUD.

People with opioid-induced anxiety may take opioids to relieve the anxiety. However, this can trigger the brain to produce even more norepinephrine. This may lead to a spiral in which people take more opioids to ease their anxiety, but the anxious feelings increase.

A 2017 study evaluated anxiety in people who were taking opioids to treat chronic pain. The study found that 50% of people who had clinically significant anxiety also misused opioids. The same 2017 study also stated that only 10% of people who misused opioids did not have anxiety.

The treatment for OUD typically includes a combination of medications and psychotherapy.

Medications a doctor may prescribe to relieve the withdrawal symptoms and cravings a person may experience after stopping opioids include:

Doctors may also prescribe an antidepressant to help with anxiety and depression, such as tricyclic antidepressants or selective serotonin reuptake inhibitors. However, psychotherapy treatment, such as integrated cognitive behavioral therapy (I-CBT), can play a significant role in preventing OUD relapse.

If a person experiences OUD or has anxiety after taking opioids, they may consider speaking with a specialist. Doctors can recommend the most appropriate plan to treat OUD.

Opioid medications can cause anxiety and depression. People who take these drugs long term to treat chronic pain may have an increased risk of developing anxiety, depression, and OUD.

Opioids have a high risk of dependence, making it difficult for people to stop taking them. If a person experiences symptoms such as anxiety or depression, they should speak with a doctor as soon as possible to get support and appropriate treatment.

People should only take opioids when prescribed by a doctor and follow the doctor’s dosage instructions. Taking opioids with other medications or not taking them as prescribed can increase the risk of OUD.