From Painkiller to Panic: The Hydrocodone-Anxiety Paradox

The hydrocodone-anxiety paradox is a phenomenon in which hydrocodone, an opioid pain reliever, has been observed to cause or worsen anxiety in some people. Some studies suggest that opioid use may increase the likelihood of developing certain mental health issues, like anxiety or depression.[1,2]

Does Hydrocodone Cause Anxiety?

Yes, hydrocodone can cause anxiety in some people. 

Hydrocodone is an opioid medication that is prescribed for the treatment of moderate to severe levels of pain. As with most opioids, hydrocodone works by attaching to specific opioid receptors in the brain and central nervous system. This blocks any painful sensations and induces feelings of relaxation and tranquility.[1] 

With these effects, it seems counterintuitive that the drug could trigger anxiety, but it’s a potential side effect of hydrocodone. Ultimately, opioids like hydrocodone lower levels of norepinephrine in the body, helping to promote relaxation and potentially causing drowsiness. Once the drug wears off, the brain releases norepinephrine to return to its normal state, and this surge in norepinephrine can trigger feelings of anxiety and jitteriness.[3]  

Side Effects of Hydrocodone

As with any opioid medication, hydrocodone can cause a number of side effects, ranging from mild to severe. In some cases, anxiety is one of these effects.[4] 

Common side effects of hydrocodone may include the following:[5]

• Sedation and drowsiness: Many people taking hydrocodone experience feelings of excessive sleepiness. 
• Nausea and vomiting: Gastrointestinal upset is a standard side effect of opioids. 
• Constipation: Opioids slow down bowel movements, so someone taking hydrocodone may experience constipation.
• Dizziness: Balance issues, brought about by dizziness or lightheadedness, are commonly experienced by people taking hydrocodone.
• Itchiness: Hydrocodone has been known to cause skin rashes and itching in some patients
• Mood changes: Opioids, like hydrocodone, can induce mood swings, ranging from feelings of euphoria to depression and anxiety.

Can Hydrocodone Worsen Anxiety?

In some patients, hydrocodone can potentially worsen anxiety (intrusive emotional and physiological responses to perceived threats or stressors, ranging from everyday worries to overwhelming fears) or contribute to the development of that anxiety.[2,3] Although primarily prescribed for pain relief, hydrocodone is a central nervous system depressant, and this can affect moods and emotions in unpredictable ways. 

Hydrocodone-inducing (or worsening) anxiety is known as the hydrocodone-anxiety paradox, which is thought to be due to a number of factors:[6-8]

• Opioid-induced hyperalgesia: Opioids can actually make pain worse in some people, a condition known as opioid-induced hyperalgesia. This can lead to increased anxiety, as people may feel like they are not getting their expected (and necessary) pain relief.
• Opioid-induced respiratory depression: Opioids like hydrocodone can suppress breathing, which can cause anxiety, especially for people who have a history of anxiety disorders.
• Individual differences in metabolism: Hydrocodone is metabolized into hydromorphone, which is a more potent opioid. Some people metabolize hydrocodone more quickly than others, which can lead to higher levels of hydromorphone in the bloodstream. This might increase the risk of side effects, including anxiety.
• Misuse: If hydrocodone is misused, higher doses are usually taken more frequently, and the drug may be mixed with other substances. This is dangerous, as it increases the potential for overdose as well as side effects like anxiety.
• Underlying anxiety disorders: People with underlying anxiety disorders may be more likely to experience anxiety when taking hydrocodone.

Anxiety in Hydrocodone Withdrawal

The hydrocodone-anxiety paradox is rare and not fully understood. Most patients who take hydrocodone as prescribed do not experience any symptoms of anxiety. 

Anxiety can also be a development during hydrocodone withdrawal.[9] Suppose a person who has been regularly taking hydrocodone suddenly stops or significantly reduces their intake. In that case, the body goes through a period of adjustment as it tries to stabilize without the chemical changes brought about by hydrocodone. 

Anxiety is a common symptom of such an adjustment. This is more likely if a person has a history of anxiety or similar mood disorders. 

What to Do if You Feel Anxious After Taking Hydrocodone

If you experience anxiety after taking hydrocodone, try these tips to manage it:[10,11]

• Seek medical help. Call your doctor to discuss this potential side effect of hydrocodone. They may switch you to a different form of pain management or recommend other strategies to manage the issue. 
• Do not self-medicate. Do not increase the hydrocodone dose or take other medications in an attempt to solve the problem. Taking more hydrocodone or another drug during this period of anxiety can exacerbate the problem and lead to other health risks. 
• Try to stay calm. Try some simple deep breathing exercises, meditation, mindfulness techniques or other coping strategies to settle your mind and breathing. 
• Get help. Talk to a trusted friend or family member about what you’re experiencing. Emotional support during an anxiety attack can be very comforting. Once you get through the moment, you can seek other means of managing the condition, such as therapy, medical advice or lifestyle changes.
• Stay away from stimulants. Caffeine, for example, can exacerbate your anxiety. 

Getting Help for Hydrocodone Addiction

If you’ve been misusing hydrocodone or any opioid repeatedly, you may have opioid use disorder (OUD). It’s incredibly difficult to recover from OUD without help, but Medication for Addiction Treatment (MAT) can put recovery within reach.

At Bicycle Health, we MAT to effectively treat OUD on a long-term basis. Suboxone manages withdrawal symptoms and cravings for hydrocodone, so you can make substantial life changes and begin to rebuild your life without opioid misuse.

You can start treatment today, thanks to the ease of our telehealth services. No matter where you live, we’re available to help. Reach out today to get started.