Why does anxiety produce nausea?

March 6, 2006 2:14 PM

I'm wondering if anyone has a clear sense of the biochemical mechanisms that cause anticipatory anxiety to result in nausea, appetite disturbance and dry mouth. I often experience these symptoms when I'm worrying about some future event or possible outcome. I've read that researchers believe serotonin receptors in the stomach have something to do with this reaction, but I'm not sure if the process is well understood. Also, does anyone know of any medications that are effective in reducing anxiety-induced nausea or lack of appetite? I am using cognitive-behavioral therapy to deal with my anxiety, but it would be nice to get some immediate relief while I'm working on my thought processes.
posted by zembla3 to Science & Nature (8 answers total)

I feel your pain. Paxil has worked for me. My doctor also said to apply direct pressure with your hand on or around your belly button when anxiety affects the stomach. I haven't had to try it.
posted by punkfloyd at 2:26 PM on March 6, 2006

I have similar symptoms; stress/anxiety and I get nauseous.

I'm supposed to be working but a quick search on Pubmed doesn't turn up anything really obvious.

Smoking a little pot works for me. Of course it's not appropriate in many situations.

Here's a review of cannabinoids and treating anxiety and nausea (among other things).
posted by PurplePorpoise at 2:31 PM on March 6, 2006

Well, from what little I know I'd guess this is mostly caused by the release of epinephrine ( = adrenaline ) from the adrenal medulla. This is your typical fight-or-flight reaction to stressful stimulus. Adrenaline differs from its close cousin norepinephrine in that it strongly excites beta-receptors for (nor)epinephrine, while plain old norepinephrine mostly excites alpha receptors. So, something that blocked beta receptors would shut down that "fight-or-flight" response that you're experiencing.

Turns out there's a class of drugs called a beta-blockers, that do just that. You should, I suppose, talk to your therapist/psychiatrist if you're looking for short-term relief.

That said, a couple of caveats: I'm not sure about nausea, but it's a reasonable extrapolation from the effects of SNS activity that I'm aware of. Also, epinephrine responses typically last only 1-3 minutes, so if it's something of longer duration that you're experiencing then this might not be the best approach.

Also, I'm not even a little bit of a doctor. I've just told you what we teach undergrads about this stuff; it's certainly not a meaningful description of a) clinical effects, or b) what will work for you. See a doc!
posted by metaculpa at 2:34 PM on March 6, 2006

I use chewable meclizine for anxiety-based nausea. It works surprisingly well, considering it's indicated for motion sickness.
posted by astruc at 2:53 PM on March 6, 2006

Ask your family doctor for some Nexium (the purple pill). I understand exactly where you're coming from with the anxiety issues and the concurrent stomach issues. It's hard to feel good when you're nauseous.

You take one a day. Some people take it every day indefinitely (though I've read some things saying that indefinite usage may not be the greatest idea). I suggest getting a script as if you are to take it daily and then if you are feeling better at some point, you might not need it.

I can usually nip any problems in the bud after a day or two, but then I've got the anxiety under control with other stuff. If only they had had this stuff when I was growing up.

Note that you can get alternative meds like prilosec over the counter in a reduced dosage. I didn't much like it. So I keep Nexium on hand in case it's needed.

It's no big deal to get some Nexium. Everybody and their brother has some. It's a hell of a lot better than pepto-bismol. And good luck in dealing with the anxiety. Life's too short to be miserable.
posted by bim at 4:42 PM on March 6, 2006

Paxil (and any of the other SSRIs that have calming side effects) are great aids to what you're doing.

Also, if there are particular events that you know are going to stress you out, a small dose of a mild sedative can help. For example, for many years I took 0.5mg of Lorazepam on the night before airplane flights as an alternative to spending the whole night freaking out.

(eventually I started to forget to take it, and now I never do at all.)

[...]but I'm not sure if the process is well understood.

Nothing about these systems is well understood, but that hasn't stopped people from coming up with some pretty good medications. It just takes a bit of trial and error to find the right one.
posted by tkolar at 5:43 PM on March 6, 2006

Michael Gershon is the serotonin neurotransmitter guy you're thinking of. His book The Second Brain is an interesting read. Here is one short article and a longer one you might find interesting.
posted by selfmedicating at 7:15 PM on March 6, 2006

I second reading The Second Brain. Gershon manages to hit just the right level scientific detail -- it can be a hard read in places, but it's ultimately accessible and definitely worth finishing if you're willing to put the work in.
posted by tkolar at 12:01 AM on March 7, 2006