Can a chemical imbalance cause anxiety?

Everyone experiences anxiety at some point. A job interview, major exam, fight with a friend, or a chemical imbalance in the brain can cause anxiety. 

Many factors are linked to mental health conditions like anxiety and depression, so it’s important to remember that a chemical imbalance is not solely responsible.

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Like depression, anxiety is impacted by many things, including lifestyle, stress, and genetics. One contributor is our own biology in the form of brain chemicals called neurotransmitters. 

Neurotransmitters––like serotonin, dopamine, norepinephrine, and GABA (gamma-aminobutyric acid)––are chemical messengers that pass information between nerve cells. They are also closely tied to emotions and mental health (Chand, 2022). 

Since brain chemistry is linked to our mental well-being, it’s not surprising that a chemical imbalance can contribute to anxiety and other mood disorder. This concept is called the chemical imbalance theory.

However, researchers agree that a chemical imbalance alone is not the exact or only cause. Family history (genetics), life stressors, medication, trauma, and environmental factors can all work with neurotransmitters to create anxiety.  

While a chemical imbalance might not be the sole cause of anxiety, neurotransmitters do impact mood. How much of an impact a chemical imbalance has depends on the neurotransmitter. Some examples include (Liu, 2018):

• Norepinephrine: This neurotransmitter plays a role in your fight-or-flight response, which regulates how you react to perceived danger. One part of anxiety might be an overactive fight-or-flight response. Abnormally high levels of norepinephrine are linked to feelings of anxiety. 

• Dopamine: Dopamine plays a role in how you respond to pleasure. But according to one study in rats, when dopamine levels are too high, it can cause dread (Faure, 2008). If there’s not enough dopamine in the brain, it can contribute to other anxious feelings like social anxiety (Tiihonen, 1997). 

• Serotonin: Serotonin is closely tied to mood, digestion, and sleep. When there isn’t enough in your brain, it can contribute to feelings of anxiety and depression. The exact link between serotonin and anxiety isn’t known, but medications that raise serotonin often help. 

• GABA: This neurotransmitter helps control signals between nerve cells in the brain. GABA also counteracts some of the chemicals that trigger anxiety. When levels are too low, it can have the opposite effect and create anxiety (Lydiard, 2003). 

No matter what the cause of your anxiety is, it’s always a good idea to know the mental and physical symptoms. Some experience it in fleeting moments, while others have anxiety for months or even years.

If anxiety takes over daily life and prevents you from doing what you want, it might be generalized anxiety disorder (GAD). The intensity and frequency of symptoms vary, but people who experience anxiety or have GAD report experiencing (Chand, 2022):

• Feelings of fear or panic

• Racing heartbeat (palpitations)

• Sweaty or cold hands

• Upset stomach

• Dizziness or lightheadedness

• Shortness of breath or rapid breathing

• Fidgeting or difficulty keeping still

• Trouble sleeping

• Intrusive, scary thoughts 

• Difficulty concentrating or remembering things

If you have these symptoms and they’re interfering with daily life, talk to a healthcare provider or mental health professional. They can help figure out what’s happening and determine the best next steps. 

Two of the most common tools for managing anxiety are psychotherapy (like cognitive behavioral therapy or CBT) and medication. Both treatments are effective, though they work even better when combined (Walkup, 2008). 

Medication for anxiety and depression is thought to work by changing the levels of certain neurotransmitters. Common ones include antidepressants called selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels. These effectively reduce anxiety, though some people may experience side effects like decreased libido (sex drive), constipation, nausea, weight changes, or trouble sleeping (Slee, 2019). 

To help regulate GABA, benzodiazepines––like lorazepam (Ativan)––are sometimes used. Benzodiazepines aren’t usually the first-line medication for anxiety since these drugs pose a risk for addiction. They may also have side effects like severe drowsiness and weakness or cause withdrawal symptoms when stopped. However, benzodiazepines may be helpful in managing anxiety symptoms for short periods (Zwanzger, 2005). 

There are many chemicals that affect the brain, and an imbalance in these may contribute to anxiety and other mental health conditions. But there are ways to manage it, including medications and therapy. If you have anxiety symptoms, speak to a healthcare professional who can help. 

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

April 13, 2022

Written by

Gina Allegretti, MD

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.