Stress and Anxiety: Safety, Substances and When to Get Help

If you need help right now

United States

• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. It is free, confidential and available 24 hours a day, 7 days a week, for suicidal crisis or emotional distress. [1][2]
• In a life-threatening situation, call 911 or go to the nearest emergency room. [2]
• If someone has taken too much of a medicine or supplement, call 911 or US Poison Help at 1-800-222-1222. See Poisoning: what to do first.

Outside the United States: use your local emergency number, or look up your country's crisis line. This site does not list other countries' numbers because they have not been verified here.

NIMH also lists a Veterans Crisis Line and a Disaster Distress Helpline on its help page; check the NIMH "Help for Mental Illnesses" page for current details. [2]

If you are worried about someone else, stay with them if you can and encourage them to contact one of the services above.

Signs that stress or anxiety needs professional care

Seek help if you are experiencing severe or distressing symptoms for 2 weeks or more, such as: [3]

• difficulty sleeping;
• changes in appetite or unplanned weight changes;
• difficulty getting out of bed because of your mood;
• difficulty concentrating;
• loss of interest in things you usually enjoy;
• inability to complete usual tasks and activities;
• irritability, frustration or restlessness.

Get help right away if stress is causing you to have thoughts of suicide, feel you cannot cope, or use drugs or alcohol more often than usual. [4] NIMH adds that stress or anxiety that interferes with your daily life, causes you to avoid things or seems always present may signal risk for an anxiety disorder. [5] Persistent impairment is the key: how long it lasts and how much it gets in the way. [6]

Where to start getting help

• Talk to a primary care provider, who can do an initial screening and refer you to a psychologist, psychiatrist or clinical social worker. [2]
• Look for SAMHSA's helpline and online locator, your insurance company's directory, a school health center or an employer's Employee Assistance Program. [2]
• Learn what treatment looks like on Therapy for anxiety and stress.
• Before an appointment, write down your symptoms, how long they have lasted and any medicines or supplements you take. See Talking with a health professional.

Alcohol, drugs and other substances

Using alcohol, cigarettes, gambling or drugs to relieve stress or anxiety can contribute to poor mental health, according to the NHS. [7][8] Anxiety disorders, including GAD and panic disorder, are commonly associated with alcohol and substance misuse. [6][9] Substance use can also produce symptoms that resemble panic attacks, which is why providers consider it. [10] If you are using more than usual to cope, tell your provider. Caffeine can disrupt sleep and make anxiety harder to control. [11]

Medicines and supplements

• Prescribed medicines. Do not stop a prescribed medicine on your own. For example, the NHS says not to stop a PTSD medicine unless a doctor tells you to, even if you feel better. [12] Benzodiazepine-type anti-anxiety medicines can cause tolerance and dependence, so providers usually prescribe them for brief periods. [6]
• Supplements and herbs. Some can interact with medicines or carry their own risks. Kava has been linked to severe liver injury and should not be combined with alcohol or other sedatives. [13] Ashwagandha may interact with diabetes, blood pressure, immune-suppressing, sedative, seizure and thyroid medicines. [14] Dietary supplements may have side effects and some can interact with medicines. [15] See Stress supplements and herbs compared, How interactions work, Interactions by drug class and Pregnancy and breastfeeding.
• Relaxation and mind-body practices. They are generally safe, but occasionally cause increased anxiety, intrusive thoughts or fear of losing control, and there are rare reports of worsening in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma. [16]
• Complementary approaches. Mindfulness, exercise and similar practices can support treatment but do not replace it. [6]

Do not self-diagnose

Anxiety, fear or panic can be the main symptom of several health conditions, so do not self-diagnose; speak to a health professional. [8] Panic attacks can feel like a heart attack, and many people first seek treatment in an emergency room. [9]