Caffeine-Related Disorders

You: “I’m so stressed and anxious!  I get weird mood swings.  I can’t sleep at all.”

Me: “How much caffeine do you drink per day?”

You: “About 12-14 cups…”

Wake up and smell the coffee!!!!!

I’ve seen so many clients over the years who were addicted to, or who over-consumed caffeine, that I am moved to dedicate a page to the subject on my website.  One, two, at the most three (and that’s pushing it!) cups of coffee a day is sufficient.  Any more than that and you’re more likely to head into difficulties.  The majority of people I have seen with insomnia, anxiety and panic disorders, consume a huge amount of caffeine.  I’d love to tell you all to abandon drinking it entirely, but that’s unlikely to happen.  Like chocolate, for many people, it’s one of life’s pleasures.  I very much enjoy the occasional cup myself.  However, like everything in life, we require balance.  A little of what you like does you good.

The following article discusses the pharmacological aspects of caffeine and explains why caffeine intoxication can resemble the symptoms of a panic attack, as well as talking about its relationship to insomnia and the withdrawal symptoms such as fatigue and drowsiness.  To read the article and learn more about the side effects and symptoms of caffeine intoxication click here.

The 4 caffeine-induced psychiatric disorders include caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified (NOS).

DSM-IV-TR criteria for caffeine intoxication include the following:

• Recent consumption of caffeine, usually in excess of 250 mg (more than 2-3 cups of brewed coffee
• Demonstration of 5 or more of the following signs during or shortly after caffeine use:

  • Restlessness
  • Nervousness
  • Excitement
  • Insomnia
  • Flushed face
  • Diuresis
  • Gastrointestinal disturbance
  • Muscle twitching
  • Rambling flow of thought and speech
  • Tachycardia or cardiac arrhythmia
  • Periods of inexhaustibility
  • Psychomotor agitation

Many psychiatric disorders seem to show a correlation with caffeine intake.  It can also interfere with medication.  According to R Gregory Lande (read his Medscape article here) severe depression is correlated with high intakes of caffeine.  However, it’s obviously important to question such things as whether or not the depression came first.

My initial advice is to reduce the amount.  If 3 cups of coffee a day does not seem like an achievable target, then gradually reduce the intake as much as possible until you are drinking no more than 3 cups a day.  Remember, the DSM criteria for caffeine intoxication is more than 3 cups of coffee per day.  If you’re drinking more than that regularly, then you will more than likely be noticing certain negative effects.  According to this article (click here), caffeine energy drinks have about the same amount of caffeine as the average cup of coffee, so take that into account when you’re trying to cut back.  Don’t forget about all the other sneaky caffeine locations e.g. chocolate and cold/flu medication.

To keep track of your intake, I’d also highly recommend keeping a diary.  Sometimes we forget how much we’ve had (conveniently!) if we are prone to consuming large amounts.  This is a useful exercise for anything you want to cut back on e.g. cigarettes, food etc.  The evidence will be right there in front of you.  Plans are also good.  They help you to get into good habits, and out of the bad habits that have gotten you into the problem in the first place!  Decide when you will have your coffee, and try to stick to that.  For example: 1 cup of coffee 8am; 1 cup of coffee 11am; 1 cup of coffee 2pm.  Also, try not to take caffeine too late in the day.  Find healthier substitutions e.g. green tea, but don’t over-indulge on these either.  Teas, including green tea, contain less caffeine, but they do contain some.

I’ll be researching this subject more fully over the next few weeks, in an effort to understand more about the effects of caffeine intoxication on mood disorders and will post up anything significant to this site.