Can Caffeine Induce Anxiety Attacks?

Merely Me Health Guide August 09, 2010
  • The short answer is a definite yes. In looking over some of the more popular member generated content here on Anxiety Connection,  I stumbled upon a post written by member Linda back in 2007 where she makes an amazing discovery about the source of her anxiety attacks. In her post entitled, “No Coffee, No Anxiety” Linda explains how she would have chronic anxiety and panic attacks during a stressful period in her life. Despite the fact that the stressors went away, she continued to have problems with anxiety. Then she found the one thing that really helped. Here is an excerpt of Linda’s story:


    “I stopped drinking coffee because I noticed that it was making me feel a bit nauseated on a regular basis. I didn't remove caffeine completely -- I started drinking tea instead. It was about two weeks without coffee when I realized that the anxious feeling was gone. Completely. The ONLY change I made in my life at the time was cutting out the coffee. That was more than two years ago and the anxiety has never returned, even in stressful situations. It may sound crazy, but I'm a firm believer that coffee was the cause of my anxiety.”

     

    Could such a story be true? Can a habit of millions of people around the world be an underlying source of anxiety for some? Many health experts including our writers here on Anxiety Connection have reported about caffeine induced anxiety. In a post entitled, “Diet and Anxiety” Eileen Bailey writes about the possible detrimental effects of caffeine: “While a small amount of caffeine may help some people be more alert and focus, excessive caffeine can have just the opposite impact, causing irritability, loss of focus and can cause people to feel jittery and anxious.” Jerry Kennard has also discussed some of the symptoms of caffeine induced anxiety in his post, “10 Reasons Why Anxiety Isn’t Always in the Mind”: “Caffeine can trigger a number of sensations including sweaty palms, a racing heart and ringing in the ears, that has been known to result in panic attacks.”

     

    I am not sure how many people know this or not but there are actually four psychiatric conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) as related to caffeine consumption. They include: Caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified (NOS).

     

    For example here are the criteria outlined in the DSM-IV-TR for Caffeine intoxication:

     

    • 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 o 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
    • The above symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
    • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder, such as an anxiety disorder.

      If your anxiety attacks come on in the morning following your morning coffee this just may be a pattern to examine.   


      We know that people with already existing mental health issues may be especially vulnerable to suffering from ill effects from caffeine consumption. Here are some things to know:

      • The pyschostimulant properties of caffeine puts people having bipolar disorder  more at risk for having manic symptoms if they consume large quantities of caffeine.

      •  In an article entitled, “Caffeine-Related Psychiatric Disorders,” author, R Gregory Lande states that high blood-caffeine levels are correlated with severe depression.

      • In a 2009 study, Antonio E. Nardi and colleagues, found that patients having an already existing panic disorder reacted with having increased anxiety and panic attacks after undergoing a 480-mg caffeine test.  
         
      One conclusion we can draw from such studies is that for some people, caffeine consumption can exacerbate the symptoms of existing mental health problems especially those who already suffer from anxiety.

      Although there are a number of caffeinated beverages out there, coffee is probably the most popular among them. With a Starbucks on most every corner of urban streets, coffee consumption has steadily increased over the years. One estimate is that up to 80% of Americans drink coffee. And according to The National Coffee Association more young adults are drinking coffee than ever: “Young adults (18-24) who drank coffee consumed an average of 3.2 cups per day as compared with 3.1 in 2007, a significant increase over 2005’s level of 2.5 cups per day.” 

    The National Coffee Association also found that coffee outranked pop and soda as the favorite choice of caffeinated beverage: “In 2007, past-day consumption of coffee surpassed that of soft drinks for the first time. While the gap narrowed in 2008, daily consumption of coffee is still directionally higher.”

    It does appear that most Americans are getting their caffeine fix from coffee. The risk of adverse symptoms from caffeine consumption are related to dosage. The Johns Hopkins Baview Medical Center gives a rough estimate that adults consume approximately 280 milligrams (the equivalent of 17 ounces of brewed coffee or 84 ounces of soft drink) per day in the United States.

    According to this same source:

    • 100 mg of caffeine per day can lead to physical dependence and withdrawal symptoms upon ceasing to consume caffeine.

    • 200 mg of caffeine per day can increase anxiety ratings and induce panic attacks for some individuals.

    • Caffeine intoxication (see DSM-IV-TR symptoms listed in this article) can occur for some individuals when they consume caffeine in excess of 250 mg (more than 2-3 cups of brewed coffee) per day.

    So let’s look at how much caffeine is included in various caffeinated beverages to make a comparison.
    (Source: Mayo Clinic’s Nutrition and Healthy Eating.)

    • Now I know why some of you are drinking the Mountain Dew in the morning. It is a soda with one of the highest amounts of caffeine. A 12 ounce can of Mountain Dew has a whopping 54 mg of caffeine in it.

    • 12 ounces of Dr. Pepper has approximately 42-44 mg of caffeine.

    • Diet Coke has more caffeine in it than the non-diet version. A 12 ounce Diet Coke has 47 mg of caffeine as compared to 35 mg in the same sized can of Coca-Cola Classic.

    • Sodas like 7Up, Sprite, and Mug Root Beer are reported to have no caffeine.

    • An 8.3 oz red bull energy drink has 76 mg of caffeine.

    • I am finding out that one of my favorite beverages contains a lot of caffeine! A 16 oz Starbucks Tazo Chai Tea Latte has about 100 mg of caffeine. Yikes!

    • A regular generic 8 oz cup of brewed coffee has a range of 95-200 mg of caffeine.

    Decaffeinated coffee usually still contains a little caffeine. An 8 ounce cup of generic decaf coffee can contain between 2-12 mg of caffeine.

    • A 16 oz Starbucks vanilla latte has about 150 mg of caffeine in it.

    You do the math. How much caffeine are you consuming in a day do you guesstimate? Do you feel that your caffeine consumption is causing you to be more nervous or prone to anxiety attacks? In my next post we will be discussing how to break an addiction to caffeine and how to deal with withdrawals. Stay tuned!

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    Sources:


    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). Washington, DC: 2000:212-5, 708-9.


    Broderick PJ, Benjamin AB, Dennis LW. Caffeine and psychiatric medication interactions: a review. J Okla State Med Assoc. Aug 2005;98(8):380-4


    Nardi AE, Valenca AM, Nascimento I, Freire RC, Veras AB, de-Melo-Neto VL, et al. A caffeine challenge test in panic disorder patients, their healthy first-degree relatives, and healthy controls. Depress Anxiety. 2008;25(10):847-53