Caffeine-Related Psychiatric Disorders

[historyteach]

Jenna,
I found this for you. I hope it makes some sense for you. Caffeine is a strong drug, and many people do not realize how addicting it really is. And the havoc it can play on us!

Caffeine-Related Psychiatric Disorders
Author: R Gregory Lande, DO, FACN, Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

Background

Caffeine is the world's favorite psychoactive substance. Only petroleum exceeds coffee as a globally traded commodity, and commerce and history of the United States are closely linked to tea consumption. Soft drinks now rank as the most popular beverage in the United States, and most contain caffeine. Beverage trade groups estimate the annual per capita soft drink consumption at 56 gallons. Research and worldwide beverage history confirm the safety of moderate caffeine consumption in healthy individuals.

The universal appeal of caffeine is related to its psychostimulant properties. In a healthy person, caffeine promotes cognitive arousal and fights fatigue. These same activating properties can produce symptomatic distress in a small subset of the population. Susceptibility to this symptomatic distress is broadly determined by 3 factors—the dose consumed, individual vulnerability to caffeine, and preexisting medical or psychiatric conditions (mood disorders in particular) that are aggravated by mild psychostimulant use.

Pathophysiology

Caffeine is a xanthine derivative. It acts by pharmacologically stimulating the CNS, heart, voluntary muscles, and gastric acid secretion, and it induces diuresis. Caffeine is rapidly absorbed. Peak plasma levels are achieved in about 1 hour. Caffeine saturates all body tissues and fluids, including breast milk. The half-life of caffeine is 4-6 hours.

The amount of caffeine in coffee and tea varies based on brewing times and methods. General guidelines for beverage caffeine content include the following:


Brewed coffee (8 oz) - 120 mg
Instant coffee (8 oz) - 70 mg
Iced tea (8 oz) - 60 mg
Hot tea (8 oz) - 60 mg
Caffeinated soft drink (12 oz) - 50 mg

The average daily consumption of caffeine among Americans is 219 mg.1 Adults receive nearly three quarters of their daily caffeine from coffee. Children receive one half of their caffeine from soft drinks. Energy drinks represent a fast-growing beverage market. A combination of caffeine and herbal ingredients are touted as providing an energy boost. Energy drinks vary in the amount of caffeine included in their formulations and can range from around 50-300 mg. Although it sounds more exotic in some drinks, guaranine is caffeine. Consumers seeking the activating qualities of caffeine in pill form can find many preparations, the more well known having 200 mg. Individuals worldwide consume about 76 mg of caffeine per day.

Caffeine symptoms appear to be dose-related. Most people experience no behavioral effects with less than 300 mg caffeine. Sleep is more sensitive and can be disrupted by 200 mg caffeine. At doses exceeding 1 g per day, susceptible individuals experience toxic effects.

Frequency

United States
Prevalence rates for caffeine-induced psychiatric disorders have not been well established. Mood disorders and other substance abuses coexist with caffeine disorders. Some studies report 50% comorbidity.2, 3

History

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).

Diagnostic criteria for the 4 psychiatric disorders are described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR).4

DSM-IV criteria 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
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.

DSM-IV criteria for caffeine-induced anxiety disorder

Prominent anxiety predominates in the clinical picture.

There is evidence from the history, physical examination, or laboratory findings suggesting that the anxiety developed within 1 month of caffeine intoxication or withdrawal or that medications containing caffeine are etiologically related to the disturbance.

The disturbance is not better accounted for by an anxiety disorder that is not substance-induced.

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM-IV criteria for caffeine-induced sleep disorder

A prominent disturbance in sleep occurs that is sufficiently severe to warrant independent clinical attention.

There is evidence from the history, physical examination, or laboratory findings that the sleep disturbance is the direct physiological consequence of caffeine consumption.

The disturbance is not better accounted for by another mental disorder.

The disturbance does not occur exclusively during the course of a delirium.

The disturbance does not meet the criteria for breathing-related sleep disorder or narcolepsy.

The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM-IV criteria for caffeine-related disorder NOS

This includes any caffeine disorder other than those previously listed.

Symptoms of caffeine withdrawal that are not currently an officially recognized diagnosis are present.

Caffeine withdrawal is listed in DSM-IV in the appendix, "Criteria Sets and Axes Provided for Further Study." Based on clinical experience, further research, and DSM-IV task force review, the diagnosis may become officially recognized. Symptoms may begin 6-12 hours after stopping or decreasing consumption, peak in 1-2 days, and persist for a week. The research criteria include the following:

Prolonged daily use of caffeine

Abrupt cessation of caffeine use or reduction in the amount of caffeine used, closely followed by headache and one or more symptoms that include marked fatigue or drowsiness, marked anxiety or depression, and nausea or vomiting.

The symptoms in the criteria listed above cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The symptoms are not due to the direct physiologic effects of a general medical condition (eg, migraine, viral illness) and are not better accounted for by another mental disorder.

Apart from the caffeine-induced psychiatric disorders, clinicians must consider the influence of psychostimulants on other mental disorders.

Individuals who abuse other substances commonly consume large quantities of caffeine.

People with schizophrenia typically consume large amounts of caffeine.

Caffeine may contribute to agitation, irritability, and, possibly, interfere with antipsychotic medications. On the other hand, caffeine can markedly elevate blood levels of antipsychotic medications, increasing the probability of adverse effects. The possible mechanism explaining this finding is that caffeine and antipsychotic medications both compete for metabolism at the hepatic P-450 isoenzyme system. Patients with bipolar disorder are at risk for an exacerbation of manic symptoms when they consume large amounts of caffeine. This is due both to its direct psychostimulant properties and secondary to increase renal excretion of lithium.

Severe depression is correlated with high blood-caffeine levels.(emphasis added)

People with panic disorders may consciously decrease caffeine use.

Diagnosis of any caffeine-related disorder begins with clinical awareness.

Beverage caffeine is such a common component of social activity that its consideration as a psychostimulant often is neglected.

Too many clinical histories fail to record caffeine use.

A complete caffeine history includes doses associated with beverages and medications.

Several over-the-counter analgesic, sinus, and weight loss compounds contain caffeine.

There are preparations that exploit caffeine's alerting affect. They are marketed as stimulants or "stay-awake" preparations, and they can contain 200 mg of caffeine.

Physical
The observable signs associated with caffeine consumption are dose dependent. For most individuals who consume caffeine in the average range, the physical stigmata will include arousal signs. Expect to see nervousness, elevated heart rate, increased respiratory rate, flushed face, and an exaggerated startle response. Caffeine is a mild diuretic and may contribute to vague gastrointestinal complaints. In rare cases where an individual's dose exceeds 1 g/d, the picture changes. Gross muscle tremors, highly disorganized speech, and possible arrhythmias herald a more sinister outcome.

Mental Status Examination

Many of the effects of caffeine consumption are expressed in behavioral manifestations. The most common is anxiety, with its associated fidgetiness, distractibility, poor eye contact, hesitating speech, and prolonged bursts of energy.

Caffeine's effect on mood is complicated and not fully understood. Although initially it may promote some improvement in mood, notably identified by some slight euphoria or focused attention, this pattern may give way to a chronic dysphoria. This mildly depressed state may be a consequence of withdrawal.

Any complaint of sleep difficulty should begin with a careful assessment of beverage consumption.

Caffeine would not produce perceptual problems such as hallucinations, alterations in thinking (such as delusions, disorientation, memory problems), or raise safety concerns such as suicidal or homicidal tendencies.

Causes

The means by which caffeine exerts its pharmacologic effects remain uncertain.

A leading theory suggests that caffeine is an adenosine receptor antagonist.

Adenosine is an inhibitory neuromodulator affecting norepinephrine, dopamine, and serotonin activity.

Caffeine's putative antagonism of adenosine would increase those neurotransmitters promoting psychostimulation.

The same neurotransmitter systems are implicated in the pathophysiology of several psychiatric disorders.

Hope this helps!

Shalom!

[shutterbug]

gotta bump this up so it doesn't run away from me before i get to go through it!

[Cleansing]

Yeah I still don't know what to think about caffeine. I drink one cup of coffee a day, and have tea like 3 times a week (which isn't much). I also drink "caffeine free" soft drinks.

However, when I'm in a social setting (like a concert) I now go for Red Bull since I cannot take alcohol.

This weekend, I will be jamming on Saturday and Sunday -- at least that's the plan, but you can never really rely on musicians who use haha.

I know my group members will be drinking and maybe even smoking weed, so I will bring along an energy drink so I can keep up with their energy. I'm not sure if I'm doing the right thing though. My depression and psychotic features have cause much insomnia in the past and I get irritated/agitated easily. I figure it's better than drinking alcohol though, alcohol will worsen the depression. And if anything, the two dosages of Zyprexa that I take will help me fight off any insomnia or sueprfluous excitability that the energy drink may create. Am I making the right choice in having an energy drink?

Am I making sense? Am I worried about nothing?

[historyteach]

Well, I can't speak for you, but, I know I can get irritated and aggitated, and also anxious without sleep too. So, *I* wouldn't touch a Red Bull or any of those types of drinks, myself.

Seems to me the music itself would give you the energy to keep you going, no?
And, as far as keeping up with the others, well, if they are drinking and smoking, you'll be far ahead of them by keeping your head straight! They are the ones who will be nodding! :rof

Just my opinion. Take what you need and leave the rest, as they say...

Shalom!

[PaperDolls]

I think I'm going to have to really consider cutting caffeine out completely.

Yikes!

[mattcake79]

PaperDolls, if you do decide to cut out caffeine, try to do it gradually to avoid withdrawal. I don't know how much caffeine you take, but the general advice is to cut 50 mg (approx 1 cup of espresso) per day, if not slower.

I used to drink about 8 cups a day and quit cold turkey. The w/d was nothing compared to alcohol, but it was still pretty uncomfortable. Headaches that don't respond to medication, lots of fatigue and sleepiness and general crankiness. Lasted about a week.

On the upside, I found that eventually my quality of sleep improved a lot, and my energy levels leveled out. I'm now drinking 2 cups a day, however - my one guilty pleasure.

Usual disclaimers apply

Matt

[shutterbug]

hummm.....okay.....so reading most of this is about as clear as reading through mud to me.

Basically, it's saying it's caffiene intoxification IF the symptoms are not better explained by another reason such as a mental illness or other.

And then there's this part:

Patients with bipolar disorder are at risk for an exacerbation of manic symptoms when they consume large amounts of caffeine. This is due both to its direct psychostimulant properties and secondary to increase renal excretion of lithium.

i'm bipolar II, rapid cycler.
i NEED the caffiene to function in the morning/early day. It does NOT cause me to switch into hypomania or mania. If i was bipolar I, then.....who knows?

But, UNTIL they have personally ever slept 23 hours a day for a week or longer WITHOUT it being caused by any meds or anything else.....THEN they can talk to me about what i can do to possibly function better/healthier without it.

That quote also assumes ALL bipolars take Lithium and we don't.

Severe depression is correlated with high blood-caffeine levels.(emphasis added)

what the heck does that sentence mean really?

That those of us in severe depression episodes tend to have a lot of caffeine in our blood? And that "(emphasis)" is added because that's important to the writer?

Well....my thoughts are: DUH!!!!

You try working a 50+ hour work weeks and living on your own while going through a major depressive episode and just SEE how well you are able to function at ALL without the use of caffiene!! LOL It's just not gunna happen, nope, nope.

People with panic disorders may consciously decrease caffeine use.

Huh? Are they saying that people who panic over things will decide for themselves to lower their intake? If so, then that i can see....since i do agree that caffiene increases your heart rate and all that jazz.

Physical
The observable signs associated with caffeine consumption are dose dependent. For most individuals who consume caffeine in the average range, the physical stigmata will include arousal signs. Expect to see nervousness, elevated heart rate, increased respiratory rate, flushed face, and an exaggerated startle response. Caffeine is a mild diuretic and may contribute to vague gastrointestinal complaints. In rare cases where an individual's dose exceeds 1 g/d, the picture changes. Gross muscle tremors, highly disorganized speech, and possible arrhythmias herald a more sinister outcome.

Mental Status Examination

Many of the effects of caffeine consumption are expressed in behavioral manifestations. The most common is anxiety, with its associated fidgetiness, distractibility, poor eye contact, hesitating speech, and prolonged bursts of energy.

Caffeine's effect on mood is complicated and not fully understood. Although initially it may promote some improvement in mood, notably identified by some slight euphoria or focused attention, this pattern may give way to a chronic dysphoria. This mildly depressed state may be a consequence of withdrawal.

Any complaint of sleep difficulty should begin with a careful assessment of beverage consumption.

Caffeine would not produce perceptual problems such as hallucinations, alterations in thinking (such as delusions, disorientation, memory problems), or raise safety concerns such as suicidal or homicidal tendencies.

while i believe a persons level of anxiety is probaby increased by caffiene consumption, i don't think it's enough to really worry about. I think anxiety issues are mostly having to do with underlying causes and i think PaperDolls said it best in her thread about why she's probably been so much more anxious lately (and myself included) and that's because she recently quit smoking (as did i) which was an anti-anxiety method/coping mechonism.

A leading theory suggests that caffeine is an adenosine receptor antagonist.

Adenosine is an inhibitory neuromodulator affecting norepinephrine, dopamine, and serotonin activity.

Caffeine's putative antagonism of adenosine would increase those neurotransmitters promoting psychostimulation.

The same neurotransmitter systems are implicated in the pathophysiology of several psychiatric disorders.

i don't know about you guys, but even with my studying this stuff for the past 4-5 years and knowing what neurotransmitters are and dopamine and serotonin........that's just a whole different language being used right there!



Jenna

[CAPTAINZING2000]

$hit

never entertained this thought before

I drink mine so strong, I can feel my hair grow

[historyteach]

Hi, Jenna;

I don't think it assumes most people who are bipolar are on lithium. But, many are, and the article does have to make note that caffeine causes us to pee more. Therefore, any medication, including lithium, that passes through our pee is going to be passed more quickly by drinking large amounts of caffeine in any form.

The emphasis was added by me for your benefit, Jenna. You've been dealing with such depression, I wanted to point this out to you. I'm sorry.

My anxiety level was substantial lowered when I changed my caffeine level. I used to drink large amounts of coffee. I drank it all day long and into the night. First, I switched to lite coffee with 1/2 the caffeine. Then, I cut down the amount. My doc wants me to have no more than 2 cups of regular coffee a day, or the equivalent of caffeine in any form -- soda, chocolate, etc. When I go over, I can really feel the difference. And if I really go overboard, my hands shake, my head buzzes, my startle reflex is exagerated, my throat begins to close, and I'm close to a panic attack. It can make a big difference to some of us.

That doesn't preclude other issues creating anxiety. When I quit smoking, I was filled with anxiety too. And the issues at that school caused much anxiety! OY! My son's condition through the year; my ex gambling away the mortgage; my mom's illness.... Many things in life can and do create the conditions that fill us with anxiety, especially if we are of the temperment to begin with. That doesn't mean caffeine does not. THey are not diametrically opposed. Caffeine is just one more to think about when we consider the origen of our anxiety.

I hate it when authors use jargon too! When I took the anxiety test for the counselor, there were so many words I had to look up, just to take the test!!! LOL! But, jargon is just a part of every discipline. I'm sure photography has it's own, just as history does.

I think that section of the article means that caffeine inhibits the neurotransmitters that effect norepinephrine, dopamine, and serotonin activity. I can look it up later if you want me to, but, it's too early in the morning right now, and I want to go back to bed, if I can... LOL!

I hope this addresses some of your concerns, Jenna!

Shalom!

[historyteach]

Hiya, Capt!!!

Yea, for me, it made a big difference. Especially as I got older.
I guess it's a combination of age and life experience that added to my anxiety, but, it is what it is.

Shalom!

[CAPTAINZING2000]

My sleep habits sux

[Latte]

I cut out my six sodas a day and couldn't figure out why I was getting heachaches. Keep in mind, I was still drinking two 12 oz cups of coffee a day along with that. I then remembered the nutritionist in my Al-Anon class in rehab (I went to rehab but also went to an Al-Anon class because I grew up with an alcoholic). He basically used laymans terms in describing the original post.

I am so thankful for my recovery. I have learned so much on this journey.

[historyteach]

Capt;

Here's some sleep hygiene tips to help you get some restful sleep. It helped me.

Sleep Hygiene: Helpful Hints to Help You Sleep

Poor sleep habits (referred to as hygiene) are among the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals and work, and we overstimulate ourselves with late-night activities such as television.

Below are some essentials of good sleep habits. Many of these points will seem like common sense. But it is surprising how many of these important points are ignored by many of us. Click on any of the links below for more information:

Your Personal Habits

Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.


Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.


Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.


Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.


Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.


Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.
Your Sleeping Environment
Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.


Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.


Block out all distracting noise, and eliminate as much light as possible.


Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.

Getting Ready For Bed
Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.


Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.


Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.


Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.


Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

Getting Up in the Middle of the Night
Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.

A Word About Television
Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

Other Factors
Several physical factors are known to upset sleep. These include arthritis, acid reflux with heartburn, menstruation, headaches and hot flashes.


Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty. In many cases, difficulty staying asleep may be the only presenting sign of depression. A physician should be consulted about these issues to help determine the problem and the best treatment.


Many medications can cause sleeplessness as a side effect. Ask your doctor or pharmacist if medications you are taking can lead to sleeplessness.


To help overall improvement in sleep patterns, your doctor may prescribe sleep medications for short-term relief of a sleep problem. The decision to take sleeping aids is a medical one to be made in the context of your overall health picture.


Always follow the advice of your physician and other healthcare professionals. The goal is to rediscover how to sleep naturally.

Hope it helps. Remember, nothing works overnight, but, practicing these helpful tips will help you get a more restful night's sleep.

Shalom!

[CAPTAINZING2000]

lol

I know what you used to help me sleep but, that was some time ago (wink)

[shutterbug]

Hi Teach....sorry for being such an argumentative "B". Some days I just have that "all-or-nothing" thought process going where if i start out disagreeing with something in an article then for some reason my brain just decides i'm going to disagree and argue with everything else in it too!

Argue Alley -- that's where my brain's been living lately...no matter who: mom, sis, boss, friends, addicts, strangers on the street who could be dangerous especially when i'm already alone in a dark alley....

Thursday's date with my pdoc can't come soon enough for my likings.

love you,
Jenna

:sorry

[historyteach]

No need to be sorry. It's good to question. Questioning is what helps us learn, and keeps us sharp!

Capt,
You're baaaaadddddd!!!!!

Shalom!