Mental Health
March 20, 2023
TLDR: Caffeine and Anxiety - A Complex Relationship
This article explores the effects of caffeine on anxiety and mental health. Key points include:
Caffeine's classification as a drug and its potential for addiction
Varying caffeine content in popular beverages
The impact of caffeine on anxiety disorders and vulnerable populations
Key takeaways:
Caffeine can worsen anxiety in some individuals, particularly those with pre-existing anxiety disorders
The safe upper limit for caffeine consumption is generally 400 mg per day
Genetic factors can influence how individuals metabolize caffeine
People with substance use disorders or eating disorders may be more prone to caffeine misuse
Wise Mind Nutrition's stance:
Recommends caution with caffeine intake, especially for those with anxiety disorders
Suggests eliminating or reducing caffeine intake for mental wellness
Proposes periodic caffeine breaks (3 days off, twice a year) for regular consumers
Emphasizes the importance of personalized approaches to caffeine consumption
The article concludes that while moderate caffeine consumption can be beneficial for most people, others may benefit from reduction or elimination. Individual factors play a crucial role in determining the appropriate caffeine intake for optimal mental health.
[Read full article for detailed information on caffeine content in various beverages, its effects on different populations, and full references to scientific studies]
Caffeine and Anxiety: How Caffeine Affects Your Mental Health
Caffeine is the most popular drug in the world. Some people might be uncomfortable with the idea that caffeine is a “drug” particularly since nonproblematic caffeine use is so common and widespread. This article breaks down the effects of caffeine and anxiety. We’ll also identify specific groups of people that may be particularly vulnerable to caffeine misuse, such as those with certain mental health disorders.
The discussion of caffeine as a drug is not intended to pathologize its use, but rather to recognize its addictive and anxiogenic (anxiety-producing) potential. Caffeine Use Disorder is recognized in the DSM-5 as an area for future research and is based on the criteria for other substance use disorders such as alcohol, stimulants, opiates, etc.
Addiction is generally characterized by the activation of the dopamine system; however, it has been suggested that the effect of caffeine on dopamine receptors is indirect (rather than direct modulation) [1]. Heavy coffee users tend to experience strong wanting (craving), despite low liking (enjoyment), where the wanting becomes independent from the linking through repeated consumption of caffeine [2]. In other words, the dopaminergic effect of caffeine can drive substance-seeking behavior among those vulnerable to addiction-like processes.
Caffeine Content of Popular Beverages
Caffeine is used across the globe, mostly in the form of coffee and tea (specifically Camellia sinensis, the plant used to make black, green, and white teas). There are differing amounts of caffeine in coffee and teas. Interestingly, manufacturers are not required to list the caffeine content on their products but can usually be found on their website. Several over-the-counter pain relievers and some prescription drugs also contain caffeine.
It is generally accepted that a standard cup (8 oz.) of brewed coffee contains between 80-100 mg of caffeine. However, popular coffee chains provide coffee with higher caffeine content, to maximize the reinforcing qualities of their products. For example, an 8 oz. coffee from Starbucks contains between 130-180 mg. A generic shot of espresso is generally somewhere between 50-80 mg of caffeine whereas espresso at commercial coffee chains can exceed 100 mg. It makes sense why so many people prefer Starbucks or the equivalent!
Of all forms of Camellia sinensis, black tea contains the most caffeine (approximately 50-70 mg) whereas green tea is about half of that (20-50 mg) and white tea has the least. One of the benefits of green tea is its polyphenolic content. Sodas vary in their caffeine content but generally, a 12 oz. can contain between 20-50 mg. Energy drinks can contain anywhere from 50-300 mg of synthetic caffeine, depending on the brand and size. Pre-workout supplements are also a common form of synthetic caffeine and contain anywhere from 50-300 mg per scoop.
Chocolate does not contribute significantly to caffeine intake. However, people who are highly sensitive to caffeine might have difficulties sleeping if consuming chocolate before bed. Genetic variability of CYP1A2 leads some people to metabolize caffeine faster than others. Fast metabolizers are considered more likely to consume more caffeine [3]. This can be easily determined through at-home genetic testing (saliva) through companies such as Ancestry.
Can Caffeine Worsen Anxiety?
Yes and no - there are groups of people that are more vulnerable than others.
Caffeine intake from sodas is decreasing, whereas intake from energy drinks is on the rise [4]. Energy drinks have been associated with a wide range of adverse health effects, including insomnia, restlessness, jitteriness, and gastrointestinal upset [5]. Given the recognition of sleep as a pillar of health, it is likely that some of the downstream effects of excess caffeine on health are mediated through impaired sleep.
Individuals with substance use disorders or other addictions (e.g., nicotine) are more likely to consume higher amounts of caffeine [6]. Among adult polysubstance users, caffeine use has been associated with depression [7]. People with eating disorders also tend to misuse caffeine [8], perhaps due to stimulant appetite-suppressing effects.
The weight of the evidence suggests that caffeine is not a cause of anxiety disorders. However, among those with a pre-existing panic disorder, caffeine intakes in the range of 400-750 mg (roughly 5 cups of coffee) can induce panic attacks [9]. Individuals with anxiety-related disorders may be considered a vulnerable group that should be particularly cautious about excess caffeine intake.
Caffeine Recommendations
The average daily intake of adults is roughly 180 mg (roughly 2 cups of coffee or one commercial coffee beverage from a Starbucks or equivalent) [10]. Adults aged 51-70 average above 200 mg [11]. The safe upper limit is generally 400 mg per day. Individuals with genetic variants that lead to slower metabolism of caffeine should probably consume less. Those with anxiety and panic disorders should also consume less, perhaps by setting an upper limit of 200 mg/day. It might be time to check the caffeine content of the beverages you order!
For those interested in a mental wellness journey, eliminating caffeine altogether can be a wise option. From our clinical experience, many do report noteworthy benefits of coming off caffeine altogether. If this is not a realistic or desirable goal, taking three days off twice per year can also be helpful. For those who experience withdrawal symptoms, it can be helpful to taper off slowly, for example switching from coffee to black tea and then to green and then to white.
Wise Mind Nutrition is here to support you in your journey to use nutrition to optimize mental health. While moderate caffeine can be beneficial for mental health in most of the population, others benefit from elimination or reduction. If drinking caffeine has created problems for you, we can help! Find out what is true for you through some trial-and-error, and through doing some deep introspective healing work!
References
1. Santos M dos, Gavioli EC, Rosa L, Soares-Rachetti V de, Lobão-Soares B. Craving espresso: the dialetics in classifying caffeine as an abuse drug. Naunyn-Schmiedeberg’s Archives of Pharmacology. Published online 2018:1-18. doi:10.1007/s00210-018-1570-9
2. Koranyi N, Brückner E, Jäckel A, Grigutsch LA, Rothermund K. Dissociation between wanting and liking for coffee in heavy drinkers. J Psychopharmacol. 2020;34(12):1350-1356. doi:10.1177/0269881120922960
3. Guessous I, Dobrinas M, Kutalik Z, et al. Caffeine intake and CYP1A2 variants associated with high caffeine intake protect non-smokers from hypertension. Hum Mol Genet. 2012;21(14):3283-3292. doi:10.1093/hmg/dds137
4. Tran NL, Barraj LM, Bi X, Jack MM. Trends and patterns of caffeine consumption among US teenagers and young adults, NHANES 2003–2012. Food Chem Toxicol. 2016;94:227-242. doi:10.1016/j.fct.2016.06.007
5. Nadeem IM, Shanmugaraj A, Sakha S, Horner NS, Ayeni OR, Khan M. Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis. Sports Heal Multidiscip Approach. 2021;13(3):265-277. doi:10.1177/1941738120949181
6. Sweeney MM, Weaver DC, Vincent KB, Arria AM, Griffiths RR. Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample. J Caffeine Adenosine Res. 2020;10(1):4-11. doi:10.1089/caff.2019.0020
7. Yudko E, McNiece SI. Relationship between coffee use and depression and anxiety in a population of adult polysubstance abusers. J Addict Med. 2014;8(6):438-442. doi:10.1097/adm.0000000000000077
8. Winston AP, Hardwick E, Jaberi N. Neuropsychiatric effects of caffeine. Adv Psychiatric Treat. 2005;11(6):432-439. doi:10.1192/apt.11.6.432
9. Klevebrant L, Frick A. Effects of caffeine on anxiety and panic attacks in patients with panic disorder: A systematic review and meta-analysis. Gen Hosp Psychiat. 2022;74:22-31. doi:10.1016/j.genhosppsych.2021.11.005
10. Temple JL, Bernard C, Lipshultz SE, Czachor JD, Westphal JA, Mestre MA. The Safety of Ingested Caffeine: A Comprehensive Review. Frontiers in Psychiatry. 2017;8:80. doi:10.3389/fpsyt.2017.00080
11. Drewnowski A, Rehm CD. Sources of Caffeine in Diets of US Children and Adults: Trends by Beverage Type and Purchase Location. Nutrients. 2016;8(3):154. doi:10.3390/nu8030154
