Mindpath Health’s Brian Zachariah, M.D. discusses whether or not caffeine may cause anxiety.

does caffine cause anxiety_brian zachariah_mindpath health

Coffee is one of the most popular beverages in the world; many people rely on the caffeine in that first cup of joe to manage energy levels throughout their day. Caffeine is consumed by over 80% of adults in the U.S. and has been shown to enhance alertness and reaction time but can there be too much of a good thing? Is there a link between coffee and anxiety?

Does caffeine cause anxiety?

Caffeine is a stimulant, meaning it increases activity in the brain and central nervous system. This can lead to feelings of nervous energy or “jitters” but caffeine does not directly cause anxiety, which is defined as a feeling of worry, unease, or dread.

“Though caffeine intake has been shown to be associated with some psychiatric symptoms like anxiety, nervousness etc., there is no evidence of causality i.e., no evidence yet to suggest that caffeine itself is causing them,” says Rajnish Jaiswal, MD, associate chief of emergency medicine at NYC Health and Hospitals Metropolitan Hospital in New York.

Caffeine does not directly cause anxiety, but it can make anxiety symptoms worse, especially when consumed in excess. So, how much coffee is too much? The U.S. Food and Drug Administration (FDA) recommends a daily limit of 400 mg of caffeine for healthy adults which is equal to about four, 8-ounce cups of brewed coffee or 10 cans of cola.

Some symptoms of overusing caffeine include:

  • Dizziness
  • Rapid heartbeat
  • Nervousness/restlessness
  • Headache
  • Insomnia

Drinking more than the recommended daily amount of coffee for an extended period of time may also lead to caffeine withdrawal symptoms (such as headaches, fatigue, and irritability) when a person tries to cut back on caffeine intake.

For most people, moderate caffeine intake is safe, and coffee even boasts some health benefits when enjoyed in moderation, but studies show that excessive caffeine consumption can lead to symptoms that overlap with those of many psychiatric disorders and that it may exacerbate anxiety—especially for those with anxiety disorders and/or sleep disorders.

Does caffeine make anxiety worse?

Anxiety disorder is a mental health disorder in which a person experiences overwhelming feelings of worry and fear, interfering with daily life and activities. There are several types of anxiety disorders including generalized anxiety disorder and panic disorder. Those with anxiety disorders may want to decrease their daily caffeine intake.

“Caffeine is known for its mild stimulant effects and excessive amounts can lead to jitteriness, anxiety, irritability, and insomnia,” says Brian Zachariah, MD, a psychiatrist with Mindpath Health. “In fact, it’s listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under causes for substance-induced anxiety disorders (caffeine-induced anxiety disorder).”

Caffeine-induced anxiety disorder is a condition recognized by the American Psychiatric Association where the symptoms of anxiety are directly caused by the excessive consumption of caffeine and are interfering with a person’s daily functioning.

“We still don’t have evidence that caffeine directly induces anxiety, but caffeine intake has been known to be associated with anxiety symptoms,” Dr. Jaiswal says. “Excessive caffeine intake can cause palpitations, sweating, nervousness, change in mood or behavior in healthy individuals and worsen them in people suffering from anxiety disorders.”

Additionally, drinking large amounts of coffee may cause interactions with some medications and dietary supplements.

“Caffeine does interact with several classes of medications (antiarrhythmics, antipsychotics, bronchodilators) and of concern with fluvoxamine, which is an SSRI medication often used for anxiety disorders,” Dr. Zachariah says. “Also, the effects of caffeine can mimic worsening anxiety, wherein providers may increase the dose of the anxiolytic medication without realizing the actual culprit.”

Many people may not think to mention their daily caffeine intake with their healthcare provider, but it’s important—especially for those who are drinking many caffeinated beverages daily.

“There is some data that show caffeine can affect the absorption and metabolism of certain medications like bupropion and clozapine, but more studies are still needed to establish a definite interaction,” Dr. Jaiswal says. He says that for those who consume high amounts of caffeine (more than 400 mg a day) “some changes may have to be made to their anxiety medications after discussion with their treating physician.”

Can coffee trigger panic attacks?

Caffeine intake has not been directly linked to panic attacks, but excessive caffeine consumption could possibly be a contributing factor to a panic attack.

For those who live with anxiety and/or panic disorders, changes in the body (such as increased heart rate, blood pressure, and sweating that can be caused by caffeine) may trigger the fight or flight response and raise internal alarms that a panic attack is starting, which may lead to intense feelings of anxiety and even a full-blown panic attack in some cases.

One study found that people with panic disorder who were given a large dose of caffeine (480 mg) had a hyperreactivity and higher number of induced panic attacks than people with generalized social anxiety disorder and people with no anxiety diagnosis.

How long does caffeine-induced anxiety symptoms last?

One reason for the popularity of coffee is that its effects are felt rather quickly, which can be a wonderful thing in those early morning hours when you feel sluggish. When too much caffeine is ingested, however, unpleasant symptoms may last a while as caffeine stays in the system for several hours.

“Caffeine’s effects can vary due to individual variation, but it usually starts to peak in effect in about 15 minutes and wears off in about two and a half to five hours,” Dr. Zachariah says. Dr. Jaiswal agrees: “There is a wide range of when and how long caffeine lasts in people as many factors like age, gender, genetics, lifestyles can influence it.”

Caffeine may not completely leave your system for 10 hours and can interfere with sleep. The American Academy of Sleep Medicine recommends avoiding caffeine in late afternoon or evening.

How to prevent and overcome caffeine-induced anxiety

To prevent unwanted caffeine side effects that mimic anxiety symptoms, consume caffeine in moderation and be aware of how many caffeinated products you may ingest daily.

“Most people don’t realize that caffeine is present in many other foods and drinks besides coffee and hence may be underestimating their total caffeine intake,” Dr. Jaiswal says. In addition to coffee, caffeine can also be found in energy drinks, soft drinks, green tea, and chocolate.

If you’ve overindulged with any caffeinated products and want to minimize the unpleasant side effects, stay well hydrated by drinking plenty of water and exercise to help your body metabolize the caffeine faster.

People who are sensitive to caffeine (or who want to consume less) may try drinking alternatives such as decaffeinated coffee, decaf espresso, herbal tea, golden milk, or lemon water.

In all, drinking coffee in moderation is safe for most people. While coffee does not cause anxiety, consuming excessive amounts of caffeine can make anxiety symptoms worse, especially for those with baseline anxiety disorders.

To read the full article in PsycheCentral on whether or not caffeine may cause anxiety, click here.

Brian Zachariah, M.D.

Sugar Land, TX

Dr. Brian Zachariah chose the mental health field because of a patient, who once told him that they were “smiling on the outside, but screaming on the inside”, which inspired him to go into psychiatry. Mental health is often neglected, and people put on a face every day to hide the suffering on the inside. Dr. Zachariah hopes that he ... Read Full Bio »

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