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Neuropsychiatric effects of caffeine

  • Anthony P. Winston, Elizabeth Hardwick and Neema Jaberi

Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.

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Neuropsychiatric effects of caffeine

  • Anthony P. Winston, Elizabeth Hardwick and Neema Jaberi
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Please, I beg you...

Name witheld, N/A
05 April 2006

Please, I beg you, don't ban coffee.It's really nice and I like it a lot.It helps me stay awake when I should be sleeping, and stops me from sleeping when I want to sleep.Coffee has made my life so much more interesting than it would have been without it.What ever did that coffee bean do to you?I love the stuff. Please don't take away my coffee.I'm fine as long as I don't have 5 sugars in it.40 cups a day and I'm fine. It never made me manic ever.Honest. ... More

Conflict of interest: None Declared

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The Attack of the Turks

Yasir Abbasi, SHO in Child and Adolescent Psychiatry
16 December 2005

This article by Winston et al particularlyinterested me because as an international medical graduate I had to go through the process of PLAB exams and one of the stations in the OSCE was of a women suffering from caffeine induced anxiety.

This was my first encounter with the effects of the most widely used psychoactive substance in the world. As the drinking of coffee with such enthusiasm is usually encountered in the West rather than the subcontinent,I had not been exposed to its clinical effects. It is also interesting to note the amount of caffeine we normally take each day in the form of coffee, tea, chocolate, cola drinks and energy drinks.

The coffee tree originated from Ethiopia but was cultivated in Arabia. The pleasant and mildly stimulating effects of the beverage were recognised by Muslims who were forbidden to drink alcohol. Thus its use spread throughout the Muslim world and its peak utilisation came under the Ottoman Empire.

Its introduction to Europe came through Vienna when the Ottoman Empire had spread to the Balkans and was about to besiege Vienna. A mannamed Kolschitsky swam across the Danube to the camp of the King of Polandand asked him to expedite his attack. Therefore in a quick retreat the Turks left behind many sacks of coffee beans which were given to Kolschitsky who eventually opened up a coffee house by the name of Blue Bottle and this began the use of coffee as a beverage.

I am sure Mr Kolschitsky was not aware that coffee would become so popular in the forthcoming ages, nor that it would have such clinical implications.
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Caffeine-induced mania

Sumudu Chandraratne, Senior House Officer
09 December 2005

We read with interest the article by Winston et al (2005), which gavea comprehensive account of the neuropsychiatric effects of caffeine. It noted the wide availability of this seemingly innocuous substance that could cause side effects, dependence and withdrawal effects. The role of caffeine in provoking anxiety and sleep disorders, as well as its association with binge eating in eating disorders, and the high caffeine intakes found among patients with schizophrenia were well described and backed up by a strong evidence base. However, our attention was drawn to the statementthat, ‘surprisingly, there are no published case reports linking caffeine use with mania or hypomania’.

We have identified several published case reportslinking excessive consumption of caffeine with mania. Ogawa et al (2003) reported a patient who satisfied DSM-IV criteria for substance –induced mood disorder with manic features and similar criteria for mania when his caffeine intake reached about 1000 mg a day. He had no previous history of manic or depressive episodes. Machado-Vieira et al (2001) reported an acute manic episode associated with the energy drink ‘Red Bull’ in a man with DSM-IV diagnosis of bipolar I disorder who had been stable on medication for 5 years prior to ingestion of this drink which contains caffeine, taurineand inositol as psychoactive substances. Tondo et al (1991) described thecourse of seasonal bipolar disorder influenced by caffeine in a patient who achieved remission following cessation of caffeine consumption. Marian et al (1981) pointed out that diet aids containing caffeine have been associated with precipitating affective illness in individuals with asusceptibility to affective illness.

Although these are individual case reports, they do point towards a possible link between excessive caffeine consumption and the precipitation of a manic illness. It has been found that caffeinecan induce kindling which has been associated with changes described duringmania (Moraidis et al 1994).

We believe that these reports highlight furtherthe importance of enquiring about caffeine intake when assessing patients.

Sumudu Chandraratne, Senior House Officer in Psychiatry & DeborahStinson, Consultant in Old Age Psychiatry,South West London & St George's Mental Health NHS Trust, Sutton Hospital, Sutton, Surrey SM2 5NF, UKTel/fax: 020 8296 4342E-mail:

Declaration of interest: none

Machado-Vieira, R., Viale, C. I., Kapczinski, F., (2001) Mania associated with an energy drink: the possible role of caffeine, taurine and inositol Canadian Journal of Psychiatry 46(5): 454-455.

Marian, B., Achor, R. N., (1981) Diet Aids, mania and affective illness. American Journal of Psychiatry 138(3): 392

Moraidis I., Bingmann D., Epileptogenic actions of xanthanes in relation to their affinities for adenosine A1 receptors in CA3 neurons of hippocampal slices (guinea pig). Brain Res 1994; 21, 640: 140-145

Ogawa, N., Ueki, H., (2003) Secondary mania causes by caffeine. General Hospital Psychiatry 25: 138-139

Tondo, L., Rudas, N., (1991) The Course of a bipolar disorder influenced by caffeine. Journal of Affective Disorders 32: (249-251).

Winston, A. P., Hardwick, E., Jaberi, N., (2005) Neuropsychiatric effects of caffeine. Advances in Psychiatric Treatment 11: 432-439.
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