Can Caffeine Cause Anxiety and Panic Attacks? Navigating the Relationship between Caffeine and Anxiety

From your morning cup of joe to that afternoon energy drink or soda, caffeine is an intrinsic part of many people’s daily routines. It’s praised for its ability to ward off tiredness, increase alertness, and even enhance mood. But have you ever stopped to wonder about the not-so-celebrated side effects?

The term caffeine and anxiety pops up with increasing frequency in medical discussions and lifestyle blogs alike. While some view caffeine as a harmless stimulant, others swear it’s the culprit behind their anxiety spells. It’s high time we got to the bottom of this (and as you read it you might get to the bottom of your mug of coffee too!).

Caffeine’s Direct Effects on the Body and Mind

Caffeine is a methylxanthine that can easily pass through biological membranes, including the blood-brain barrier. It’s absorbed almost completely within 45 minutes of consumption. Its primary mode of action is the antagonism of adenosine receptors in the brain.

Adenosine is a neurotransmitter responsible for promoting sleep and relaxation. So, when caffeine enters the scene, it essentially gives adenosine a backseat, leading to increased alertness and wakefulness[1].

Yet, as the old saying goes, “too much of a good thing can be bad.” High doses of caffeine can lead to symptoms eerily similar to those of anxiety disorders. This includes restlessness, nervousness, excitement, and even insomnia.

While many of us relish the buzz we get from our caffeinated beverages, for some, this buzz can transition into something more daunting.

Caffeine-Induced Anxiety Disorder

And, indeed there exists a condition called caffeine-induced anxiety disorder—a subclass of the DSM-5 (the go-to manual for psychiatric diagnosis in the U.S.) diagnosis of substance/medication-induced anxiety disorder.

Consuming more than 400 mg of caffeine can increase the likelihood of anxiety and panic attacks. This is especially true for those predisposed to such conditions[2]. Think about it: the heart palpitations, the sudden rush of energy, the jitteriness — all can be reminiscent of an impending anxiety attack.

But, don’t be mistaken, not all jitters resulting from caffeine consumption are caffeine-induced anxiety disorder!

The DSM-5 sets specific criteria for diagnosing this disorder. Patients must exhibit symptoms of panic attacks or anxiety directly resulting from caffeine consumption. The substance (caffeine, in this case) must be physiologically capable of leading to these symptoms. Additionally, these symptoms should not have another clinical cause or persist for an extended period after stopping caffeine consumption.

It’s important to note that our genetic makeup plays a significant role in how we respond to caffeine. Some individuals are more prone to its anxiety-inducing effects, while others might be more susceptible to insomnia. Studies with twins have shown that genetics influence individual differences in response to caffeine[4].

Top Questions: Caffeine and Other Substances

When understanding the dynamics of caffeine, it’s useful to compare the substance’s physiological effects, especially when considered alongside other stimulants and depressants.

How alcohol and caffeine affect anxiety?

While caffeine acts as a stimulant, increasing alertness and reducing the feeling of fatigue, alcohol is a central nervous system depressant. This means that while caffeine boosts neurotransmission, alcohol reduces it[4]. For many, alcohol can act as an initial anxiolytic, calming nerves. However, in the longer term, excessive alcohol intake can exacerbate anxiety, much like excessive caffeine. But their mechanisms differ — caffeine’s stimulation may amplify pre-existing anxiety, while alcohol’s withdrawal can induce it.

Have you ever felt more anxiety when tired and had caffeine?

There’s a reason behind that. When you’re already fatigued, your body is in a stressed state. Adding caffeine to the mix can amplify the body’s stress response, making symptoms of anxiety more pronounced.

Can caffeine make anxiety worse compared to other substances?

While many drugs can lead to heightened anxiety as a side effect, caffeine’s direct action on the central nervous system makes its impact more immediate. In susceptible individuals, this can lead to rapid heart rate, heightened alertness, and even panic attacks — more direct effects than some other substances.

How does caffeine interact with anxiety medication?

For those being treated with benzodiazepines for anxiety disorders, even small amounts of caffeine can negate the effects of the medication, leading to increased anxiety levels. While benzodiazepines can manage acute caffeine-induced anxiety symptoms, it’s generally recommended to reduce or abstain from caffeine intake.

I stopped drinking caffeine and have anxiety in the morning; what is wrong?

Simply put, it might be your body reacting to the sudden absence of its regular caffeine fix. Caffeine is, after all, a drug that can cause dependence and caffeine withdrawal is a genuine phenomenon. Symptoms can include fatigue, irritability, and even flu-like symptoms. And yes, a spike in anxiety levels too[3].

Caffeine, Sleep and Anxiety

Its a truism to say that caffeine’s impact on sleep can be profound, especially when consumed closer to bedtime.

Research[7] has shown that even a dose of caffeine taken 6 hours before bedtime can result in over an hour of lost sleep. In the same study, caffeine taken 3 hours before bed had the most significant effect on sleep latency (the time it takes to fall asleep) and the amount of wake time during sleep increased with all three caffeine administration times.

This disruption in sleep patterns can have cascading effects on one’s mental well-being. Sleep deprivation or irregular sleep can exacerbate feelings of anxiety, especially during the nighttime when the world is quiet, and our minds tend to race.

The combination of caffeine-induced sleep disturbances and the natural anxiety many feel at night can create a cycle of restlessness and heightened stress. For those already prone to anxiety disorders, this can be particularly challenging.

It’s essential to be mindful of caffeine consumption, especially in the afternoon and evening, to ensure not only a peaceful night’s sleep but also a calmer, more centered mind.

Practical Guidelines: How Much Caffeine is Too Much?

While moderate caffeine consumption can have benefits, chronic and excessive intake can lead to long-term health deficits. Over several years, it can permanently alter the brain’s excitability[6] and affect neuroendocrine functions, increasing the risk of anxiety disorder development.

Most research indicates that moderate caffeine intake — about 200-400mg per day, equivalent to 2-4 cups of brewed coffee — is generally considered safe for most people[5]. However, sensitivity varies greatly among individuals.

If you choose to reduce the amount of coffee (and other caffeinated beverages) here are some useful tips:

1. Start a Caffeine Diary: Keep track of your daily caffeine intake. Jot down each caffeinated drink, its size, and the time you consume it. Over time, this can provide valuable insights into your habits.
2. Mix It Up: If you love coffee, try blending regular beans with decaf. Over time, you can adjust the ratio to favor the decaf.
3. Expand Your Drink Horizons: Explore caffeine-free herbal teas. There’s a vast world of flavors out there, from soothing chamomile to zesty peppermint.
4. Mindful Morning Routine: Sometimes, the ritual is more important than the caffeine. Enjoy the process of brewing and sipping your morning drink, regardless of its caffeine content.
5. Educate Yourself: Understanding the caffeine content in various drinks can be eye-opening. You might find that switching from espresso to a latte provides a gentler caffeine kick.
6. Stay Hydrated: Often, we reach for caffeinated drinks out of habit or thirst. Make sure to drink plenty of water throughout the day.
7. Natural Energy Boosts: Consider natural ways to invigorate your body, like a quick stretch, a brisk walk, or a few minutes of deep breathing.
8. Listen to Your Body: Everyone metabolizes caffeine differently. Pay attention to how your body reacts at different times of the day and adjust your intake accordingly.
9. Set a Caffeine Curfew: To ensure better sleep, try to avoid caffeine in the evening. Establishing a “last call” for caffeine can make a big difference.
10. Reach Out: Talk to friends (or professionals!) about your desire to reduce caffeine. They might offer support, advice, or even share their personal experiences.

For those wanting to reduce caffeine without ramping up anxiety, it’s crucial to do so gradually. A sudden stop can lead to withdrawal symptoms, which, as previously mentioned, can include heightened anxiety.

👉 If you struggle with symptoms of anxiety, give Mind Ease a try. The app is designed to gently bring you back into a state of calm, using a variety of science-backed exercises.

Footnotes & References:

[1] Temple JL, Bernard C, Lipshultz SE, Czachor JD, Westphal JA, Mestre MA. The Safety of Ingested Caffeine: A Comprehensive Review. Front Psychiatry. 2017 May 26;8:80. doi: 10.3389/fpsyt.2017.00080. PMID: 28603504; PMCID: PMC5445139.
[2] McLellan, Tom M.; Caldwell, John A.; Lieberman, Harris R. (2016). “A review of caffeine’s effects on cognitive, physical and occupational performance”. Neuroscience & Biobehavioral Reviews. 71: 294–312. doi:10.1016/j.neubiorev.2016.09.001. PMID 27612937.
[3] Meredith SE, Juliano LM, Hughes JR, Griffiths RR. Caffeine Use Disorder: A Comprehensive Review and Research Agenda. J Caffeine Res. 2013 Sep;3(3):114-130. doi: 10.1089/jcr.2013.0016. PMID: 24761279; PMCID: PMC3777290.
[4] Nehlig, Astrid; Daval, Jean-Luc; Debry, Gérard (June 2, 1992). “Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic, and psychostimulant effects”. Brain Research Reviews. 17 (2): 139–170 doi:10.1016/0165-0173(92)90012-B. PMID 1356551. S2CID 14277779.
[5] “Spilling the Beans: How Much Caffeine is Too Much?”, FDA, https://www.fda.gov/consumers/consumer-updates/spilling-beans-how-much-caffeine-too-much & Dietary Guidelines for Americans 2015-2020, https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf
[6] This has been shown in rodents. Tchekalarova, Jana D.; Kubová, Hana; Mareš, Pavel (2014). “Early caffeine exposure: Transient and long-term consequences on brain excitability”. Brain Research Bulletin. 104: 27–35. doi:10.1016/j.brainresbull.2014.04.001. PMID 24727007. S2CID 22339434.
[7] Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013 Nov 15;9(11):1195-200. doi: 10.5664/jcsm.3170. PMID: 24235903; PMCID: PMC3805807.