If your patients are like most people, they knock down a couple hundred milligrams of caffeine a day. Whether this is excessive is in the eyes of the drinker….or the experts. Some experts believe caffeine should be limited to less than one caffeinated beverage a day whereas others say there’s no need for concern unless the person experiences some negative consequence associated with the stimulant intake.
Regardless, most experts believe that moderation is the key when it comes to caffeine. A little bit here and there is harmless. However, for people who experience anxiety, even small amounts can be problematic. For example, people who experience significant anxiety, panic symptoms in particular (racing heart, feeling of impending doom, sweating), are more sensitive to the effects of caffeine.
Caffeine can actually induce a full-blown panic attack, which is a combination of highly distressing psychological and physical fear-based symptoms (see below for symptoms of a panic attack). At a minimum, caffeine mimics many of the symptoms associated with panic and leads to increased worry and risk of having an attack. Short of panic, caffeine also causes jitteriness, trembling and feelings of nervousness and apprehension. It also fuels worry, restlessness, and irritability.
Symptoms of a Panic Attack● palpitations, pounding heart or accelerated heart rate ● sweating ● trembling or shaking ● sensations of shortness of breath or smothering ● feeling of choking ● chest pain or discomfort ● nausea or abdominal distress ● feeling dizzy, unsteady, lightheaded or faint ● feelings of unreality or being detached from oneself ● fear of losing control or going crazy ● fear of dying ● numbness or tingling sensations ● chills or hot flushes American Psychiatric Association, 2004.
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Effects of Caffeine● rapid or irregular heartbeat ● nausea ● diarrhea ● lightheadedness ● flushed face ● trembling/shaking ● nervousness ● insomnia ● feelings of being detached from reality ● mood swings ● muscle tremors ● fast breathing ● restlessness ● increased urination ● racing thoughts
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What is Caffeine?
Caffeine is a central nervous system stimulant and is the most widely used psychoactive drug in the world. It is used primarily as a means of restoring alertness and focus by blocking the chemical adenosine, which is responsible for promoting sleep. Caffeine is both a natural and synthetic (manmade) chemical found in a variety of beverages such as coffee, soda, tea, and the ever popular energy drinks. It is also found in certain foods (chocolate) and some medicines (headache pain relievers).
How Much is Too Much?
In moderate doses (200-300 milligrams or two to four cups of coffee daily), caffeine is considered safe and causes no noticeable problems in the average person. However, as noted above, people with anxiety cannot tolerate as much caffeine as those without anxiety. Therefore, your anxious clients should be careful when getting their morning or afternoon fix. It is also important to be aware of the caffeine level of their favorite drink, food, or medicine. Levels vary considerably. What may seem like a small cup of Joe or a harmless piece of candy can cause their anxiety to skyrocket. Below are caffeine levels of some commonly consumed beverages, foods, and medicines. A more comprehensive list can be found at www.energyfiend.com.
| Chocolate: | Average: |
| Chocolate milk (8 oz) | 8 mg |
| Milk chocolate (1 oz) | 7 mg |
| Semi-sweet chocolate (1 oz) | 18 mg |
| Unsweetened chocolate (1 oz) | 25 mg |
| Coffee: | |
| Brewed (6 oz) | 100 mg |
| Instant (1 rounded tsp) | 57 mg |
| Brewed decaffeinated (6 oz cup) | 3 mg |
| Instant decaffeinated (1 rounded tsp) | 2 mg |
| Cappuccino (4 oz) | 100 mg |
| Espresso (2 oz) | 100 mg |
| Latte (single) | 50 mg |
| Other Beverages (12-oz servings): | |
| Coca-Cola, Diet Coke | 46 mg |
| Dr. Pepper (regular & sugar-free) | 40 mg |
| Mountain Dew | 54 mg |
| Pepsi-Cola, Diet Pepsi | 38 mg |
| Red Bull (8.2 oz) | 80 mg |
| 5-Hour Energy | 138 mg |
| Monster Energy | 160 mg |
| Tea (5-oz cup): | |
| Brewed, green or black, U.S. brands (3 minutes) | 40 mg |
| Brewed, imported brands | 60 mg |
| Instant (1 tsp) | 30 mg |
| Iced (8 oz) | 25 mg |
| Decaffeinated | 5 mg |
| Non-Prescription Drugs:** | |
| Caffeine Tablets: | |
| No-Doz | 100 mg |
| Vivarin | 200 mg |
| Pain Relievers (per tablet): | |
| Anacin | 32 mg |
| Excedrin | 65 mg |
| Midol (maximum strength) | 60 mg |
University Health Service, University of Michigan
Should Your Client Quit?
If your patient experiences increased anxiety after using caffeine, then the simple answer is YES! But, this is a personal decision just like losing weight or quitting smoking. Letting go of caffeine is not easy, especially if the person has been drinking large amounts of it for many years. But, if your client is one of those people who is more sensitive to caffeine, then it is time to stop. Stay tuned for my next article, which will show them how.
*This article is based on a chapter in Dr. Moore’s book “Taking Control of Anxiety: Getting the Best of Worry, Stress, and Fear.
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