Caffeine Withdrawal Now a Mental Disorder

While many of us thought that paying $5 for a tasty herbal beverage was the real mental disorder, we’ll have to wait for the next psychiatric manual for that diagnosis because a new one is on the table.

If you are a committed coffee drinker or enjoy a few too many caffeinated sodas or drinks on the weekends and are considering modifying your habits, your morning routine and entire world as you know it now has new implications. You may be crazy.

The DSM-V (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders version five) has a quirky new diagnosis that may affect you. It is called withdrawal from caffeine intoxication. The diagnosis is well meaning. People who consume 250 mg of caffeine can experience caffeine intoxication and can fundamentally change their brain chemistry and the withdrawal period of this drug, yes drug, is now a listed and recognized diagnostic mental disorder. How much is 250 mg?

·      12 ounces (Tall) Starbucks Coffee            

·      32-56 ounces of green tea, brewed for 3 minutes            

·      100 ounces of most sodas (5 – 20 ounce bottles)

·      1.5-16 ounce cans of most energy drinks

·      1.9 ounces of 5-Hour Energy (contains about 208 mg)

Caffeine-related disorders include intoxication which first made it into the DSM-IV in 2011 with symptoms of restlessness, nervousness, excitement, insomnia, flushed face, excessive urination (diuresis), gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility or unintentional motion (psychomotor agitation).

Caffeine withdrawal and its inclusion as a mental disorder started rumbling almost 10 years ago when an article appeared in Psychopharmacology where researchers from American University (Washington, DC a bastion of caffeine consumption) wrote about the symptoms of withdrawal including

·       Headache

·       Fatigue

·       Decreased energy/activeness

·       Decreased alertness

·       Drowsiness

·       Decreased contentedness

·       Depressed mood

·       Difficulty concentrating

·       Irritability

·       Foggy/not clearheaded

·       Flu-like symptoms

·       Nausea/vomiting

·       Muscle pain/stiffness

With a list of symptoms like this, I’m starting to believe this should be included in the manual. They go on to say “the incidence of headache was 50% and the incidence of clinically significant distress or functional impairment was 13%.” Those are high numbers for withdrawal from a widely available, freely distributed, and highly utilized drug.  

During the first few days of withdrawal, those who drop caffeine cold turkey display all of the tell-tale signs of an addict. They often search for every version of “coffee-methadone” they can find. Yes, the symptoms are transient, but they are intense. Headache and irritability top the symptom list.

What is interesting to me is that they noted that these symptoms of caffeine withdrawal tend to occur 12-24 hours after the high and continue for 2-9 days.

And this may come as no shock, but the higher the daily dose of caffeine, the worse the symptoms. What I found really curious is that symptoms were caused by doses as low as 100 mg. They concluded, mind you, this is 2004, “The caffeine-withdrawal syndrome has been well characterized and there is sufficient empirical evidence to warrant inclusion of caffeine withdrawal as a disorder in the DSM and revision of diagnostic criteria in the ICD.” It is 2013 and now it is included. So instead of being shocked, maybe we should be appalled at how long this inclusion took!

There is a take home point. For those who are embarking upon a new detoxification program, a new health habit, or simply shifting your gears in relation to the food, supplements, or medications you are using, please remember that it is not always the addition of a substance that causes symptoms, but it can also be the removal of substances that causes symptoms (or improvements). So, don’t just tell your healthcare practitioner what you started to fix your problem, but also tell them what you stopped. 

Reference: Juliano LM, Griffiths RR. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology (Berl). 2004 Oct;176(1):1-29. Epub 2004 Sep 21.