Caffeine-induced Anxiety Disorder

Caffeine-induced Anxiety Disorder

Definition

In addition to the symptom of anxiety that can be a component of caffeine intoxication and caffeine withdrawal, caffeine can also produce anxiety disorder, caffeine-induced anxiety disor-der (American Psychiatric Association, 2000) (see DSM-IV-TR (criteria). Although there has been no work using this specific set of diagnostic criteria, there have been several studies examin-ing the relationship between caffeine in general, and this work is reviewed here.

Etiology and Pathophysiology

Caffeine-induced anxiety disorder by definition is etiologically related to caffeine. Caffeine’s primary cellular site of action appears to be the adenosine receptor, where it functions as an antagonist.

Caffeine’s Anxiety-inducing Effects in Persons with Anxiety Disorders

Several studies have examined caffeine consumption in patients with an independent anxiety disorder. Interestingly, patients with anxiety disorders generally have lower levels of caffeine consumption compared with patients without an anxiety disor-der (Boulenger et al., 1984; Rihs et al., 1996). After the acute consumption of caffeine, self-reports by patients with anxiety disorders versus control subjects show greater anxiety scores. This suggests that some people (such as patients with an anxi-ety disorder) may avoid caffeine use because of anxiety effects produced by caffeine.

Assessment and Differential Diagnosis

The diagnosis of caffeine-induced anxiety disorder is based on evidence of an anxiety disorder etiologically related to caffeine (see previous diagnostic decision tree for caffeine intoxication disorder, caffeine-induced anxiety disorder and caffeine-induced sleep disorder). Other diagnostic considerations besides caf-feine-induced anxiety disorder include caffeine intoxication and caffeine withdrawal, a primary anxiety disorder, and an anxiety disorder due to a general medical condition. Caffeine-induced anxiety disorder can occur in the context of caffeine intoxica-tion or caffeine withdrawal, but the anxiety symptoms associated with the caffeine-induced anxiety disorder should be excessive relative to the anxiety seen in caffeine intoxication or caffeine withdrawal. In addition to these conditions, substance-induced anxiety disorder can be produced by a variety of other psychoac-tive substances (e.g., cocaine).

Epidemiology and Comorbidity

There are no specific data on the prevalence or incidence of caffeine-induced anxiety disorder, and there is no information known about comorbid conditions.

Course

There is no known information on the course or natural history of caffeine-induced anxiety disorder.

Treatment

 Although there are no studies on the treatment of caffeine-induced anxiety disorder, guidelines for treatment should gen-erally follow those recommended for the treatment of caffeine dependence (see earlier). Thus, an initial, careful assessment of caffeine consumption should be conducted, and a program of gradual decreasing caffeine use should be instituted. Abrupt ces-sation of caffeine use should be avoided to minimize withdrawal symptoms and to increase the likelihood of long-term compli-ance with the dietary change. Given the etiological role of caf-feine in caffeine-induced anxiety disorder, the prudent course of treatment would avoid the use of pharmacological agents such as benzodiazepines for the treatment of the anxiety disorder until caffeine use has been eliminated. A temporary caffeine-free trial may be useful in persuading skeptical patients about the role of caffeine in their anxiety symptoms.