Caffeine-induced Anxiety Disorder
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.
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.
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.
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).
There are no specific data on the prevalence or
incidence of caffeine-induced anxiety disorder, and there is no information
known about comorbid conditions.
There is no known information on the course or
natural history of caffeine-induced anxiety disorder.
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