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Caffeine withdrawal

Caffeine is the worlds most commonly consumed psychoactive substance. It functions as a central nervous system stimulant, meaning it affects neural activity in the brain and increases alertness while reducing fatigue. If the body becomes dependent on caffeine, eliminating it from the diet can cause withdrawal symptoms that typically begin 12–24 hours after stopping caffeine. Caffeine withdrawal is a recognized medical diagnosis and can affect anyone who regularly consumes caffeine.

If you’ve had more than 250 mg of caffeine (two to three cups of brewed coffee) and experienced five or more of the following symptoms, says the guide, you’ve probably been caffeine-buzzed: restlessness, nervousness, excitement, insomnia, flushed face, diuresis (having to pee a lot), gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility or psychomotor agitation (unintentional motion, say, rapidly bouncing one leg).

This disorder, as it’s described in both the older dsm-iv and new dsm-5, falls under the heading “caffeine-related disorders,” but in dsm-5, that section includes a new entry: caffeine withdrawal. According to dsm-5, symptoms of caffeine withdrawal include fatigue, headache and difficulty focusing.
“caffeine is a drug, a mild stimulant, which is used by almost everybody on a daily basis,” said dr. Charles O’Brien, who chairs the substance-related disorder work group for dsm-5 (via new York post). “but it does have a letdown afterwards. If you drink a lot of coffee, at least two or three [236 ml] cups at a time, there will be a rebound or withdrawal effect.”

Anyone who’s binged on caffeine then stopped, cold turkey, knows the withdrawal symptoms are anything but make-believe — the headaches alone can be excruciating. The question some are asking is whether it belongs in a guide devoted to mental disorders (or, for that matter, whether caffeine intoxication does). 

Energy drinks, soft drinks, brewed tea and even chocolate can contain large quantities of caffeine. According to drug info Australia, “caffeine is a stimulant drug, which means it speeds up the messages travelling between the brain and the body.”

Caffeine can cause us to feel either good or bad depending on how it affects the individual. Taken into consideration is the amount consumed, their size, weight and health, if the person is accustomed to drinking it or not and if other drugs are taken at the same time. For some, the effects after consuming caffeine can begin as fast as 5 minutes to half an hour and lasting for as long as 12 hours.

Caffeine affects each one of us differently. These effects can either cause us to feel more alert, more active; our heart rate can increase, we may begin to breathe faster, have raised body temperature, we can experience stomach aches, have headaches, urinate more frequently and become dehydrated. We may also begin to feel restless, experience anxiety and irritability. Others may feel dizzy or simply excitable. After consuming large quantities of caffeine based products a person may feel tired or lethargic the next day as a common side-effect. 

All in our head  Experiment 

Remember those 1990s commercials in which a wife would secretly switch her husband's regular coffee with decaf and watch as he never noticed the difference? The ads may not have been far off, according to caffeine researcher Laura Juliano, PhD. She found that expecting to receive caffeine mitigated some of the effects of caffeine withdrawal, at least in the short term.

In the experiment, Juliano, a psychologist at American University in Washington, D.C., working with graduate student Peter Kardel, recruited about 90 people to come in to her lab one afternoon in early 2007 and drink a cup of coffee. She then asked them to abstain from eating or drinking all further items containing caffeine until the end of the experiment unless she gave it to them.

Participants returned the next morning and were assigned to one of four groups. One group was told they would receive a cup of caffeinated coffee, and did, in fact, receive regular ol' joe. A second group was also told they would receive regular coffee but instead were given decaf. A third group was told they'd get decaf and were given regular, and the final group was told they'd receive decaf and actually got it.

After 45 minutes, participants completed a questionnaire asking them to rate their caffeine withdrawal symptoms, including headache, fatigue, decreased alertness, drowsiness, irritability and difficulty concentrating, on a scale from 1 to 5. Finally, they returned to the lab a third time that evening for a final assessment.

When Juliano analyzed the data, she found that the groups told caffeine/given caffeine and told decaf/given decaf had the expected withdrawal effects. Namely, the former felt few caffeine withdrawal effects while the latter expressed many withdrawal symptoms. But the group given caffeine that they thought was decaf actually had higher initial withdrawal scores than those who were given decaf but told they got caffeine. Just believing they were being denied caffeine made people feel like they were in withdrawal, even though pharmacologically, they weren't.

By the final evening visit, caffeine showed its true colors. Those who were given caffeine but thought they received decaf reported lower levels of withdrawal symptoms--levels nearly equal to those experienced by the group that was promised and received caffeine. But the symptoms were much more intense for those who drank decaf that they thought were caffeine. Clearly, expectancy had an early effect on withdrawal, but it was only temporary relief.

"In the long run, pharmacology is what matters," says Juliano, who presented the research at the 41st Annual Convention for the Association for Behavioral and Cognitive Therapies in November. "In the short term, expectancy plays a little bit of a role, but your body eventually catches up with your mind. If you haven't had caffeine for 36 hours and you have a headache, you have a headache." 

Wise use

Want to try to limit your caffeine intake? Try these research-based tips:

- Delay having coffee for at least an hour after you wake in the morning since that is when your body doesn't actually need a caffeinated pick-me-up: Soon after waking, your body produces cortical, a natural energy booster, so save your coffee breaks for mid-morning or the early afternoon, when cortical levels dip, advises Dartmouth University neuroscientist Steven Miller, PhD.
- Similarly, if you don't habitually drink caffeine, consider drinking it only when you really need a functional boost, such as before a long drive or particularly long seminar, Juliano suggests.
- Caffeine can interfere with sleep when consumed as long as six hours before bedtime, reducing sleep by an hour and interfering with sleep efficiency and REM patterns.
- There are no formal guidelines to help people get off caffeine, but strategies that are effective in stopping other problem behaviors such as smoking, drinking alcohol or overeating may help, psychologists say. They include stimulus control, such as learning to watch out for triggers that spur caffeine use and asking friends to help you reach your goal, Budney suggests. Juliano has been developing and testing manualized treatment to help people reduce caffeine use. An early test, in press in the Journal of Consulting and Clinical Psychology, suggests that keeping a daily diary of consumption is effective. Also, gradually cutting back on caffeine may help you avoid withdrawal symptoms.

Symptoms of caffeine withdrawal

1. Headache

Headaches are among the most commonly reported symptoms of caffeine withdrawal. Caffeine causes blood vessels in the brain to constrict, which slows blood flow. One study found that just 250 mg (less than three cups of coffee) can reduce cerebral blood flow by as much as 27%. Since caffeine consumption causes blood vessels to narrow, reducing or stopping intake allows blood vessels to open up and increases blood flow to the brain. This sudden change in blood flow can cause painful withdrawal headaches that can vary in length and severity as the brain adapts to the increase in blood. Headaches will subside as the brain adapts to this increase in blood flow. Even though caffeine withdrawal can cause headaches, caffeine is used to treat certain types of headaches like migraines. Caffeine helps enhance the power of pain-relieving medications and reduces headache pain when consumed on its own.

2. Fatigue

Many people depend on a daily cup of coffee to give them an energy boost. Caffeine helps increase alertness and reduces fatigue by blocking receptors for adenosine, a neurotransmitter that can make you feel drowsy. This is also why it has been proven to enhance athletic performance, improve energy and reduce chronic fatigue. However, eliminating caffeine from your diet can have the opposite effect, causing drowsiness and fatigue.

3. Anxiety
Caffeine is a stimulant that increases heart rate, blood pressure and the stress hormones cortical and epinephrine. In people who are sensitive to caffeine, just one cup of coffee can cause them to feel jittery and anxious. While consuming caffeine can cause feelings of anxiousness, cutting it out can cause this side effect as well. Anxiety is a commonly reported symptom in people who withdraw from regular caffeine consumption. The body can become mentally and physiologically dependent on it, causing feelings of anxiety. Plus, if you consume the majority of your caffeine in the form of soda or sugar-sweetened coffee, the sudden reduction in sugar may make caffeine withdrawal-induced anxiety even worse. Animal studies suggest that suddenly removing sugar from the diet after a long period of sugar consumption can cause symptoms of anxiety. 

4. Difficulty Concentrating

One of the main reasons that people choose to consume caffeine in the form of coffee, tea or energy drinks is to boost concentration. Caffeinated beverages are commonly consumed before tests, athletic events or presentations to improve focus. Caffeine increases levels of adrenaline, a hormone produced by the adrenal glands as part of the body’s normal reaction to stress. It also boosts the activity of the excitatory neurotransmitters dopamine and norepinephrine. This combination of reactions raises heart rate and blood pressure and stimulates the brain, causing increased alertness and improved focus. Phasing out caffeine can negatively impact concentration as your body struggles to become accustomed to functioning without it.

5. Depressed Mood

Caffeine is well known for its ability to elevate mood. Its ability to block adenosine not only increases alertness but also has been found to improve mood. One study in people who consumed caffeine regularly found that consuming 0.68 mg per pound (1.5 mg per kg) of body weight led to a more positive mood, compared to a placebo. Additionally, many studies have linked regular caffeine consumption to a reduced risk of depression.

6. Irritability

It’s common for regular coffee drinkers to be cranky before their morning cup of joe. The caffeine in coffee may be the culprit for this feeling of irritability. Because coffee only lasts in the system for four to six hours, withdrawal-like symptoms like irritability can occur after a night’s rest. Coffee drinkers are used to the mood-enhancing effects of caffeine, as well as the shot of energy they receive. For some, weaning off caffeinated beverages like coffee causes them to become irritable and moody. In fact, it may be difficult for heavy caffeine users to cut back on the amount they are accustomed to without negatively impacting their mood. In a study in 94 caffeine-dependent adults, 89% of participants reported that although they desired to cut back on caffeine, they had been unsuccessful in their efforts due to withdrawal symptoms, including irritability and anger.

7. Tremors

Though not as common as other symptoms, those who have a serious dependency on caffeine can experience tremors in cases of caffeine withdrawal. Since caffeine is a central nervous system stimulant, common side effects of drinking too much include feeling jittery or anxious and having shaky hands. In fact, those with anxiety disorders are often advised against consuming caffeine to avoid worsening feelings of anxiousness. However, for people who consume large amounts of caffeine daily, quitting cold turkey can also lead to tremors. Tremors related to caffeine withdrawal typically occur in the hands and should only last for two to nine days. If you are experiencing hand tremors that last longer than nine days, consult your doctor to rule out other causes. 

8. Low Energy 

Most everyone who consumes caffeinated beverages and foods is looking for a way to improve lagging energy levels. Lifestyle factors like poor sleep, demanding jobs and unhealthy diets can drain energy, causing many people to reach for external sources of energy like coffee and energy drinks to revive them. Caffeinated beverages are often used as a crutch to deliver the energy needed to make it through the day or compensate for lack of sleep. Sipping on a cup of coffee or energy drink boosts concentration increases heart rate and increases blood sugar, leading to feelings of increased physical and mental energy. These desired effects can lead to caffeine dependence, causing the need for more and more caffeine to produce the same energy boost. This is why low energy is a common complaint of people who are reducing or eliminating caffeine.

Symptoms of caffeine withdrawal should only last between two and nine days, with peak intensity of symptoms occurring 24–51 hours after caffeine is cut out. While these symptoms are usually short-lived, they can be uncomfortable and make life difficult. Fortunately, there are ways to reduce the chances of experiencing these unpleasant side effects. Try the following tips to reduce or completely avoid symptoms of caffeine withdrawal. Cut back slowly: Quitting cold turkey can shock the body and make withdrawal symptoms worse. Gradually weaning off caffeine can reduce the chances of experiencing unpleasant side effects. 

Myth: Caffeine's effects are addictive

Fact: People often say they are "addicted" to caffeine in much the same way they say they are "addicted" to shopping, working or television. Caffeine is not addictive by accepted definitions and according to most authorities. When regular caffeine consumption is abruptly ceased, some individuals may experience headache, fatigue or drowsiness. These symptoms usually last only a day or so, and can be avoided if caffeine intake is reduced gradually.

Myth: Caffeine increases the risk of heart disease

Fact: Large-scale studies have shown that caffeine consumption does not increase the risk of cardiovascular disease and does not raise cholesterol levels or cause irregular heartbeat. A slight, temporary rise in blood pressure has been observed with caffeine consumption with individual who are sensitive to caffeine. However, this rise is similar to that resulting from normal activity, such as climbing stairs. Still, people with high blood pressure are wise to consult their physician about caffeine intake.  

Myth: Caffeine causes cancer

Fact: Substantial scientific evidence demonstrates that caffeine does not increase cancer risk. Two studies of large numbers of people in Norway and Hawaii and a review of 13 studies involving more than 20,000 subjects found no relationship between regular coffee or tea consumption and cancer risk.

Myth: Caffeine is a risk factor for osteoporosis

Fact:  Some studies suggest that caffeine intake may increase calcium loss in the urine. However, any loss has been found to be minimal and caffeine intake at normal levels does not appear to affect calcium balance or bone density. More recent studies have confirmed that caffeine intake is not a risk factor for osteoporosis, particularly in women who consume adequate calcium.

Myth: Pregnant women or those trying to get pregnant should avoid caffeine

Fact: A large number of studies have looked at the effects of caffeine-containing beverages on reproductive factors. The data suggests that moderate caffeine consumption is safe for a pregnant woman and her unborn child. Results from studies into caffeine intake and time taken to conceive have provided no solid evidence that consumption of caffeine containing beverages may reduce the likelihood of a woman conceiving. Two major studies in the U.S. found no correlation between caffeine consumption and pregnancy outcome or birth defects.

Myth: Caffeine adversely affects the health of children

Fact: Children generally have the same ability to process caffeine as adults. Studies have shown that foods and drinks containing caffeine when taken in moderate amounts have no detectable effects on hyperactivity or attention span of children. However, in sensitive children, high doses of caffeine may cause temporary effects such as excitability, irritability or anxiety.

Myth: There are no positive effects of caffeine

Fact: Caffeine is well recognized as increasing both alertness levels and attention spans. A cup of coffee or tea is often recommended to counter sleepiness, especially for those driving long distances and many people resort to an afternoon "cuppa" to get back on top of their workload. Studies have shown that caffeine may also improve memory and logical reasoning.

Many caffeine-containing beverages, most notably tea and more recently coffee and chocolate, have been found to contain antioxidants. Antioxidants appear to have health benefits especially in the area of heart health and cancer prevention.

Recent reports suggest that caffeine may be useful in treating allergic reactions due to its ability to reduce the concentration of histamines, the substances that cause the body to respond to an allergy-causing substance. More research is need in this area before conclusions can be drawn however. 

Caffeine has long been known to help some people suffering from asthma. 

How to Reduce Caffeine Withdrawal Symptoms

Reduce caffeinated beverages: If you’re used to drinking full-strength coffee, start drinking half-decaf, half-regular coffee to slowly reduce your dependence. Even better, swap one of your coffees for a decaf herbal tea. Shop for herbal tea online.

Stay hydrated: Drinking enough water is crucial when cutting out caffeine. Dehydration can worsen symptoms of withdrawal, such as headache and fatigue.

Get enough sleep: To combat fatigue, try getting the recommended seven to nine hours of sleep per night

Boost energy naturally: If your energy levels have taken a hit after giving up caffeine, try incorporating natural sources of energy like exercise, nutrient-dense foods and stress reduction techniques into your routine.

The Bottom Line

Caffeine is a widely consumed stimulant that can cause withdrawal-like symptoms in some. Caffeine withdrawal can occur in anyone who regularly consumes caffeine and then abruptly discontinues its use. Common symptoms include headache, fatigue, low energy, irritability, anxiety, poor concentration, depressed mood and tremors, which can last anywhere from two to nine days. Thankfully, there are ways to reduce these symptoms, including cutting back on caffeine gradually, staying hydrated, getting plenty of sleep and finding ways to naturally boost your energy. Although caffeine withdrawal may seem unbearable at first, this temporary reaction is just a bump in the road to limiting your dependence.