Editorial
Volume 14 Issues 1 January, 2024
Caffeine is the most commonly used psychoactive drug in the world. The recently launched ICD – 11 (International Classification of Diseases) includes a dedicated section on disorders due to caffeine use under the broader category of disorders related to substance use. While caffeine dependence is not yet included in the classification, harmful use, intoxication, withdrawal, and caffeine-induced anxiety disorder are recognized.[1] Caffeine acts as a non-selective adenosine receptor antagonist, targeting primarily adenosine A1 and A2A receptors in the brain and indirectly modulating dopamine.[2] Although often perceived as benign, excessive or unregulated caffeine consumption can result in significant physical and psychiatric morbidity, highlighting the importance of acknowledging its impact in clinical practice. While coffee and tea remain the most prominent sources of caffeine, many other products also contain substantial amounts of this stimulant.
Food and Beverages
These include:
- Chocolate: Higher cocoa content correlates with increased caffeine levels.
- Energy Drinks: Frequently marketed for enhanced physical and cognitive performance, many of these beverages contain caffeine levels equivalent to or exceeding a strong cup of coffee.
- Certain Herbal Teas: Many of them contain considerable caffeine.
- Dietary Supplements: Often labeled as energy boosters, these can significantly contribute to cumulative caffeine intake.
Medicinal Products
Caffeine is a common ingredient in over-the-counter (OTC) and prescription medications, often unbeknownst to consumers.
- Analgesics: Combination pain relievers frequently include caffeine for its synergistic effect with analgesics like acetaminophen.
- Cold and Flu Remedies: These may contain caffeine to counteract drowsiness caused by antihistamines.
- Weight Loss Supplements: Caffeine is used for its thermogenic and appetite-suppressing properties.
Non-Food Sources
The rise of caffeine-infused products extends beyond consumables.
- Skincare Products: Caffeine-enriched creams claim to reduce puffiness and cellulite.
- Breath Fresheners: Chewing gum, mints, and some mouth fresheners may have some amount of caffeine.
For most adults, the FDA (Food and Drug Administration) cites 400 mg of caffeine per day as an amount not generally associated with adverse effects.[3] However, cumulative consumption can sometimes exceed this limit, often without the individual’s awareness. Clinicians must recognize caffeine’s role in exacerbating symptoms such as insomnia, anxiety, mood fluctuations, arrhythmias, and acid reflux, particularly when these symptoms prove resistant to standard treatments.[4] Additionally, caffeine consumption during pregnancy is linked to risks such as low birth weight and preterm delivery. A thorough clinical history should include inquiries about caffeine intake, including potential hidden sources.
Raising awareness of caffeine as a psychoactive substance is crucial in psychiatric practice. Public health initiatives should prioritize transparent labeling of caffeine content in all products. Despite its widespread use, caffeine has profound implications for both mental and physical health. Its inclusion in ICD-11 emphasizes the importance of vigilance in recognizing and addressing caffeine use disorders.
References:
- ICD W. for Mortality and Morbidity Statistics [Internet]. 11
- Ferré S. Caffeine and substance use disorders. Journal of Caffeine Research. 2013 Jun;3(2):57.
- Wikoff D, Welsh BT, Henderson R, Brorby GP, Britt J, Myers E, Goldberger J, Lieberman HR, O’Brien C, Peck J, Tenenbein M. Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. Food and chemical toxicology. 2017 Nov 1;109:585-648.
- Lara DR. Caffeine, mental health, and psychiatric disorders. Journal of Alzheimer’s disease. 2010 Apr 14;20(s1):S239-48.
