Caffeine-induced psychosis

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Coffee is a popular source of caffeine. White cup of black coffee.jpg
Coffee is a popular source of caffeine.

Caffeine-induced psychosis is a relatively rare phenomenon characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. [2] [3] This is caused by an overuse of caffeine and which can occur in otherwise healthy people. Caffeine may also worsen psychosis in people suffering from schizophrenia. [4] This can happen with ingestion of high doses of caffeine or when caffeine is chronically abused. However, there is a limited amount of evidence that confirms this.[ clarification needed ] [4] [5] [6]

Contents

Psychosis refers to a collection of symptoms that affect the mind, characterized as a loss of contact with reality. During an episode of psychosis, a person's thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not. This state of mind may be caused by a range of mental illnesses (schizophrenia, bipolar disorder), physical illnesses (Parkinson's disease, Alzheimer's), and some substances such as stimulant drugs.

While rare, caffeine-induced psychosis has been reported in both clinical studies and case reports. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – Text Revision (DSM-5-TR) outlines five caffeine-related syndromes, [7] including caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and unspecified caffeine-related disorders, under stimulant-related diagnostic codes. The International Classification of Diseases, Tenth Revision (ICD-10) [7] classifies disorders associated with caffeine more broadly, as "mental and behavioural disorders due to use of other stimulants, including caffeine". [7]

Several case studies and reviews have suggested that excessive caffeine intake may provoke psychotic or manic symptoms in vulnerable individuals. [7] [8] [9] Caffeine may also worsen recovery in patients with bipolar disorder or pre-existing psychotic conditions, such as schizophrenia, which has led some clinical guidelines to recommend reducing or eliminating caffeine intake during psychiatric treatment, particularly for mania. [2] [9] [10]

Some case reports suggest that psychotic symptoms can emerge in individuals without a history of mental illness after consuming high doses of caffeine. [2] [7] [10] [11] Though not conclusively confirmed, it is hypothesized that caffeine may exacerbate underlying paranoid traits or lower the threshold for developing psychopathology in those predisposed to psychosis. Symptom resolution following caffeine discontinuation has been observed in several cases, supporting the existence of caffeine-induced psychosis. [9]

Mechanisms

Caffeine acts as an antagonist of adenosine receptors, particularly A1 and A2A receptors. Under normal conditions, adenosine inhibits neurotransmission, which promotes sleep and suppresses arousal. By blocking these receptors, caffeine limits adenosine's inhibitory influence, which results in increased neuronal activity and the enhanced release of excitatory neurotransmitters, such as dopamine and glutamate.

This mechanism contributes to improved alertness, attention, and mood at moderate doses. However, high doses or chronic overuse may overstimulate dopamine pathways in the brain, particularly in areas like the mesolimbic system, which are associated with the development of psychotic symptoms. [ citation needed ]

The elevated dopaminergic activity resembles the neurochemical abnormalities observed in psychotic disorders to a lesser degree, and may trigger hallucinations, delusions, or manic symptoms, particularly in individuals who are genetically or biologically vulnerable. [9]

Additionally, caffeine-induced sleep deprivation, anxiety, and increased arousal can further exacerbate the risk of psychotic symptoms, either independently or in combination with other stressors or substances. [12]

Epidemiology

In healthy individuals

While caffeine is widely consumed for its stimulant effects, excessive intake has been associated with the onset of acute psychotic symptoms in individuals without prior psychiatric diagnoses, particularly under conditions of sleep deprivation, stress, or concurrent substance use. A growing number of case reports have described caffeine-induced psychosis in otherwise healthy individuals, with symptoms typically resolving after caffeine cessation, although some cases necessitated psychiatric treatment.[ citation needed ]

Though a definitive causal relationship has not been established, caffeine's effect on dopamine levels may increase arousal and contribute to the onset of psychotic symptoms. Additionally, symptom improvement has been observed following caffeine reduction in individuals with pre-existing psychotic disorders. These findings suggest that individuals with a predisposition to psychosis may possess a lower threshold for developing psychopathological symptoms in response to caffeine intake. [7]

In individuals with schizophrenia

People with schizophrenia may be more inclined to overuse caffeine for a variety of reasons. Many people with schizophrenia use caffeine to combat boredom or to fight the sedating effects of antipsychotic medications. Many antipsychotics can also cause dry mouth. Additionally, people with schizophrenia may experience psychogenic polydipsia (excessive thirst). These factors could increase the amount of caffeine one may consume. [13]

Eighty percent of people with schizophrenia smoke daily and are heavy smokers. Smoking tends to deplete much of ingested caffeine, so users with schizophrenia may consume more caffeine than others to make up for this. [13]

"Caffeine use can cause restlessness, nervousness, insomnia, rambling speech, and agitation", [13] worsening the symptoms of schizophrenia. "Caffeine is metabolized by the CYP1A2 enzyme and also acts as a competitive inhibitor of this enzyme. Thus, caffeine can interact with a wide range of psychiatric medications, including antidepressant agents, antipsychotic agents, antimanic agents, antianxiety agents, and sedative agents." [14]

A consumption of less than 250 mg of caffeine a day has been associated with better results on cognitive tasks in people with schizophrenia. However, more research still needs to be done to determine if the amount of caffeine that is safe to consume by schizophrenics (>250 mg/a day) is the same as the general population of people without schizophrenia. [15]

Treatment and prevention

For people who have an addiction to caffeine, the best way to treat caffeine-induced psychosis is to gradually consume smaller amounts of it over a period of time. Withdrawal from certain drugs may worsen side effects of psychotic or mood disorders.[ citation needed ] For people who consume excessive amounts of caffeine without a prior psychotic disorder, a doctor may prescribe antipsychotics to help stop the effects of psychosis. [16]

References

  1. ↑ van Dam, Rob M.; Hu, Frank B.; Willett, Walter C. (2020-07-23). Campion, Edward W. (ed.). "Coffee, Caffeine, and Health" . New England Journal of Medicine. 383 (4): 369–378. doi:10.1056/NEJMra1816604. ISSN   0028-4793. PMID   32706535.
  2. 1 2 3 Hearn, John; Reiff, Thea; McBride, Anne; Kelly, Michael (May 2020). "Caffeine-Induced Psychosis and a Review of Statutory Approaches to Involuntary Intoxication". The Journal of the American Academy of Psychiatry and the Law. 48 (3). Journal of the American Academy of Psychiatry and the Law: 376–383. doi:10.29158/JAAPL.003923-20. PMID   32404360 . Retrieved 21 June 2023.
  3. ↑ Kamau, Caroline (3 June 2020). "Can Caffeine Induce Psychosis?". psychologytoday.com. Psychology Today. Retrieved 21 June 2023.
  4. 1 2 Hedges, Dawson; Woon, Fu; Hoopes, Scott (March 2009). "Caffeine-induced psychosis". CNS Spectrums. 14 (3). PubMed®: 127–129. doi:10.1017/s1092852900020101. PMID   19407709. S2CID   32188625.
  5. ↑ Cerimele, Joseph M.; Stern, Adam P.; Jutras-Aswad, Didier (March 2010). "Psychosis Following Excessive Ingestion of Energy Drinks in a Patient With Schizophrenia". American Journal of Psychiatry. 167 (3): 353. doi:10.1176/appi.ajp.2009.09101456. PMID   20194494. S2CID   5832823.
  6. ↑ Broderick, P.; Benjamin, A. B. (2004). "Caffeine and psychiatric symptoms: A review". The Journal of the Oklahoma State Medical Association. 97 (12): 538–542. PMID   15732884.
  7. 1 2 3 4 5 6 Hernandez-Huerta, Daniel; Martin-Larregola, Maria; Gomez-Arnau, Jorge; Correas-Lauffer, Javier; Dolengevich-Segal, Helen (2017). "Psychopathology Related to Energy Drinks: A Psychosis Case Report". Case Reports in Psychiatry. 2017 5094608. doi: 10.1155/2017/5094608 . ISSN   2090-682X. PMC   5237741 . PMID   28116203.
  8. ↑ GÖRGÜLÜ, Yasemin; TAŞDELEN, Öznur; SÖNMEZ, Mehmet Bülent; KÖSE ÇINAR, Rugül (2014-03-05). "Enerji İçeceği Tüketimi Sonrası Gelişen Bir Akut Psikoz Olgusu". Nöro Psikiyatri Arşivi. 51 (1): 79–81. doi:10.4274/npa.y6772. ISSN   1300-0667. PMC   5370257 . PMID   28360600.
  9. 1 2 3 4 Mannix, Dylan; Mulholland, Kate; Byrne, Fintan (2024-08-06). "Caffeine-Induced Psychosis: A Case Report and Review of Literature". Cureus. 16 (8) e66306. doi: 10.7759/cureus.66306 . ISSN   2168-8184. PMC   11376648 . PMID   39238723.
  10. 1 2 Valdivieso-JimÃnez, Glauco (2025). "Psychotic symptoms and consumption of energy drinks: Case report". Journal of Neuropsychiatry, Chile. Retrieved 2025-05-05.
  11. ↑ Görgülü, Yasemin; Taşdelen, Öznur; Sönmez, Mehmet Bülent; Köse Çinar, Rugül (March 2014). "A Case of Acute Psychosis Following Energy Drink Consumption". Noro Psikiyatri Arsivi. 51 (1): 79–81. doi:10.4274/npa.y6772. ISSN   1300-0667. PMC   5370257 . PMID   28360600.
  12. ↑ Arciniegas, David B. (June 2015). "Psychosis". Continuum (Minneapolis, Minn.). 21 (3 Behavioral Neurology and Neuropsychiatry): 715–736. doi:10.1212/01.CON.0000466662.89908.e7. ISSN   1538-6899. PMC   4455840 . PMID   26039850.
  13. 1 2 3 Hughes, John R.; McHugh, Pauline; Holtzman, Stephen (November 1998). "Alcohol & Drug Abuse: Caffeine and Schizophrenia" . Psychiatric Services. 49 (11): 1415–1417. doi:10.1176/ps.49.11.1415. ISSN   1075-2730. PMID   9826240.
  14. ↑ Broderick, Pamela J.; Benjamin, Ashley B.; Dennis, Leland W. (August 2005). "Caffeine and psychiatric medication interactions: a review". The Journal of the Oklahoma State Medical Association. 98 (8): 380–384. ISSN   0030-1876. PMID   16206866.
  15. ↑ Apostolakopoulou, Xenia A; Kontopoulou, Lamprini; Karpetas, Georgios E; Marakis, Georgios; Vasara, Eleni; Katsaras, Ioannis G; Maraki, Zoi; Papathanasiou, Ioanna V; Bonotis, Konstantinos S (2022). "Sugars, Alcohol, and Caffeine Intake From Drinks Among Outpatients With Mental Health Disorders in Greece: A Pilot Study". Cureus. 14 (1) e21563. doi: 10.7759/cureus.21563 . ISSN   2168-8184. PMC   8873368 . PMID   35228922.
  16. ↑ "Substance-Induced Psychotic Disorder | Knowledge Center". Sheppard Pratt. Retrieved 2024-03-18.
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