Author: Dr. Kevin Fleming, Ph.D.













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Caffeine Intoxication DSM-5 305.90 (F15.929)

Caffeine Intoxication

Caffeine intoxication is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) diagnosis assigned to individuals who experience symptoms like restlessness, nervousness, insomnia or digestive issues after consuming a high dose of caffeine.

Introduction

The world’s most popular drug, caffeine is a naturally occurring stimulant used to boost wakefulness and alertness. More than 80 per cent of adults in North America consume caffeine, typically through drinks like coffee, tea or energy drinks, or via weight loss aids, chocolate and over-the-counter medication.

Health professionals recommend limiting daily caffeine intake to 400mg, which is a moderate amount equivalent to about eight and a half cups of black tea, or just over four cups of regular brewed coffee. (National Consumers League 2016)

According to the DSM-5, a dose of caffeine that’s well over 250mg can cause caffeine intoxication - a condition in which an individual may feel nervous, restless, excited, twitchy and flushed. The symptoms of caffeine intoxication can be distressing and affect areas of an individual’s functioning, such as work, school or social life.

Symptoms

Someone experiencing caffeine intoxication will usually display a range of symptoms, either while they’re consuming caffeine, or just after - often around five or more symptoms will be recorded.

Common symptoms include feeling nervous, restless or excited, becoming red in the face, having to go to the toilet more often and experiencing gastrointestinal disturbances.

Even after consuming a low dose of caffeine - around 200mg - symptoms may still occur, especially among individuals who haven’t consumed caffeine before or who are vulnerable to the effects, such as children and the elderly.

Other symptoms may also present among individuals who have consumed high doses of caffeine above 1g per day, including muscle twitches, rambling thoughts and speech, panic attacks, inexhaustibility and mental agitation. (American Psychiatric Association 2013)

Diagnostic criteria for caffeine intoxication

For a diagnosis of caffeine intoxication to be made, a medical practitioner will refer to the DSM-5 guidelines, which stipulate that various criteria need to be met.

Firstly, the patient must have recently consumed a high dose of caffeine - well above 250mg. They must then display five or more of the following symptoms either during or shortly after consumption:

Nervousness

Restlessness

Excitement

Facial flushing

Digestive complaints

Increased or irregular heart rate

Diuresis

Insomnia

Muscle twitching

Nervous energy

Periods of tirelessness

The symptoms identified must cause the patient significant distress or impair them in some way, such as in their social interactions, at work, or in some other important area of functioning.

Lastly, the signs and symptoms must not be attributable to another medical condition, or better explained by a mental disorder, including intoxication from a different substance.

In some cases, individuals may experience some mild sensory disturbance like ringing in the ears after a high dose of caffeine, and while large doses can make the heart beat faster, smaller amounts of caffeine can reduce the heart rate.

Usually, an individual can provide the information necessary to diagnose caffeine intoxication, recalling what they’ve consumed that’s likely to have caused the reaction. Other times, it’s necessary to perform a blood test to assist with diagnosis. (American Psychiatric Association 2013)

Causes of caffeine intoxication

Caffeine intoxication is caused by consumption of a high dose of caffeine. Relatively speaking, what’s high for one person may not be high for another, but it’s classed as being well over 250mg.

Caffeine is most commonly consumed by drinking coffee and tea but is often a key ingredient in energy drinks, too. It’s also present in many dietary supplements or can be consumed in the form of caffeine tablets.

Over the last few years, pure powdered caffeine has entered the market as a dietary supplement, and experts warn that just one teaspoon is equivalent to as many as 28 cups of coffee - a toxic amount. (FDA 2018)

The human body starts to be affected by caffeine at around 15mg per liter of blood, and a concentration of between 80 and 100mg per liter can result in death. (Medical News Today 2019)

Risk factors and prevalence of caffeine intoxication

It is not known just how prevalent caffeine intoxication is but in the United States, estimates suggest that around seven per cent of the population may experience at least five symptoms of caffeine intoxication along with impairment consistent with the disorder.

There are environmental risk factors associated with caffeine intoxication, such as significantly increasing the amount of caffeine consumed, or increased use among individuals who don’t frequently consume the substance.

Oral contraceptives may also increase the risk of caffeine intoxication by reducing caffeine elimination, and genetic factors many also affect the likelihood of someone being intoxicated with caffeine. (American Psychiatric Association 2013)

Comorbidity and differential diagnosis

When consumed in typical amounts, caffeine has not been consistently associated with medical issues, although heavy use may make conditions like anxiety worse. In cases of extremely high doses of caffeine being consumed, an individual may experience violent seizures and respiratory failure.

Excessive use of caffeine is associated with a range of conditions, including depressive disorders, sleep disorders, bipolar conditions, eating disorders and psychotic disorders.

Caffeine intoxication shares some symptoms of primary mental disorders, such as panic attacks. A range of conditions can present in a similar way to caffeine intoxication, including panic disorder, manic episodes, generalized anxiety disorder and amphetamine intoxication.

The signs and symptoms on display may also overlap with other caffeine-induced disorders. Symptoms can be attributed to caffeine intoxication rather than caffeine-induced anxiety disorder or caffeine-induced sleep disorder by establishing that symptoms of these two conditions are in excess of the signs usually associated with caffeine intoxication and severe enough for independent medical attention. (American Psychiatric Association 2013)

Living with caffeine intoxication

Caffeine intoxication is a temporary state but, depending on the amount of caffeine, consumed, individuals may require immediate medical attention.

Someone who has consumed a very high dose of caffeine - between 5g and 10g - may need attending to urgently, as such doses can prove fatal.

During caffeine intoxication, an individual may feel energetic and excited, struggle to sleep and experience physical side effects like digestive discomfort. Normal activities and relationships may be affected over this period, too, although symptoms usually abate within a day or so.

There are no known long-lasting effects of caffeine intoxication but as we age, we’re more likely to experience intense reactions to caffeine - older people more frequently report trouble sleeping or hyperarousal after consuming caffeine.

Over the long term, regular consumption of high amounts of caffeine (four cups of coffee a day or more) may be associated with increased cholesterol levels and an irregular heartbeat. It’s also been linked with loss of bone density, which can increase an individual’s risk of osteoporosis. (CAMH 2011)

Treatment for caffeine intoxication

Caffeine intoxication will usually go away on its own after several hours. During an episode, it’s advisable to treat caffeine intoxication by drinking water for rehydration, walking to relieve restlessness and not consuming any further caffeine.

In severe cases, when someone has overdosed on caffeine, medical treatment may be necessary. Patients may be given supplements, intravenous fluids or activated charcoal, which stops caffeine being absorbed in the gut. (Medical News Today 2019)

Individuals who consume caffeine regularly or in high doses might want to reduce their usage to combat symptoms of caffeine intoxication or to prevent any associated problems, such as sleeping difficulties, anxiety and stomach ulcers. (Medical News Today 2019)

Options for reducing caffeine use include ordering a smaller coffee when out and about, switching out some caffeinated drinks for an alternative like fruit-infused water or herbal tea, or choosing decaffeinated versions of coffee and tea.

Dr. Kevin Fleming obtained his PhD from Notre Dame and is the Founder of Grey Matters International ( www.greymattersintl.com ), a neuroscience-based behavior change consulting firm.

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

National Consumers League (2016) 11 surprising facts you may not know about caffeine https://www.nclnet.org/27422/caffeine_facts Date Accessed: 11/28/2019.

US Food and Drug Administration (FDA) (2018) Pure and Highly Concentrated Caffeine https://www.fda.gov/food/dietary-supplement-products-ingredients/pure-and-highly-concentrated-caffeine Date Accessed: 11/28/2019.

Medical News Today (2019) Can you overdose on caffeine?

https://www.medicalnewstoday.com/articles/322933.php#how-likely-is-an-overdose Date Accessed: 11/28/2019.

Centre for Addiction and Mental Health (CAMH) (2011) Caffeine

https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/caffeine Date Accessed: 11/28/2019.

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