Britt Talley Daniel M.D.
7777 Forest Lane Suite B-220
Dallas, Texas 75230
Caffeine is a Drug
The current 1994 edition of the Diagnostic and Statistical Manual for Psychiatric Diagnosis (DSM IV) added a new drug to the list of known addictive drugs—Caffeine, in amounts as small as 120 mg/day. Criteria for caffeine withdrawal: Prolonged daily use of caffeine, abrupt cessation or reduction of total caffeine use, closely followed by headache and one or more of the following symptoms — fatigue/drowsiness, anxiety/depression, nausea/vomiting–, clinically significant distress or impairment in social, occupational or other important areas of functioning.
The diagnostic criteria for caffeine intoxication are recent consumption of caffeine, use in excess of 250 mg a day and the development of five or more the following signs during, or shortly after caffeine use: Restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, or psychomotor agitation.
Approximate amounts of caffeine in various beverages:
Coffee, grande 16 oz Starbucks 550
Coffee, tall 12 oz Starbucks 375
Coffee, short 8 oz Starbucks 250
Redline RTD 250
NoDoz, max strength or Vivarin 200
7-Eleven Big Gulp cola 64 oz 190
Coffee non-gourmet 8 oz 135
Coffee instant 8 oz 95
Cola 12 oz 35
Mt. Dew 55
Dr. Pepper 39
Cappuccino, 8 or 12 oz 35
Expresso Starbucks 1 oz 35
Tea, green or instant 8 oz 30
Chocolate dark, semisweet 1 oz 20
Coffee decaf Starbucks 8 or 12 oz 10
Coffee decaf non-gourmet 8 oz 5
Hot chocolate or cocoa 8 oz 5
Chocolate milk 1 oz 5
Liquid Speed (amount concealed within a proprietary formula)
Caffeinated water ?
Pharmacologically, caffeine acts as a central nervous system stimulator, a point that is well made by the coffee ad on TV which calls it “the think drink.” The duration of the effect of the drug is 6-8 hours, but even one drink in the morning will interrupt sleep in some persons. Caffeine also acts as a constrictor of smooth muscle, which is found in arteries, the bladder, and the colon. It is the arterial vasoconstrictive action which helps with mild migraine (Excedrin, B.C. Powder, and Vivacin) and may lead to the rebound vasodilatation headache when one withdraws from caffeine. The smooth muscle effect also acts as a mild stimulant on the bladder, promoting urination and in the colon, a bowel movement.
I urge all Caffeine addicted patients, migraine patients, Panic Disorder patients, and patients with sleep disorders to taper off caffeine (which, as I said above, is a drug).
Consider what the migraine expert, Dr. Marcelo Bigal, wrote in October 2009: ”The role of caffeine in the evolution from episodic into chronic headaches is of enormous interest, due to wide populational exposure to caffeine. In the population, individuals with chronic migraine are more likely to be high caffeine consumers while they had episodic headaches, as compared to individuals that did not develop chronic migraine. Abrupt withdrawal of caffeine in individuals with chronic migraine is associated with rebound headaches, further supporting the importance of this substance as a risk factor.” http://www.discoverymedicine.com/Marcelo-Bigal/2009/10/12/migraine-chronification-concept-and-risk-factors/