Caffeine is a Drug

The DSM V which is the current edition of the Diagnostic and Statistical Manual for Psychiatric Diagnosis includes in the list of 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

  • Monster energy drink 16 oz 160

  • 7-Eleven Big Gulp cola 64 oz 190

  • Coffee non-gourmet 8 oz 135

  • Excedrin 2 130

  • Coffee instant 8 oz 95

  • Jolt 711

  • Anacin 65

  • Cola 12 oz 35

  • Mt. Dew 55

  • Dr. Pepper 39

  • Pepsi 37

  • Tab 46

  • 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. Coca Cola which has 39 mg of caffeine was marketed in the United States after the Civil War as an over the counter treatment for migraine.  The smooth muscle effect also acts as a mild stimulant on the bladder, promoting urination and in the colon, a bowel movement. The International Classification of Headache states using caffeine 15 days a month can cause daily headaches in some patients, called chronic migraine, due to medication overuse headache. The American Migraine Society has stated that caffeine is the number 1 over the counter cause of medication overuse headache.  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).