When a colleague recently began seeing a therapist, the intake form contained an interesting question: “Do you drink coffee? If so, how much per day?”
My colleague was surprised—and I was, too. Why did her therapist care if her patients drank coffee?
When she asked the owner of the counseling center, Jennifer Hill, a licensed professional clinical counselor in Encinitas, California, why that question appeared on the form, she explained, “Caffeine usage is good to know. If the client is struggling with anxiety, it can trigger anxiety and cause anxiety-like symptoms in those who don’t have anxiety.”
Caffeine works as a central nervous system (CNS) stimulant and is the most popular psychoactive drug in the world, according to a review study published in Frontiers in Psychiatry. Additionally, a study in Food and Chemical Toxicology found that 85 percent of the U.S. population consumes at least one caffeinated beverage per day.
No surprise there, really—caffeine, a natural stimulant harvested from certain plants, can be found in widely available beverages like coffee, tea and soda. It works to stimulate by blocking your body’s adenosine receptors—this blockage prevents you from becoming tired, and can make you feel more alert and energized.
But, by the same token, since it’s a stimulant, an overuse of caffeine can cause problems, depending on your body type. Too much of this substance can lead to nausea, dizziness, dehydration, headaches, restlessness, rapid heartbeat, insomnia and feelings of anxiety—the latter of which is typically defined as a feeling of fear, dread and uneasiness, which can cause you to sweat, feel restless and tense, and have a rapid heartbeat.
According to the Harvard T.H. Chan School of Public Health, one 8-ounce cup of brewed coffee contains about 95 mg of caffeine. They explain that low to moderate doses of caffeine (around 50 to 300 mg) may cause “increased alertness, energy and ability to concentrate,” while higher doses may lead to the negative effects listed above.
The Frontiers review found that “for healthy adults, caffeine consumption is relatively safe, but that for some vulnerable populations, caffeine consumption could be harmful, including impairments in cardiovascular function, sleep and substance use.”
Nevertheless, many celebs—and plenty of regular folks—are beginning to ditch caffeine in order to make strides to beat their anxiety, get better Zzzs and gain some equilibrium. Michael Pollan famously wrote about his experience temporarily escaping his caffeine addiction in his book, This Is Your Mind On Plants, while Jeff Goldblum recently told the Wall Street Journal, “I got off of [coffee]. It was a mental crutch for myself, and I've enjoyed eliminating it entirely from my diet.”
“Caffeine is a love-hate relationship for many people,” explains Dr. Raghu Appasani, an integrative psychiatrist, MUD\WTR’s mental health advisor and founder and CEO of the Minds Foundation, a nonprofit focused on providing mental health literacy tools. “You think [caffeine is] good because it increases your alertness and energy levels and keeps you up later. And it does, but it also completely screws up your circadian rhythm so your quality of sleep is not as good. And you tend to start to have a harder time waking up in the morning.”
Over time this need to have caffeine in order to wake up can cause a tolerance to lower doses of caffeine—causing users to increase dosage to get the same stimulating effect—as well as a daily dependence on it.
In his book mentioned above, Pollan notes that the association of coffee with productivity has made coffee—and coffee breaks—staples of companies throughout the world. In other words, coffee goes hand in hand with capitalism. And in capitalism, near-constant productivity is king. Which might explain why caffeine can have such a damaging effect on one’s ability to get a good night’s sleep.
How Coffee Impacts Sleep
As Appasani said, one of the biggest areas where we see potentially harmful impacts of too much caffeine is in reduced quality and quantity of sleep.
“Pharmacologically, it helps increase the feeling of energy levels and alertness,” Appasani explains. “It blocks adenosine in your brain, which is the molecule that builds up throughout the day and makes you drowsy at the end of the day. So, when you block the receptors, the adenosine can’t work, and so coffee is in this battle with it.”
“You start to need more of it to get the same feelings of energy and alertness,” Appasani adds. “You start to become dependent on it, so you need it or you start to have withdrawal symptoms—things like anxiety, irritability, fatigue, headaches and nausea. No one really wants to have that.”
According to a study by Christopher Drake, PhD, of the Henry Ford Hospital in the Journal of Clinical Sleep Medicine, “caffeine can interfere with sleep when consumed as long as six hours before bedtime, reducing sleep by an hour and interfering with sleep efficiency and REM patterns.”
Hill, the therapist in Encinitas, Calif., explains that caffeine can be a big contributor to the issues of those suffering from sleep disorders. She explains that if a patient seeing her has anxiety, she might advise them to try to cut caffeine entirely in order not to make the anxiety worse. Or, if they have a sleep disorder, she advises them not to ingest caffeine after 2 p.m. so they can try to regain sleep equilibrium.
Appasani says he sees the sleep impact as caffeine’s most detrimental effect.
“The reason I say that,” he explains, “is because sleep is one of the key factors when we think about mental health. Sleep is one of the first things to have symptoms. If people have a hard time falling asleep or staying asleep or waking up, low energy and fatigue, then those are the predispositions or early signs of a mental health condition coming up—things like depression and anxiety.”
“We know that people who struggle with their mental health are more likely to struggle with their sleep,” he adds. “It’s pretty detrimental. If you’re drinking caffeine and it’s impacting your sleep, then you know you’re not on the right path to taking care of your mental health.”
Coffee and Anxiety
In addition to issues of restless sleep and insomnia, more and more mental health professionals are addressing caffeine consumption because it can cause symptoms of anxiety—especially if someone is having a lot of caffeine.
“I address caffeine use with every patient that I see, the same way I address alcohol and tobacco and marijuana use, as well as diet,” says Appasani. “It’s all a part of how you treat someone. You have to look at everything they’re putting into their body, the context they’re putting their body into and the people that are involved in their life.”
That concept of coffee being tied to productivity plays out in many highly productive people’s dependence on coffee to accomplish tasks throughout the day—to have an extra cup (or a shot or two of espresso) to push through into the afternoon or evening, even when their body is tired and signaling that it needs rest.
Appasani says that often when patients see him for mental health counseling, and they’re complaining about anxiety, there tends to be a correlation with them also consuming a high level of caffeine. “This is not always the case,” he adds, “but it’s typically someone who is hyperproductive, they’re Type A, they’re trying to get a lot done. They’re overwhelmed, and they’re using caffeine as a way to feel as though they are being more productive and alert.”
Caffeine has also been shown to have an “expectancy effect,” Appasani explains. “What that means is that people will consume caffeine, and they have a perception of how that impacts them,” he says. “So that might actually make them work more efficiently. It’s not directly related to caffeine—it’s just this placebo effect that tends to happen. People will consume more and more caffeine thinking it’s having this effect on them, and unfortunately this [can potentially] lead to other health conditions like increased anxiety symptoms and cardiovascular health and metabolic health issues.”
Nevertheless, “It’s a stimulant and it’s not doing any favors for your brain when you’re already having symptoms of anxiety,” Hill says. “I’m very aware it’s not that easy to not have caffeine, but that’s our recommendation for people with anxiety—to not take it at all.”
Caffeine can make symptoms of anxiety much worse, agrees Appasani. He explains that, at high doses, caffeine can have [effects] on your cardiovascular system, on your autonomic nervous system and it can cause symptoms of anxiety, like restlessness and tremors and maybe even chest pain or tachycardia, which is an accelerated heart rate. “It’s not directly causing any clinical diagnosis of anxiety,” he explains, “but it is [possibly] causing some of the typical symptoms that when one experiences, you might have anxiety.”
A Complicated Substance
So caffeine can contribute to anxiety-like symptoms and sleep issues. Yet still, many people—myself included—feel that they work and create best after a cup of coffee or caffeinated tea. So, are there benefits to caffeine, too?
“The research is mixed,” says Appasani. “It does show if you have low to moderate amounts or doses of coffee it can potentially improve your mood. It has been shown to help with depression and decreasing suicidality in some research. However, if you have underlying anxiety—and a lot of anxiety gets tied in with depression—it can make those symptoms worse. It can decrease the threshold to having an anxiety attack or a panic attack, so you’re more at risk if you have some form of anxiety disorder.”
When it comes to her own coffee consumption, Hill says the dose determines the effect.
“I don’t personally have anything against caffeine but I also use it in moderation,” she says.
How much to drink depends on the person and how anxiety-prone they already are. If you’re a person who enjoys using caffeine as a stimulant while you work or problem-solve, you might look to cut back your consumption, or cut out all consumption after a certain time of day, rather than totally kicking the habit.
It’s important to note that the withdrawal process can also create a temporary mental health impact. If someone who is dependent on caffeine tries to go cold turkey, they will likely feel sluggish and potentially moody and out-of-sorts as well, and may experience headaches and other similar physical withdrawal symptoms.
“A lot of people who try to stop caffeine do get symptoms of withdrawal,” Hill says. “People don’t realize because everyone drinks caffeine; it’s everywhere—more so than even alcohol. So [people think] if everyone does it, then it must be OK. The point I try to make is to pay attention to [the fact] that it does cause withdrawal symptoms and your body does get dependent on it.”
Keeping in mind our ubiquitous, widespread cultural practice of using caffeine, Appasani suggests cutting back, not cutting out, as a more reasonable goal for those worried about their immediate caffeine consumption.
“When I work with patients, or even friends, who struggle with coffee, I first try to set goals that they can try to reach,” explains Appasani. “The aim is to try to decrease the time until they have the last [caffeine] drink in the day. For example, you don’t want someone drinking coffee in the afternoon, so I have patients set a goal of the last time that they can consume any form of caffeine—say 1 or 2 p.m. We start with that first, and work from there to cut down.”
Beginning to be more mindful of caffeine intake—both quantity and time of day—as well as its effects on your body, sleep and mental health, is already a huge step. For those without mood disorders or other health concerns which might make them more vulnerable, Appasani says there is no necessity to immediately go cold turkey.
One to two servings of caffeine a day is fine for most people, Appasani says. “I’m not talking about Starbucks’ venti large extra sugar shot coffees,” Appasani explains, “but one to two servings of caffeine a day is OK. You just want to notice how it impacts your functioning, how you feel, as well as your sleep, in particular.”
Gina Tomaine is a writer based in Philadelphia. Follow her on Twitter.
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