Reviewed By Gary Vogin
When patients have trouble with panic attacks and come to psychologist Norman B. Schmidt, PhD, he asks if they drink coffee and whether the anxiety strikes shortly afterward, say, in the morning on the way to work.
If their answer is "yes," he has a surprising treatment: More coffee. But now these patients carefully sip their java while noting their physical reactions. That way, Schmidt hopes, they'll learn to recognize their pounding hearts and quickened pulses for what those symptoms really represent: a caffeine-induced buzz.
With coffeehouses springing up on every street corner, researchers like Schmidt are increasingly concerned about caffeine's role in panic and other anxiety disorders. Indeed, caffeine's power has become so well recognized that the American Psychiatric Association has added three related disorders to its list of official diagnoses: caffeine intoxication, caffeine-related anxiety, and caffeine-related sleep disorders.
"Caffeine is the most widely used mood-altering drug in the world," says Roland Griffiths, PhD, a professor in the departments of psychiatry and neuroscience at the Johns Hopkins University School of Medicine. "People often see coffee, tea, and soft drinks simply as beverages rather than vehicles for a psychoactive drug. But caffeine can exacerbate anxiety and panic disorders."
It's no surprise that caffeine gets so much attention from scientists these days. After all, 80% of Americans drink it. In fact, occasional coffee consumption rose 6% in the last year alone, according to the National Coffee Association. At the same time, panic and other anxiety disorders have become the most common mental illnesses in the United States. When caffeine overlaps with these disorders, the result can be trouble.
"If you tend to be a high-strung, anxious person," says Schmidt, "using a lot of caffeine can be risky."
Technically, caffeine works by blocking the depressant function of a chemical called adenosine, says Griffiths. For most of us, the result is a pleasurable sense of energy and focus. Indeed, a British study published in the October 1999 issue of Human Psychopharmacology confirmed what most latte-lovers already know: Caffeine enhances alertness, concentration, and memory.
Drink more coffee than you're accustomed to, however, and that same stimulant can cause the jitters. And in people predisposed to anxiety disorders, caffeine can trigger a spiral of sensations -- sweaty palms, a pounding heart, ringing in the ears -- that leads to a full-blown panic attack.
What makes some of us feel panic while others feel pleasantly alert? Susceptible people experience caffeine's effects as signs of impending doom. Once that happens, anxiety can take on a life of its own. While many give up coffee, others give up whatever they were doing when struck by caffeine's disturbing side effects. Someone who downs coffee at breakfast and then hops on the freeway to work, for example, may attribute feelings of panic to rush-hour traffic rather than to caffeine.
To help people with panic and related anxiety disorders, psychologists typically ask patients to taper their caffeine use while they learn how to respond appropriately to their own physiological reactions. At the Center for Stress and Anxiety Disorders in Albany, N.Y., psychologist John Forsyth, PhD, uses an approach known as cognitive-behavioral therapy. Gradually, patients learn to interpret their symptoms. A fast-beating heart, they discover, is the body's normal reaction to a stimulant like caffeine -- not a sign of an impending heart attack.
But not all psychologists think that avoiding caffeine is a long-term cure. Norman Schmidt, an associate professor of psychology at Ohio State University, is one who actually prescribes coffee as part of treatment. The goal? To help patients confront their fears head-on and learn to distinguish unfounded panic from a real threat.
After teaching patients to recognize caffeine's effects, Schmidt has them desensitize themselves by gradually increasing their consumption of caffeine over the course of a month or two. Patients start with sips of soda, then work up to a cup of coffee.
The final exam? A strong cup of coffee spiked with No-Doz. "They don't feel great, but they learn they can have these feelings and nothing terrible happens," says Schmidt. "We could tell them that over and over again, but they've got to know it in their gut."
If patients ending treatment announce they still don't intend to drink coffee, Schmidt knows they haven't overcome their unfounded fear. So there's one more test they must pass. He tells them to down a triple espresso without triggering a panic attack.
Says Schmidt: "We call it the 'Starbucks challenge.' "
Rebecca A. Clay is a writer based in Washington, D.C., whose articles have also appeared in Psychology Today, Modern Maturity, and The Washington Post.
Originally published July 10, 2000.
Updated and medically reviewed on March 22, 2002.