Caffeine dependence

Caffeine dependence is the condition of having a substance dependence on caffeine, a commonplace central nervous system stimulant drug which occurs naturally in coffee, tea, yerba mate, cocoa, and other plants. Caffeine is one of the most common additives in many consumer products, including pills and beverages such as caffeinated alcoholic beverages, energy drinks, and colas. Studies have found that 89 percent of adults in the U.S. consume on average 200 mg of caffeine daily.[1] Cultural influence is a large factor in deciding how and what way caffeine is used. For example, in African, Asian and Pacific countries, tea is the most popular form of caffeine, while in Europe and North America, coffee is the mainstream choice.[2]

See also: Caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeinism
Caffeine dependence
Other namesCaffeine addiction
Molecular structure of caffeine
Molecular structure of caffeine
SpecialtyPsychiatry

The Diagnostic and Statistical Manual of Mental Disorders describes four caffeine-related disorders including intoxication, withdrawal, anxiety, and sleep.[3]

Dependence
See also: Caffeine § Dependence and withdrawal

Mild physical dependence can result from long-term caffeine use.[4] In the human body, caffeine blocks adenosine receptors A1 and A2A.[5] Adenosine is a by-product of cellular activity, the stimulation of adenosine receptors produces feelings of tiredness and the need to sleep. Caffeine's ability to block these receptors means the levels of the body's natural stimulants, dopamine, and norepinephrine, continue at higher levels.

Continued exposure to caffeine leads the body to create more adenosine-receptors in the central nervous system, which makes it more sensitive to the effects of adenosine. This reduces the stimulatory effects of caffeine by increasing tolerance. It also causes the body to suffer withdrawal symptoms (such as headaches, fatigue, and irritability) if caffeine intake decreases.[6]

Addiction vs. dependence

Caffeine use is classified as a dependence, not an addiction. For a drug to be considered addictive, it must activate the brain's reward circuit. Caffeine, like addictive drugs, enhances dopamine signaling in the brain (is eugeroic), but not enough to activate the brain's reward circuit like addictive substances such as cocaine, morphine, and nicotine.[7] Caffeine dependence forms due to caffeine antagonizing the adenosine A2A receptor,[8] effectively blocking adenosine from the adenosine receptor site. This delays the onset of drowsiness and releases dopamine.[9] As of right now, caffeine withdrawal qualifies as a psychiatric condition by the American Psychiatric Association, but caffeine-use disorder does not.[2]

Professor Roland R. Griffiths, a professor of neurology at Johns Hopkins in Baltimore, strongly believes that caffeine withdrawal should be classified as a psychological disorder.[10] His research suggests that withdrawal affects 50% of habitual coffee drinkers, beginning within 12–24 hours after cessation of caffeine intake, and peaking in 20–48 hours, lasting as long as 9 days.[11][12] In another study, he concluded that people who take in a minimum of 100 mg of caffeine per day (about the amount in one cup of coffee) can acquire a physical dependence that would trigger withdrawal symptoms, including muscle pain and stiffness, nausea, vomiting, and depressed mood.[10][13]

Physiological effects

Caffeine dependence can cause a person to suffer different physiological effects if caffeine consumption is not maintained. Commonly known caffeine withdrawal symptoms include headaches, fatigue, loss of focus, lack of motivation, mood swings, nausea, insomnia, dizziness, cardiac issues, hypertension, anxiety, and backache and joint pain; these can range in severity from mild to severe.[14] These symptoms may occur within 12–24 hours and can last well up to two to nine days.[15][16][17]

Tests are still being done to get a better understanding of the effects that occur to people when they become dependent on different forms of caffeine to make it through the day. There has been research findings that suggest that the circadian cycle is not significantly changed under popular practices of caffeine consumption in the morning and during the afternoon.[18]

Pregnancy

If pregnant, it is recommended not to consume over 200 mg of caffeine a day (though relative to the physical of the person).[19] If a pregnant female consumes high levels of caffeine, it can result in low birth weights due to loss of blood flow to the placenta[20] which could lead to an increase in health problems later in that child's life.[21] It can also result in premature labor, reduced fertility, and other reproductive issues. The American Pregnancy Association suggests "avoiding caffeine as much as possible" before and during pregnancy or discussing how to curtail dependency with a healthcare provider.[22]

Children and teenagers

According to the American Academy of Pediatrics (AAP), it is not recommended for individuals under the age of 18 to consume several caffeinated drinks in one day. If they were to consume caffeine, it is recommended to follow some guidelines, so they do not consume too much throughout the day.[23] Such guidelines are commonly lacking in actual strategies to incorporate into daily life.[2] If they do not follow, they can become dependent on caffeine and without it can suffer many different side effects. These include increase of heart rate and blood pressure, sleep disturbance, mood swings, and acidic problems. Long lasting problems on children's nervous system and cardiovascular system are currently unknown, and studies are still being conducted on it. Some research has suggested that caffeinated drinks should not focus on children as their target audience or to be consumed by children.[24][25]

References
  1. Fulgoni, Victor L; Keast, Debra R; Lieberman, Harris R (2015-05-01). "Trends in intake and sources of caffeine in the diets of US adults: 2001–2010". The American Journal of Clinical Nutrition. 101 (5): 1081–1087. doi:10.3945/ajcn.113.080077. ISSN 0002-9165. PMID 25832334. S2CID 22251069.
  2. Rodda, Simone; Booth, Natalia; McKean, Jessica; Chung, Anita; Park, Jennifer Jiyun; Ware, Paul (2020-07-01). "Mechanisms for the reduction of caffeine consumption: What, how and why". Drug and Alcohol Dependence. 212: 108024. doi:10.1016/j.drugalcdep.2020.108024. ISSN 0376-8716. PMID 32442750. S2CID 218859858.
  3. Addicott, Merideth A. (2014). "Caffeine Use Disorder: A Review of the Evidence and Future Implications". Current Addiction Reports. 1 (3): 186–192. doi:10.1007/s40429-014-0024-9. PMC 4115451. PMID 25089257.
  4. Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. p. 375. ISBN 9780071481274. Long-term caffeine use can lead to mild physical dependence. A withdrawal syndrome characterized by drowsiness, irritability, and headache typically lasts no longer than a day. True compulsive use of caffeine has been documented.
  5. Fisone, G, Borgkvist A, Usiello A (2004):  Caffeine as a psychomotor stimulant:  Mechanism of Action. Cellular and Molecular Life Sciences 61:857-872
  6. Stroh, Michael. "Just one cup a day is enough to hook coffee drinkers". LA Times. Retrieved 15 August 2023.
  7. Volkow, N D; Wang, G-J; Logan, J; Alexoff, D; Fowler, J S; Thanos, P K; Wong, C; Casado, V; Ferre, S; Tomasi, D (April 2015). "Caffeine increases striatal dopamine D2/D3 receptor availability in the human brain". Translational Psychiatry. 5 (4): e549–. doi:10.1038/tp.2015.46. PMC 4462609. PMID 25871974.
  8. Froestl, Wolfgang; Muhs, Andreas; Pfeifer, Andrea (14 November 2012). "Cognitive Enhancers (Nootropics). Part 1: Drugs Interacting with Receptors". Journal of Alzheimer's Disease. 32 (4): 793–887. doi:10.3233/JAD-2012-121186. PMID 22886028. S2CID 10511507.
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  10. Studeville, George (January 15, 2010). "Caffeine Addiction Is a Mental Disorder, Doctors Say". National Geographic. Archived from the original on 2005-01-22.
  11. Hall, Harriet (5 February 2019). "Caffeine Withdrawal Headaches". Science-Based Medicine. Retrieved May 30, 2019.
  12. Juliano, L. M.; Griffiths, R. R. (2004). "A critical review of caffeine withdrawal: Empirical validation of symptoms and signs, incidence, severity, and associated features". Psychopharmacology. 176 (1): 1–29. doi:10.1007/s00213-004-2000-x. PMID 15448977. S2CID 5572188.
  13. Stroh, Michael. "Just one cup a day is enough to hook coffee drinkers". LA Times. Retrieved 15 August 2023.
  14. Temple, Jennifer L.; Bernard, Christophe; Lipshultz, Steven E.; Czachor, Jason D.; Westphal, Joslyn A.; Mestre, Miriam A. (2017-05-26). "The Safety of Ingested Caffeine: A Comprehensive Review". Frontiers in Psychiatry. 8: 80. doi:10.3389/fpsyt.2017.00080. ISSN 1664-0640. PMC 5445139. PMID 28603504.
  15. Juliano, Laura M.; Huntley, Edward D.; Harrell, Paul T.; Westerman, Ashley T. (2012-08-01). "Development of the Caffeine Withdrawal Symptom Questionnaire: Caffeine withdrawal symptoms cluster into 7 factors". Drug and Alcohol Dependence. 124 (3): 229–234. doi:10.1016/j.drugalcdep.2012.01.009. ISSN 0376-8716. PMID 22341956.
  16. Meredith, Steven E.; Juliano, Laura M.; Hughes, John R.; Griffiths, Roland R. (September 2013). "Caffeine Use Disorder: A Comprehensive Review and Research Agenda". Journal of Caffeine Research. 3 (3): 114–130. doi:10.1089/jcr.2013.0016. ISSN 2156-5783. PMC 3777290. PMID 24761279.
  17. "Caffeine Calculator". Roaster Coffees. Retrieved 2022-07-11.
  18. Weibel, Janine; Lin, Yu-Shiuan; Landolt, Hans-Peter; Garbazza, Corrado; Kolodyazhniy, Vitaliy; Kistler, Joshua; Rehm, Sophia; Rentsch, Katharina; Borgwardt, Stefan; Cajochen, Christian; Reichert, Carolin Franziska (2020-04-20). "Caffeine-dependent changes of sleep-wake regulation: Evidence for adaptation after repeated intake". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 99: 109851. doi:10.1016/j.pnpbp.2019.109851. ISSN 0278-5846. PMID 31866308.
  19. American College of Obstetricians and Gynecologists (August 2010). "ACOG CommitteeOpinion No. 462: Moderate caffeine consumption during pregnancy". Obstetrics and Gynecology. 116 (2 Pt 1): 467–8. doi:10.1097/AOG.0b013e3181eeb2a1. PMID 20664420.
  20. Sajadi-Ernazarova, Karima R.; Anderson, Jackie; Dhakal, Aayush; Hamilton, Richard J. (2020), "Caffeine Withdrawal", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 28613541, retrieved 2020-11-06
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  22. "Caffeine Intake During Pregnancy". American Pregnancy Association. 2016-04-27. Retrieved 2020-11-06.
  23. Branum, Amy M.; Rossen, Lauren M.; Schoendorf, Kenneth C. (March 1, 2014). "Trends in Caffeine Intake Among US Children and Adolescents". Pediatrics. 133 (3): 386–393. doi:10.1542/peds.2013-2877. ISSN 0031-4005. PMC 4736736. PMID 24515508.
  24. Higgins, John P.; Babu, Kavita; Deuster, Patricia A.; Shearer, Jane (February 2018). "Energy Drinks: A Contemporary Issues Paper". Current Sports Medicine Reports. 17 (2): 65–72. doi:10.1249/JSR.0000000000000454. ISSN 1537-890X. PMID 29420350. S2CID 46821793.
  25. McVay, Ellen (February 19, 2020). "Is Coffee Bad For Kids?". Retrieved November 5, 2020.
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