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href="#Antagonism_of_adenosine_receptors"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Antagonism of adenosine receptors</span> </div> </a> <ul id="toc-Antagonism_of_adenosine_receptors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_actions_of_caffeine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_actions_of_caffeine"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Other actions of caffeine</span> </div> </a> <ul id="toc-Other_actions_of_caffeine-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Genetics_and_variability_of_caffeine_consumption" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Genetics_and_variability_of_caffeine_consumption"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Genetics and variability of caffeine consumption</span> </div> 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</div> </div> <div class="vector-column-end"> <div class="vector-sticky-pinned-container"> <nav class="vector-page-tools-landmark" aria-label="Page tools"> <div id="vector-page-tools-pinned-container" class="vector-pinned-container"> </div> </nav> <nav class="vector-appearance-landmark" aria-label="Appearance"> <div id="vector-appearance-pinned-container" class="vector-pinned-container"> <div id="vector-appearance" class="vector-appearance vector-pinnable-element"> <div class="vector-pinnable-header vector-appearance-pinnable-header vector-pinnable-header-pinned" data-feature-name="appearance-pinned" data-pinnable-element-id="vector-appearance" data-pinned-container-id="vector-appearance-pinned-container" data-unpinned-container-id="vector-appearance-unpinned-container" > <div class="vector-pinnable-header-label">Appearance</div> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-pin-button" data-event-name="pinnable-header.vector-appearance.pin">move to sidebar</button> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-unpin-button" data-event-name="pinnable-header.vector-appearance.unpin">hide</button> </div> </div> </div> </nav> </div> </div> <div id="bodyContent" class="vector-body" aria-labelledby="firstHeading" data-mw-ve-target-container> <div class="vector-body-before-content"> <div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Subclass of substance/medication-induced anxiety disorder</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Caffeine-induced_psychosis" title="Caffeine-induced psychosis">Caffeine-induced psychosis</a>, <a href="/wiki/Caffeine-induced_sleep_disorder" title="Caffeine-induced sleep disorder">caffeine-induced sleep disorder</a>, <a href="/wiki/Caffeine_dependence" title="Caffeine dependence">caffeine dependence</a>, and <a href="/wiki/Caffeinism" title="Caffeinism">caffeinism</a></div> <p><b>Caffeine-induced anxiety disorder</b> is a subclass of the <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> diagnosis of substance/medication-induced anxiety disorder.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Consumption of <a href="/wiki/Caffeine" title="Caffeine">caffeine</a> has long been linked to anxiety.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The effects of caffeine and the symptoms of anxiety both increase activity within the <a href="/wiki/Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a>. Caffeine has been linked to the aggravation and maintenance of anxiety disorders, and the initiation of panic or anxiety attacks in those who are already predisposed to such phenomena.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Caffeine usage surpassing 400 mg has been shown to increase the likelihood for anxiety and panic attacks in a population. Individuals with panic attack disorder have a higher risk of developing a panic attack when consuming caffeine than when they do not.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Excessive amounts of caffeine can result in symptoms from general anxiety to obsessive-compulsive and phobic symptoms. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="DSM-5_classification">DSM-5 classification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=1" title="Edit section: DSM-5 classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Diagnostic_criteria">Diagnostic criteria</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=2" title="Edit section: Diagnostic criteria"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Caffeine-induced anxiety disorder is a subclass of the <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> diagnosis of substance/medication-induced anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, is the current authority for psychiatric diagnosis in the United States. Substance/medication-induced anxiety disorder falls under the category of <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a> in the DSM-5, and not the category of substance-related and addictive disorders, even though the symptoms are due to the effects of a substance.<sup id="cite_ref-DSM5_5-0" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Diagnosis according to the DSM-5 is dependent on various criteria. Patients must present symptoms of either panic attacks or anxiety. There must also be evidence that the panic or anxiety symptoms are a direct result of the use of the intoxicating substance. In caffeine-induced anxiety disorder, such symptoms would be due to the consumption of caffeine. The DSM-5 makes the distinction that the substance must be physiologically capable of leading to the anxiety and panic symptoms. This establishes the relationship between the abused chemical agent and the observed clinical effects. Caffeine has been proven to act as an antagonist on <a href="/wiki/Adenosine" title="Adenosine">adenosine</a> receptors, which acts as a stimulant and therefore fulfills this criterion. Symptoms must also not have a more likely clinical cause, such as another type of anxiety disorder, come before the ingestion of the intoxicating substance, or last for an extended amount of time after stopping the use of the substance. Diagnosis also requires that the panic attacks or anxiety due to the use of the intoxicating substance cause a certain amount of disturbance in the patient or lead to deficiency of varying types of daily performance.<sup id="cite_ref-DSM5_5-1" class="reference"><a href="#cite_note-DSM5-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Diagnostic_features">Diagnostic features</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=3" title="Edit section: Diagnostic features"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In addition to the criteria above, it is important to recognize that the diagnostic criteria for substance/medication-induced anxiety disorder are not met if the symptoms of panic come before the intoxication by the substance. In caffeine-induced anxiety disorder, a diagnosis will not be made if symptoms of anxiety or panic precede the ingestion of caffeine. Also, if symptoms persist for more than one month after substance intoxication, the diagnosis cannot be made. Persistence and continuation of symptoms beyond the initial consumption of caffeine suggest an alternate diagnosis that would better explain the long-lasting symptoms. Anxiety symptoms caused by caffeine are often mistaken for serious mental disorders including <a href="/wiki/Bipolar_disorder" title="Bipolar disorder">bipolar disorder</a> and <a href="/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>, leaving patients medicated for the wrong issue.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> A caffeine-induced anxiety disorder diagnosis should be made, rather than a substance abuse or intoxication diagnosis, when symptoms of panic attacks or anxiety predominate.<sup id="cite_ref-:2_7-0" class="reference"><a href="#cite_note-:2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Prevalence">Prevalence</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=4" title="Edit section: Prevalence"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although exact rates of prevalence are not available, general population data shows a 0.002% prevalence over a year-long period and higher prevalence within clinical populations.<sup id="cite_ref-:2_7-1" class="reference"><a href="#cite_note-:2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Caffeine">Caffeine</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=5" title="Edit section: Caffeine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Koffein_-_Caffeine.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a1/Koffein_-_Caffeine.svg/180px-Koffein_-_Caffeine.svg.png" decoding="async" width="180" height="148" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a1/Koffein_-_Caffeine.svg/270px-Koffein_-_Caffeine.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a1/Koffein_-_Caffeine.svg/360px-Koffein_-_Caffeine.svg.png 2x" data-file-width="220" data-file-height="181" /></a><figcaption>Caffeine structure</figcaption></figure> <p>Caffeine is a <a href="/wiki/Xanthine" title="Xanthine">methylxanthine</a>, and is hydrophobic.<sup id="cite_ref-:3_8-0" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The structure of caffeine allows the molecule to pass freely through biological membranes including the <a href="/wiki/Blood%E2%80%93brain_barrier" title="Blood–brain barrier">blood-brain barrier</a>. Absorption in the gastrointestinal tract reaches near completion at about 99% after only 45 minutes. <a href="/wiki/Half-life" title="Half-life">Half-life</a> of caffeine for most adults is between 2.5 and 4.5 hours when consumption is limited to less than 10 mg/kg. However, during neonatal development, half-life for the fetus is significantly longer and decreases exponentially after birth to reach a normal rate at about 6 months.<sup id="cite_ref-:3_8-1" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cytochrome_P450" title="Cytochrome P450">Cytochrome P-450</a>, a <a href="/wiki/Hemeprotein" class="mw-redirect" title="Hemeprotein">hemeprotein</a>, acts in liver <a href="/wiki/Microsome" title="Microsome">microsomes</a> to metabolize caffeine into dimethylxanthines, monomethylxanthines, dimethyl uric acids, monomethyl uric acids, trimethylallantoin, dimethylallantoin, and derivatives of <a href="/wiki/Uracil" title="Uracil">uracil</a>. Most caffeine is metabolized by 3-methyl demethylation, forming the metabolite of <a href="/wiki/Paraxanthine" title="Paraxanthine">paraxanthine</a>. Many metabolites, in addition to caffeine, act within the body and are partly responsible for the physiological response to caffeine.<sup id="cite_ref-:3_8-2" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_caffeine_action">Mechanism of caffeine action</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=6" title="Edit section: Mechanism of caffeine action"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Caffeine acts in multiple ways within the brain and the rest of the body. However, due to the concentration of caffeine required, <a href="/wiki/Receptor_antagonist" title="Receptor antagonist">antagonism</a> of <a href="/wiki/Adenosine" title="Adenosine">adenosine</a> receptors is the primary mode of action.<sup id="cite_ref-NehligEtal1992_9-0" class="reference"><a href="#cite_note-NehligEtal1992-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The following mechanisms are ways in which caffeine may act within the body, but depending on necessary caffeine concentration and other factors may not be responsible for the clinical effects of the substance. </p> <div class="mw-heading mw-heading3"><h3 id="Mobilization_of_intracellular_calcium">Mobilization of intracellular calcium</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=7" title="Edit section: Mobilization of intracellular calcium"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>At very high concentrations of about 1–2 <a href="/wiki/Molar_concentration" title="Molar concentration">mM</a>, caffeine lowers the excitability threshold in muscle cells, leading to prolonged contraction. The introduction of such high doses of caffeine allows calcium to enter the muscle cell through the <a href="/wiki/Cell_membrane" title="Cell membrane">plasma membrane</a> and <a href="/wiki/Sarcoplasmic_reticulum" title="Sarcoplasmic reticulum">sarcoplasmic reticulum</a> more readily. Influx of calcium through the membranes in muscle cells requires at least 250 μM of caffeine. Normally, other toxic effects of caffeine begin to occur in concentrations over 200 μM, however average consumption averages lead to concentrations less than 100 μM. This means that calcium influx and mobilization are most likely not the cause of caffeine's effect on the central nervous system, and are therefore not the cause of caffeine-induced anxiety disorder.<sup id="cite_ref-NehligEtal1992_9-1" class="reference"><a href="#cite_note-NehligEtal1992-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Inhibition_of_phosphodiesterases">Inhibition of phosphodiesterases</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=8" title="Edit section: Inhibition of phosphodiesterases"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Methylxanthines such as caffeine inhibit the action of <a href="/wiki/Cyclic_nucleotide_phosphodiesterase" title="Cyclic nucleotide phosphodiesterase">cyclic nucleotide phosphodiesterase</a>, which normally acts to break down <a href="/wiki/Cyclic_adenosine_monophosphate" title="Cyclic adenosine monophosphate">cAMP</a>. Cyclic adenosine monophosphate, or cAMP, is a second messenger important in many cellular processes and is a critical factor in <a href="/wiki/Signal_transduction" title="Signal transduction">signal transduction</a>. The inhibition of the phosphodiesterase would lead to a buildup of cAMP, increasing the activity of the second messenger throughout the cell. Though this mechanism is possible, it only occurs after levels of caffeine have reached a toxic level, and therefore it is unlikely to explain the mechanism of caffeine in the brain.<sup id="cite_ref-NehligEtal1992_9-2" class="reference"><a href="#cite_note-NehligEtal1992-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Antagonism_of_adenosine_receptors">Antagonism of adenosine receptors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=9" title="Edit section: Antagonism of adenosine receptors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are four well-known <a href="/wiki/Adenosine_receptor" title="Adenosine receptor">adenosine receptors</a> found in the body, <a href="/wiki/Adenosine_receptor_A1" class="mw-redirect" title="Adenosine receptor A1">A<sub>1</sub></a>, <a href="/wiki/Adenosine_A2A_receptor" title="Adenosine A2A receptor">A<sub>2A</sub></a>, <a href="/wiki/Adenosine_A2B_receptor" title="Adenosine A2B receptor">A<sub>2B</sub></a>, and <a href="/wiki/Adenosine_A3_receptor" title="Adenosine A3 receptor">A<sub>3</sub></a>. The endogenous agonist for these receptors is <a href="/wiki/Adenosine" title="Adenosine">adenosine</a>, which is a <a href="/wiki/Purine" title="Purine">purine nucleoside</a> that is important for processes such as energy transfer in the form of <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">adenosine triphosphate</a> (ATP) and <a href="/wiki/Adenosine_monophosphate" title="Adenosine monophosphate">adenosine monophosphate</a> (AMP) and signal transduction in the form of <a href="/wiki/Cyclic_adenosine_monophosphate" title="Cyclic adenosine monophosphate">cyclic adenosine monophosphate</a> (cAMP). A<sub>2B</sub> and A<sub>3</sub> receptors require concentrations of caffeine that do not occur at normal physiological levels or with normal levels of caffeine consumption in order to be antagonized, and will therefore not be considered as a possible mechanism for caffeine-induced anxiety.<sup id="cite_ref-:3_8-3" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Caffeine acts as an antagonist of adenosine A<sub>1</sub> and A<sub>2A</sub> receptors. Adenosine is a normal <a href="/wiki/Neuromodulation" title="Neuromodulation">neuromodulator</a> that activates adenosine <a href="/wiki/G_protein%E2%80%93coupled_receptor" class="mw-redirect" title="G protein–coupled receptor">g-protein coupled receptors</a>. The actions of A<sub>1</sub> and A<sub>2A</sub> receptors oppose each other but are both inhibited by caffeine due to its function as an antagonist.<sup id="cite_ref-:3_8-4" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>A<sub>2A</sub> receptors are coupled to G<sub>s</sub> proteins which activate <a href="/wiki/Adenylyl_cyclase" title="Adenylyl cyclase">adenylate cyclase</a> and some <a href="/wiki/Voltage-dependent_calcium_channel" class="mw-redirect" title="Voltage-dependent calcium channel">voltage gated Ca<sup>2+</sup> channels</a>. A<sub>2A</sub> receptors are located in <a href="/wiki/Dopamine" title="Dopamine">dopamine</a> rich brain regions. A<sub>2A</sub> receptor mRNA was found in the same neurons as the dopamine receptor <a href="/wiki/Dopamine_receptor_D2" title="Dopamine receptor D2">D<sub>2</sub></a> within the <a href="/wiki/Striatum" title="Striatum">dorsal striatum</a>, <a href="/wiki/Nucleus_accumbens" title="Nucleus accumbens">nucleus accumbens</a> and <a href="/wiki/Olfactory_tubercle" title="Olfactory tubercle">tuberculum olfactorium</a>. A<sub>2A</sub> receptors are not found in neurons that express the dopamine receptor <a href="/wiki/Dopamine_receptor_D1" title="Dopamine receptor D1">D<sub>1</sub></a> receptors and <a href="/wiki/Substance_P" title="Substance P">Substance P</a>. Within the striatum, part of the basal ganglia, activation of A<sub>2A</sub> receptors by adenosine increases <a href="/wiki/Gamma-Aminobutyric_acid" class="mw-redirect" title="Gamma-Aminobutyric acid">GABA</a> release, an inhibitory neurotransmitter. When caffeine binds to the receptor, less inhibitory neurotransmitter is released, supporting caffeine's role as a central nervous system stimulant.<sup id="cite_ref-:3_8-5" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>A<sub>1</sub> receptors are paired with the G-proteins of <a href="/wiki/G_protein%E2%80%93coupled_receptor" class="mw-redirect" title="G protein–coupled receptor">G<sub>i-1</sub>, G<sub>i-2</sub>, G<sub>i-3</sub>, G<sub>o1</sub>, and G<sub>o2</sub></a>. The g-proteins of A<sub>1</sub> receptors continue to inhibit <a href="/wiki/Adenylyl_cyclase" title="Adenylyl cyclase">adenylate cyclase</a>, some <a href="/wiki/Voltage-dependent_calcium_channel" class="mw-redirect" title="Voltage-dependent calcium channel">voltage gated Ca<sup>2+</sup> channels</a>, and activate some <a href="/wiki/Potassium_channel" title="Potassium channel">K<sup>+</sup> channels</a>, and <a href="/wiki/Phospholipase_C" title="Phospholipase C">phospholipase C</a> and <a href="/wiki/Phospholipase_D" title="Phospholipase D">D</a>. A<sub>1</sub> receptors are primarily located in the <a href="/wiki/Hippocampus" title="Hippocampus">hippocampus</a>, <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral</a> and <a href="/wiki/Cerebellum" title="Cerebellum">cerebellar cortex</a>, and particular <a href="/wiki/Thalamus" title="Thalamus">thalamic nuclei</a>. Adenosine acts on A<sub>1</sub> receptors to decrease opening of <a href="/wiki/N-type_calcium_channel" title="N-type calcium channel">N-type Ca<sup>2+</sup> channels</a> in some hippocampal neurons, and therefore decrease the rate of firing since Ca<sup>2+</sup> is necessary for neurotransmitter release. Caffeine's antagonistic action on the A<sub>1</sub> receptor thus decreases the action of adenosine, allowing increased Ca<sup>2+</sup> entry through N-type channels and higher rates of neurotransmitter release.<sup id="cite_ref-:3_8-6" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Other_actions_of_caffeine">Other actions of caffeine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=10" title="Edit section: Other actions of caffeine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Though antagonism of adenosine receptors is the primary mechanism of caffeine, Introduction of the methylxanthine into the body also increases the rate of release and recycling of some <a href="/wiki/Monoamine_neurotransmitter" title="Monoamine neurotransmitter">monoamine neurotransmitters</a> such as <a href="/wiki/Norepinephrine" title="Norepinephrine">noradrenaline</a> and <a href="/wiki/Dopamine" title="Dopamine">dopamine</a>. Caffeine also has an excitatory effect on <a href="/wiki/Cholinergic" title="Cholinergic">mesocortical cholinergic neurons</a> by acting as an antagonist on adenosine receptors that normally inhibit the neuron.<sup id="cite_ref-:3_8-7" class="reference"><a href="#cite_note-:3-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Genetics_and_variability_of_caffeine_consumption">Genetics and variability of caffeine consumption</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=11" title="Edit section: Genetics and variability of caffeine consumption"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>While many factors contribute to individual differences in a person's response to caffeine, such as environmental and demographic factors (i.e. age, drug use, circadian factors, etc.), genetics play an important role in individual variability. This inconsistency in responses to caffeine can take place either at the metabolic or at the drug-receptor level.<sup id="cite_ref-:2_7-2" class="reference"><a href="#cite_note-:2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The effects of genetic factors can occur either directly by changing acute or chronic reactions to the drug or indirectly by altering other psychological or physiological processes.<sup id="cite_ref-:2_7-3" class="reference"><a href="#cite_note-:2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Some of these processes include wakefulness, stimulation, and mood and cognition enhancement. Low doses can result in psychological effects of "mild euphoria, alertness, and enhanced cognitive performance";<sup id="cite_ref-:2_7-4" class="reference"><a href="#cite_note-:2-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> higher doses produce physiological side effects of nausea, anxiety, trembling, and jitteriness. </p><p>There are individuals who are prone to caffeine's anxiogenic effects whilst others are susceptible to its caffeine-induced sleep disturbances and <a href="/wiki/Insomnia" title="Insomnia">insomnia</a>. <a href="/wiki/Twin_study" title="Twin study">Studies with twins</a> have shown that genetics influence individual differences in response to caffeine. Homozygous twins have been found to react in more consistent ways to the caffeine than heterozygous twins.<sup id="cite_ref-NehligEtal1992_9-3" class="reference"><a href="#cite_note-NehligEtal1992-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Behavioral_effects">Behavioral effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=12" title="Edit section: Behavioral effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Caffeine's widespread appeal is due primarily to its mild psychostimulant properties, which increase alertness and cognitive arousal and diminish fatigue.<sup id="cite_ref-:0_10-0" class="reference"><a href="#cite_note-:0-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Caffeine also produces a wide range of other symptoms, including upregulation of the cardiovascular system, increased global cognitive processing, and improved physical functioning. Cardiovascular effects can range from increased heart rate and reactivity to severe cardiac arrhythmia.<sup id="cite_ref-:0_10-1" class="reference"><a href="#cite_note-:0-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The cognitive effects of caffeine include increased <a href="/w/index.php?title=Effects_of_caffeine_on_memory&action=edit&redlink=1" class="new" title="Effects of caffeine on memory (page does not exist)">performance in memory</a>, attention, and text reading.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> The physical effects of caffeine include lowered sensations of pain, less perceived effort, and increased muscle strength and endurance. However, at doses above ~400 mg, both cognitive and physical performance begins to worsen and symptoms of anxiety increase.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> One study that explored ad lib caffeine consumption in 159 college students found that high consumers reported lower academic performance. The same study also concluded that moderate and high consumers combined reported significantly higher trait anxiety and depression scores when compared with abstainers.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> These anxiety symptoms include persisting insomnia, nervousness, and mood fluctuations.<sup id="cite_ref-:0_10-2" class="reference"><a href="#cite_note-:0-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>When undergoing stress, the body activates a system-wide response mechanism known as the HPA axis. This stress signal begins at the level of the hypothalamus in the brain and undergoes subsequent amplifications throughout the body. This system elevates levels of stress hormones in the blood, which results in the body shutting down secondary bodily processes and increasing alertness to better prepare for response to the perceived threat.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Studies show that activation of this pathway is correlated with anxiety-like behaviors, including panic, post-traumatic stress, and generalized anxiety disorders,<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> as well as depression.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Rodent studies show that caffeine consumption in adolescence results in dysregulation of <a href="/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis" title="Hypothalamic–pituitary–adrenal axis">HPA axis</a> function as well as central nervous system response, which impairs the body's response to stressful stimuli.<sup id="cite_ref-:1_18-0" class="reference"><a href="#cite_note-:1-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>In cases of prolonged consumption of excess amounts of caffeine, studies show that individuals exhibit a reduced response to HPA axis activation by the hormone ACTH and a generalized increase in basal levels of stress hormone corticosterone. Researchers concluded that the sensitivity of adrenal glands to ACTH is diminished by caffeine consumption. People diagnosed with panic disorder show less HPA activity following stressful stimuli than their healthy control counterparts.<sup id="cite_ref-:1_18-1" class="reference"><a href="#cite_note-:1-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Susceptible_populations">Susceptible populations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=13" title="Edit section: Susceptible populations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Caffeine has varying effects on anxiety across given populations. The populations most susceptible to caffeine-induced anxiety disorder include those already diagnosed with an anxiety disorder and adolescents. Adolescents, particularly, are at increased risk for developing anxiety disorders and anxiety-related symptoms. While few human studies have been done to investigate this connection, many rodent studies show a correlation between caffeine consumption in adolescence and increased anxiety.<sup id="cite_ref-:1_18-2" class="reference"><a href="#cite_note-:1-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_19-0" class="reference"><a href="#cite_note-:4-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:5_20-0" class="reference"><a href="#cite_note-:5-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:6_21-0" class="reference"><a href="#cite_note-:6-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> These studies showed that in adolescent rodents exposed to caffeine, functioning of serotonin systems was affected, leading to increased anxiety;<sup id="cite_ref-:5_20-1" class="reference"><a href="#cite_note-:5-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> anxiety-related behaviors were higher than in adult rats exposed to the same amount of caffeine;<sup id="cite_ref-:6_21-1" class="reference"><a href="#cite_note-:6-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> and reward seeking behaviors as well as mood fluctuations were increased as the rodents matured.<sup id="cite_ref-:4_19-1" class="reference"><a href="#cite_note-:4-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Rats with high anxiety behavior when exposed to a high dose of caffeine decreased their risk taking as well as the expression of neurite growth signal BDNF in caudate putamen, compared to low anxiety behavior rats.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Long-term_health_effects">Long-term health effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=14" title="Edit section: Long-term health effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>When consumed in moderation, caffeine can have many beneficial effects. However, over the course of several years, chronic caffeine consumption can produce various long-term health deficits in individuals. Among these, rodent studies have suggested caffeine intake may permanently alter the brain's excitability.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=15" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For individuals being treated with <a href="/wiki/Benzodiazepines" class="mw-redirect" title="Benzodiazepines">benzodiazepines</a> such as <a href="/wiki/Alprazolam" title="Alprazolam">alprazolam</a> (Xanax) for <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a>, even small amounts of caffeine may have negative effects on treatment. Caffeine is able to negate the effects of benzodiazepines which can lead to heightened levels of anxiety and even panic attacks.<sup id="cite_ref-caffbenzo_24-0" class="reference"><a href="#cite_note-caffbenzo-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Studies have linked caffeine intake to increased rates of <a href="/wiki/Cytotoxicity" title="Cytotoxicity">cytotoxicity</a> and cell death by <a href="/wiki/Necrosis" title="Necrosis">necrosis</a> associated with benzodiazepine use.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> However, this phenomenon (thought to be mediated via <a href="/wiki/Translocator_protein" title="Translocator protein">TSPO</a>) is also present with benzodiazepine use alone. The clinical significance of caffeine-benzodiazepine induced cytotoxicity in humans is unclear and has not been shown to be harmful.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Although benzodiazepines are effective at managing acute caffeine-induced anxiety symptoms, avoiding caffeine is generally recommended rather than increasing benzodiazepine intake. Treatments for caffeine-induced anxiety disorder tend to focus on abstinence from or a reduction of caffeine intake and <a href="/wiki/Behaviour_therapy" title="Behaviour therapy">behavioral therapy</a>.<sup id="cite_ref-caffbenzo_24-1" class="reference"><a href="#cite_note-caffbenzo-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Some doctors may recommend a continuance of caffeine consumption but with the provision that the patient actively takes note of physiological changes that happen after caffeine intake. The goal of this approach is to help patients better understand the effects of caffeine on the body and to distinguish threatening symptoms from normal reactions.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Caffeine-induced_anxiety_disorder&action=edit&section=16" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output 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a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output 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substance use"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Psychoactive_substance_use" title="Special:EditPage/Template:Psychoactive substance use"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Psychoactive_substance-related_disorders301" style="font-size:114%;margin:0 4em"><a href="/wiki/Psychoactive_drug" title="Psychoactive drug">Psychoactive</a> <a href="/wiki/Substance-related_disorder" title="Substance-related disorder">substance-related disorders</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Substance-related_disorder#Substance-induced_disorders" title="Substance-related disorder">SID</a> <ul><li><a href="/wiki/Substance_intoxication" title="Substance intoxication">Substance intoxication</a> / <a href="/wiki/Drug_overdose" title="Drug overdose">Drug overdose</a></li> <li><a href="/wiki/Substance-induced_psychosis" title="Substance-induced psychosis">Substance-induced psychosis</a></li> <li><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">Withdrawal</a>: <ul><li><a href="/wiki/Neonatal_withdrawal" title="Neonatal withdrawal">Neonatal withdrawal</a></li> <li><a href="/wiki/Post-acute-withdrawal_syndrome" title="Post-acute-withdrawal syndrome">Post-acute-withdrawal syndrome</a> (PAWS)</li></ul></li></ul></li> <li><a href="/wiki/Substance_use_disorder" title="Substance use disorder">SUD</a> <ul><li><a href="/wiki/Substance_abuse" title="Substance abuse">Substance abuse</a> / <a href="/wiki/Substance-related_disorder" title="Substance-related disorder">Substance-related disorders</a></li> <li><a href="/wiki/Physical_dependence" title="Physical dependence">Physical dependence</a> / <a href="/wiki/Psychological_dependence" title="Psychological dependence">Psychological dependence</a> / <a href="/wiki/Substance_dependence" title="Substance dependence">Substance dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Combined<br />substance use</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SUD <ul><li><a href="/wiki/Polysubstance_dependence" title="Polysubstance dependence">Polysubstance dependence</a></li></ul></li> <li>SID <ul><li><a href="/wiki/Combined_drug_intoxication" title="Combined drug intoxication">Combined drug intoxication</a> (CDI)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">Alcohol</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">SID</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol_and_cardiovascular_disease" title="Alcohol and cardiovascular disease">Cardiovascular diseases</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_cardiomyopathy" title="Alcoholic cardiomyopathy">Alcoholic cardiomyopathy</a> (ACM)</li> <li><a href="/wiki/Alcohol_flush_reaction" title="Alcohol flush reaction">Alcohol flush reaction</a> (AFR)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_disease" title="Gastrointestinal disease">Gastrointestinal diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a> (ALD): <ul><li><a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a></li> <li><a href="/wiki/Zieve%27s_syndrome" title="Zieve's syndrome">Zieve's syndrome</a></li></ul></li> <li><a href="/wiki/Auto-brewery_syndrome" title="Auto-brewery syndrome">Auto-brewery syndrome</a> (ABS)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_disease" title="Endocrine disease">Endocrine diseases</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_ketoacidosis" title="Alcoholic ketoacidosis">Alcoholic ketoacidosis</a> (AKA)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nervous_system_disease" title="Nervous system disease">Nervous<br /> system diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol-related_dementia" title="Alcohol-related dementia">Alcohol-related dementia</a> (ARD)</li> <li><a href="/wiki/Alcohol_intoxication" title="Alcohol intoxication">Alcohol intoxication</a></li> <li><a href="/wiki/Hangover" title="Hangover">Hangover</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurological_disorder" title="Neurological disorder">Neurological<br /> disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_hallucinosis" title="Alcoholic hallucinosis">Alcoholic hallucinosis</a></li> <li><a href="/wiki/Alcoholic_polyneuropathy" title="Alcoholic polyneuropathy">Alcoholic polyneuropathy</a></li></ul> <ul><li><a href="/wiki/Alcohol-related_brain_damage" title="Alcohol-related brain damage">Alcohol-related brain damage</a> (ARDB)</li> <li><a href="/wiki/Alcohol_withdrawal_syndrome" title="Alcohol withdrawal syndrome">Alcohol withdrawal syndrome</a> (AWS): <ul><li><a href="/wiki/Alcoholic_hallucinosis" title="Alcoholic hallucinosis">Alcoholic hallucinosis</a></li> <li><a href="/wiki/Delirium_tremens" title="Delirium tremens">Delirium tremens</a> (DTs)</li></ul></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Fetal alcohol spectrum disorder</a> (FASD)</li> <li><a href="/wiki/Korsakoff_syndrome" title="Korsakoff syndrome">Korsakoff syndrome</a> (KS)</li> <li><a href="/wiki/Marchiafava%E2%80%93Bignami_disease" title="Marchiafava–Bignami disease">Marchiafava–Bignami disease</a> (MBD)</li> <li><a href="/wiki/Positional_alcohol_nystagmus" title="Positional alcohol nystagmus">Positional alcohol nystagmus</a> (PAN)</li> <li><a href="/wiki/Wernicke%E2%80%93Korsakoff_syndrome" title="Wernicke–Korsakoff syndrome">Wernicke–Korsakoff syndrome</a> (WKS)</li> <li><a href="/wiki/Wernicke_encephalopathy" title="Wernicke encephalopathy">Wernicke encephalopathy</a> (WE)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_disease" title="Respiratory disease">Respiratory tract diseases</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol-induced_respiratory_reactions" title="Alcohol-induced respiratory reactions">Alcohol-induced respiratory reactions</a></li> <li><a href="/wiki/Alcoholic_lung_disease" title="Alcoholic lung disease">Alcoholic lung disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">SUD</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a> (alcohol use disorder (AUD))</li> <li><a href="/wiki/Binge_drinking" title="Binge drinking">Binge drinking</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Caffeine" title="Caffeine">Caffeine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a class="mw-selflink selflink">Caffeine-induced anxiety disorder</a></li> <li><a href="/wiki/Caffeine-induced_psychosis" title="Caffeine-induced psychosis">Caffeine-induced psychosis</a></li> <li><a href="/wiki/Caffeine-induced_sleep_disorder" title="Caffeine-induced sleep disorder">Caffeine-induced sleep disorder</a></li> <li><a href="/wiki/Caffeinism" title="Caffeinism">Caffeinism</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Caffeine_dependence" title="Caffeine dependence">Caffeine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cannabis_(drug)" title="Cannabis (drug)">Cannabis</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/w/index.php?title=Cannabis_arteritis&action=edit&redlink=1" class="new" title="Cannabis arteritis (page does not exist)">Cannabis arteritis</a></li> <li><a href="/wiki/Cannabinoid_hyperemesis_syndrome" title="Cannabinoid hyperemesis syndrome">Cannabinoid hyperemesis syndrome</a> (CHS)</li> <li><a href="/wiki/Intravenous_marijuana_syndrome" title="Intravenous marijuana syndrome">Intravenous marijuana syndrome</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Amotivational_syndrome" title="Amotivational syndrome">Amotivational syndrome</a></li> <li><a href="/wiki/Cannabis_use_disorder" title="Cannabis use disorder">Cannabis use disorder</a> (CUD)</li> <li><a href="/w/index.php?title=Synthetic_cannabinoid_use_disorder&action=edit&redlink=1" class="new" title="Synthetic cannabinoid use disorder (page does not exist)">Synthetic cannabinoid use disorder</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Cocaine_intoxication" title="Cocaine intoxication">Cocaine intoxication</a></li> <li><a href="/wiki/Prenatal_cocaine_exposure" title="Prenatal cocaine exposure">Prenatal cocaine exposure</a> (PCE)</li> <li><a href="/wiki/Cocaine-induced_midline_destructive_lesions" title="Cocaine-induced midline destructive lesions">Cocaine-induced midline destructive lesions</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Cocaine_dependence" title="Cocaine dependence">Cocaine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hallucinogen" title="Hallucinogen">Hallucinogen</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Bad_trip" title="Bad trip">Acute intoxication from hallucinogens (bad trip)</a></li> <li><a href="/wiki/Hallucinogen_persisting_perception_disorder" title="Hallucinogen persisting perception disorder">Hallucinogen persisting perception disorder</a> (HPPD)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Nicotine" title="Nicotine">Nicotine</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Green_Tobacco_Sickness" title="Green Tobacco Sickness">Green Tobacco Sickness</a> (GTS)</li> <li><a href="/wiki/Nicotine_poisoning" title="Nicotine poisoning">Nicotine poisoning</a></li> <li><a href="/wiki/Nicotine_withdrawal" title="Nicotine withdrawal">Nicotine withdrawal</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Nicotine_dependence" title="Nicotine dependence">Nicotine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Opioid" title="Opioid">Opioids</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Opioid_overdose" title="Opioid overdose">Opioid overdose</a></li> <li><a href="/wiki/Opioid_withdrawal" title="Opioid withdrawal">Opioid withdrawal</a></li> <li><a href="/wiki/Opioid-induced_hyperalgesia" title="Opioid-induced hyperalgesia">Opioid-induced hyperalgesia</a> (OIH)</li> <li><a href="/wiki/Opioid-induced_endocrinopathy" title="Opioid-induced endocrinopathy">Opioid-induced endocrinopathy</a> (OIE)</li> <li><a href="/wiki/Opioid-induced_constipation" class="mw-redirect" title="Opioid-induced constipation">Opioid-induced constipation</a> (OIC)</li></ul></li> <li>SUD <ul><li><a href="/wiki/Opioid_use_disorder" title="Opioid use disorder">Opioid use disorder</a> (OUD)</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sedative" title="Sedative">Sedative</a> /<br /><a href="/wiki/Hypnotic" title="Hypnotic">hypnotic</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Kindling_(sedative%E2%80%93hypnotic_withdrawal)" title="Kindling (sedative–hypnotic withdrawal)">Kindling (sedative–hypnotic withdrawal)</a></li></ul></li> <li><i><a href="/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepine</a>:</i> SID <ul><li><a href="/wiki/Benzodiazepine_overdose" title="Benzodiazepine overdose">Benzodiazepine overdose</a></li> <li><a href="/wiki/Benzodiazepine_withdrawal_syndrome" title="Benzodiazepine withdrawal syndrome">Benzodiazepine withdrawal</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Benzodiazepine_use_disorder" title="Benzodiazepine use disorder">Benzodiazepine use disorder</a> (BUD)</li> <li><a href="/wiki/Benzodiazepine_dependence" title="Benzodiazepine dependence">Benzodiazepine dependence</a></li></ul></li> <li><i><a href="/wiki/Barbiturate" title="Barbiturate">barbiturate</a>:</i> SID <ul><li><a href="/wiki/Barbiturate_overdose" title="Barbiturate overdose">Barbiturate overdose</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Barbiturate_dependence" title="Barbiturate dependence">Barbiturate dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Stimulant_psychosis" title="Stimulant psychosis">Stimulant psychosis</a></li></ul></li> <li><i><a href="/wiki/Amphetamine" title="Amphetamine">amphetamine</a>:</i> SUD <ul><li><a href="/wiki/Amphetamine_dependence" title="Amphetamine dependence">Amphetamine dependence</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Solvent" title="Solvent">Volatile<br /> solvent</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>SID <ul><li><a href="/wiki/Sudden_sniffing_death_syndrome" class="mw-redirect" title="Sudden sniffing death syndrome">Sudden sniffing death syndrome</a> (SSDS)</li> <li><a href="/wiki/Toluene_toxicity" title="Toluene toxicity">Toluene toxicity</a></li></ul></li> <li>SUD <ul><li><a href="/wiki/Chronic_solvent-induced_encephalopathy" title="Chronic solvent-induced encephalopathy">Chronic solvent-induced encephalopathy</a></li> <li><a href="/wiki/Inhalant" title="Inhalant">Inhalant abuse</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Anabolic-androgenic_steroid" class="mw-redirect" title="Anabolic-androgenic steroid">Anabolic-androgenic steroids</a></i>: SUD <ul><li><a href="/wiki/Anabolic-androgenic_steroids_abuse" class="mw-redirect" title="Anabolic-androgenic steroids abuse">Anabolic-androgenic steroids abuse</a></li></ul></li> <li><a href="/wiki/Chocoholic" class="mw-redirect" title="Chocoholic">Chocolate</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?useformat=desktop&type=1x1&usesul3=0" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Caffeine-induced_anxiety_disorder&oldid=1255168994">https://en.wikipedia.org/w/index.php?title=Caffeine-induced_anxiety_disorder&oldid=1255168994</a>"</div></div> <div id="catlinks" class="catlinks" data-mw="interface"><div id="mw-normal-catlinks" class="mw-normal-catlinks"><a href="/wiki/Help:Category" title="Help:Category">Categories</a>: <ul><li><a href="/wiki/Category:Anxiety_disorders" title="Category:Anxiety disorders">Anxiety disorders</a></li><li><a href="/wiki/Category:Caffeine" title="Category:Caffeine">Caffeine</a></li></ul></div><div id="mw-hidden-catlinks" 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