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Caffeine and Bipolar: Do they mix?

| Indira Bulhan

Blog Post: 4


Caffeine is a part of a daily ritual for many. While it is treated like any other drink which helps us to function, it is rarely questioned how it affects people who suffer from psychiatric disorders. This blog post aims to explore the effect of caffeine on those falling under the bipolar spectrum disorder (clinically diagnosed).
   Caffeine is taken on light terms in everyday usage so not enough research has gone into its relationship with bipolar spectrum disorder. However, few studies have shown how much of a significant impact it can have.  Maremmani et al. (2011) refer to caffeine as a “social drug”. Certain things which can affect bipolar spectrum patients are dosage, administration, intervals between consumption, the severity of effects and withdrawal symptoms.
   According to DSM-5, bipolar spectrum disorder consists of bipolar I disorder, bipolar II disorder, cyclothymic disorder and other specified or unspecified bipolar related disorder (NIMH, 2016). Generally, periods of manic state (up) and depressive state (low) are observed which can be noticed by changes in sleep pattern, appetite, the energy level of the person, mood and occurrence of unusual behavior.
   Some symptoms of manic state can include restlessness, impulsiveness, reduced sleep, excitement, and irritability. While caffeine in fewer amounts can help to maintain a decent amount of energy, a dosage of over 250mg can result in intoxication, often termed as “caffeinism” (Mermi et al., 2015). Some symptoms of caffeine intoxication are irritableness, malfunction in the gastrointestinal system, psychomotor agitation, excitement and disturbances in sleep pattern. According to the study conducted by Merni et al. (2015), the prevalence of caffeine intoxication was seen more in psychiatric patients. Comparing the symptoms of the manic state of the bipolar spectrum and that of caffeine intoxication, it can be said that caffeine intoxication worsens or negatively impacts patients of bipolar spectrum disorder. Moreover, higher doses of caffeine further give rise to panic like symptoms which may worsen a manic episode or create problems.
   Now, looking at the depressive state of the bipolar spectrum, some signs which may show up are feelings of sadness or emptiness, insomnia or hypersomnia, fatigue, lack of interest, motivation and concentration, reduced energy level and death ideation (NIMH, 2016). While it can be argued that caffeine may help in relieving some symptoms like fatigue and hypersomnia, studies have shown that there exists a link between coffee consumption and suicide acts in bipolar patients (Baethge et al., 2009). Moreover, in the case of insomnia, caffeine may further disrupt with sleep pattern, causing exhaustion and fatigue.
   The biological process of how caffeine works might help us to understand its relationship with bipolar disorder. Caffeine produces neuropsychological effects by blocking adenosine receptors (A1 & A2). There exists a connection between these receptors and the dopaminergic system. Caffeine, therefore, increases dopamine signaling in the brain (Volkow et al, 2015). It should be noted that antidopaminergic drugs have been used to treat acute manic episodes in bipolar patients (Ashok et al, 2017). This shines a light on the fact that increased dopamine can make manic episodes worse or severe. Therefore, through the biological lens as well, it can be concluded that caffeine and bipolar disorder share a negative relationship.
   One interesting question which can also rise is the possibility of relapse of an episode due to caffeine consumption. When talking about the association of caffeine with bipolar spectrum disorder, it is important to take into account the chances of relapse. Rizkallah et al (2011), conducted a study on energy drinks (which contained caffeine) and relapse among abstinent substance use disorder patients with bipolar spectrum disorder acting comorbidly. The results showed that a relapse of symptoms of depressive and manic episodes after binge drinking energy drinks. This shows that not only caffeine can affect someone already suffering from bipolar spectrum disorder but can also lead to relapse if not taken in controlled amounts.
   To conclude, with reference to the title of the blog post, caffeine and don’t mix well. While fewer amounts may not have severe effects, caffeine intoxication can worsen the situation of bipolar patients. Therefore, it is essential to spread awareness about a substance which is so commonly used in society. More research in the area may prove to be beneficial along with some healthy alternatives.


Citation
 Mermi, O., KILIÇ, F., GÜROK, M. G., YILMAZ, S., BAYKARA, S., CANAN, F., . . .  KULOĞLU, M. (2015). Habitual caffeine use in psychiatric patients: Relationship with sleep quality and symptom severity. Anatolian Journal of Psychiatry,17, 26-32. doi:10.5455/apd.173655


Baethge, C. , Tondo, L. , Lepri, B. and Baldessarini, R. J. (2009), Coffee and cigarette use: association with suicidal acts in 352 Sardinian bipolar disorder patients. Bipolar Disorders, 11: 494-503. doi:10.1111/j.1399-5618.2009.00727.x

Rizkallah, É. , Bélanger, M. , Stavro, K. , Dussault, M. , Pampoulova, T. , Chiasson, J. and Potvin, S. (2011), Could the use of energy drinks induce manic or depressive relapse among abstinent substance use disorder patients with comorbid bipolar spectrum disorder?. Bipolar Disorders, 13: 578-580. doi:10.1111/j.1399-5618.2011.00951.x

Icro Maremmani, Giulio Perugi, Luca Rovai, Angelo Giovanni Icro Maremmani, Matteo Pacini,… S. Akiskal. (2011). Are “social drugs” (tobacco, coffee and chocolate) related to the bipolar spectrum?. Journal of Affective Disorders. 133(1–2): 227-233. https://doi.org/10.1016/j.jad.2011.04.019. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0165032711001868

Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5. International journal of bipolar disorders, 1, 14. doi:10.1186/2194-7511-1-14

Volkow, N. D., Wang, G. J., Logan, J., Alexoff, D., Fowler, J. S., Thanos, P. K., … Tomasi, D. (2015). Caffeine increases striatal dopamine D2/D3 receptor availability in the human brain. Translational psychiatry, 5(4), e549. doi:10.1038/tp.2015.46

Ashok, A. H., Marques, T. R., Jauhar, S., Nour, M. M., Goodwin, G. M., Young, A. H., & Howes, O. D. (2017). The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Molecular psychiatry, 22(5), 666–679. doi:10.1038/mp.2017.16

Kiselev, B. M., Shebak, S. S., & Milam, T. R. (2015). Manic Episode Following Ingestion of Caffeine Pills: A Case Report. The primary care companion for CNS disorders, 17(3), 10.4088/PCC.14l01764. doi:10.4088/PCC.14l01764

 NIMH. (2016). Bipolar Disorder. Retrieved from https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml

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