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Crazy for Coffee

Research shows that the unpleasant effects of caffeine withdrawal may be serious enough to qualify as an official psychiatric disorder.

Should a slip in the daily routine prevent you from quaffing your "cup of ambition," you probably don't need a caffeine researcher to tell you what will happen next—you will start to feel sick. In a case of science proving what anyone who has skipped their morning coffee ritual knows, researchers declared that withdrawal from caffeine (the world's most popular stimulant) constitutes an official disorder.

A Johns Hopkins Medical School study that reviewed over 170 years of research concluded that caffeine withdrawal is a verifiable syndrome, wherein at least half of regular caffeine users will experience withdrawal if denied their habitual dose. Even those who drink as little as one cup a day are at risk of experiencing withdrawal symptoms including headaches, fatigue, difficulty concentrating, depression and irritability, or even flu-like nausea and muscle pain.

As a result of the research review, "caffeine withdrawal" will likely be included in the next edition of the DSM, or Diagnostic and Statistical Manual of Mental Disorders—the bible of psychiatric disorders. While some have argued that the DSM pathologizes normal human predicaments, lead researcher Roland Griffiths, professor of psychiatry and neuroscience at Johns Hopkins, says the disorder's inclusion in the DSM will help physicians and psychologists to be more sensitive to the cause and presence of these sometimes debilitating symptoms.

Caffeine withdrawal unleashes such wide-ranging aches and pains because it acts to prohibit a major neurotransmitter called adenosine. "Adenosine is responsible for a variety of activity in the central and peripheral nervous system," says Griffiths.

"All the effects of taking caffeine are opposite of the effects of adenosine." For example, while adenosine, which depresses the nervous system, dilates the blood vessels in the head, caffeine restricts them. Withdrawal from caffeine reverses the effect with a vengeance, increasing normal blood flow through vessels, and causing a pounding headache.

As with any addictive substance, there is a reason we get hooked on caffeine in the first place. While coffee's rich aroma stimulates the senses, its caffeine revs up the brain and boosts alertness and mood.

"Caffeine is a mild stimulant," says Griffiths, "and particularly for people who don't use it regularly, it's a wonderful drug for combating fatigue and restoring mental performance. It also enhances exercise endurance." Once caffeine hits the bloodstream, the mind is quicker and memory improves.

But while coffee addicts fervently attest to caffeine's benefits, and claim they can't talk to their coworkers or turn on their computer without it, as their tolerance to the stuff increases, they mistake benefits they feel. For them the stimulatory effects have more to do with avoiding the bad effects of withdrawal, says Griffiths. "There are great benefits if you're not a regular user, but the effect that daily users attribute to caffeine is really reversal of withdrawal symptoms."

Despite having christened a new disorder, Griffiths doesn't believe everybody needs to quit caffeine consumption. "There is nothing wrong with being physically dependent on caffeine, unless the person has a condition that is worsened by caffeine, such as anxiety, insomnia, panic, and heart problems, or if they are pregnant," he says.

In fact, coffee's pros probably outweigh its cons. The Harvard Women's Health Watch reviewed the various effects of coffee on the body, and judged the drink to be beneficial, when sipped in moderation. Regular coffee drinkers show a decreased risk of type 2 diabetes, gallstones and colon cancer. And they show improved cognitive function and are less likely to develop Parkinson's disease.

For those who do want to quit without bringing on the wrath of caffeine withdrawal, Griffith recommends that junkies first take a careful inventory of exactly how much caffeinated foods and drinks they consume, and then gradually replace those with decaffeinated versions, over a period of a few weeks or a month. And for coffee adherents who find the line at Starbucks prohibitively long, you may soon be able to ask for a note from your doctor excusing you from the day ahead.