Should You Use Caffeine to Treat Your ADHD?

Harvesting coffee beans

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Many people want to avoid medication for ADHD. Some turn to a natural alternative—caffeine—and they may have some success with it. But is using caffeine for ADHD any different from using a medication?

First, let’s consider what a medication is. A medication is defined by the National Cancer Institute as a substance "used to prevent, diagnose, treat, or relieve symptoms of a disease or abnormal condition."¹ Medications contain "one or more active and/or inactive ingredients" and come in the form of tablets, capsules, liquids, creams, or patches.

In our opinion, with its effects on tiredness, mood, memory, alertness, and physical and cognitive performance, caffeine could fit this definition. That makes caffeine the world’s most common stimulant medication.

Caffeine's History

Caffeine has a long history. It probably has been used for nearly 3,000 years for this purpose. Its use in China, as an ingredient in tea, has been documented as far back as 900-207 BC. Coffee was reportedly discovered around 300-800 AD by a herder who noticed his goats became livelier after munching the berries. People then learned to dry the fruit and make it into a beverage that helped them stay awake. It was commercialized in the 14th century and came into widespread use in Europe by the 17th century. The word "caffeine" is derived from the Arabic word "qahweh" which means coffee. Today our primary sources of caffeine are coffee beans (Caffea arabica), kola nuts (Cola acuminata), tea (Thea sinensis), and chocolate (the cocoa bean).

People ingest caffeine in coffee (which varies, but averages about 100-200 mg per cup) as well as tea (approximately 50-75 mg), and soft drinks (30-50 mg), and there is about 20 mg/ounce in dark chocolate. In energy drinks, the amount of caffeine ranges from about 150-200 mg per can. The response of individual people to caffeine differs in large part because of variations in how fast the liver metabolizes it. The slower it is metabolized, the longer it stays in your body and the stronger it may feel. Typically, it is strongest for the first two hours, but in some people, the effects (and side effects) can last all day.

Caffeine does increase dopamine release in the brain, but in a different way than the stimulants prescribed for ADHD. The stimulants directly block reuptake and increase the release of the neurotransmitters dopamine and norepinephrine at synapses, with consequent benefits on focus and attention. In contrast, caffeine competes for and blocks adenosine receptors. Adenosine receptors normally increase drowsiness, so blocking them directly increases wakefulness and alertness. Blocking adenosine receptors only secondarily increases dopamine and norepinephrine in the central nervous system. So, although caffeine may end up increasing dopamine and norepinephrine release in the brain, those are downstream effects with differing degrees of effectiveness on attention and focus in different people.

Benefits and Negatives

When considering taking a medication for a condition, it is important to always consider both the benefits and negative side effects. There are benefits to caffeine use. Multiple studies have shown it increases mental and physical endurance performance. Caffeine can enhance performance on some types of cognitive tasks and boost some aspects of mood. Caffeine causes increased cortical activation, increased sensitivity (the rate at which information is accumulated), and increased speed and accuracy of target selection. As stated above, it directly helps increase wakefulness. But it does not help you remember things long term. If you are already sleep-deprived, it does help you feel more awake and think better temporarily—but it doesn’t help with this as much as getting more sleep does, certainly not in the long term.

And what are the side effects of caffeine? Of course, it causes worse sleep in many people. It also causes increased heart rate and blood pressure at levels comparable to some prescription stimulants. Most people who drink caffeine have experienced the “caffeine jitters” from consuming too much too quickly—meaning increased edginess, irritability, and anxiety. Some studies have shown worse behavior in kids and adolescents who have consumed caffeine. Caffeine can also cause physical issues: headache (either from caffeine or, more commonly, from caffeine withdrawal) and diarrhea, nausea, and vomiting. Finally, caffeine is extremely addictive. Just ask anybody who takes both coffee and a prescription stimulant every morning which one is easier to give up, and they’ll tell you in no uncertain terms: “You take my coffee away from me—out of my cold dead hands!”

So, putting this all together: Caffeine and ADHD stimulant medications both have benefits for alertness and attention, as well as negative side effects: on heart rate, blood pressure, "jitters," and negative effects of sleep, as well as addiction potential.

If they are so similar, then why not use caffeine instead of a stimulant medication? The main reason is that stimulant medications are more specific for the benefits in your brain relevant to treating ADHD. They work better for increasing attention than caffeine. To get the same benefit for attention and focus from caffeine as you get from a stimulant, you would have to take a lot more caffeine—and get all the negative side effects with it, like increased jitteriness, edginess, anxiety, and sleeplessness—side effects that directly counteract the benefits of taking a drug for ADHD.

Of course, in the real world, a lot of people with ADHD take both. They have their coffee along with their stimulant medication every morning. Sometimes people doing this experience more side effects as a result. We always advise patients starting a stimulant medication for the first time that they should cut back on their caffeine intake at least until they are familiar with the side effects. Similarly, if you are on stimulant medications along with caffeine, and need more benefits for your attention, adding more stimulant medication is likely to be a far better choice for your ADHD than adding another shot to your espresso.