THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 535-1 and 535-2

Week: 535.1 Guest: Dr. Eric Strain, Assoc. Prof. Psychiatry & Behavioral Science, Johns Hopkins School of Medicine Topic: Caffeine- effects on behavior, Part One Producer/Host: Steve Girard

NEMA: Caffeine is one of those substances that's been in our diets for a long time...but still, researchers continue to be baffled by just what long term effects it has on our physiology....should we avoid it totally? How much is too much? Well, today we're going to focus on how caffeine affects the way our brain works....we're with Dr. Eric Strain, Associate Professor of Psychiatry and Behavioral Science at Johns Hopkins School of Medicine...what chemicals or compounds do we get out of caffeine?

STRAIN: Caffeine is a psychoactive substance, it's something that produces subjective effects. People tend to self-administer it...they take it repeatedly, they like it in low to moderate doses. And it's actually one of a group of compounds we call the methylxanthines, caffeine is the most common one that we think about, but there are some other ones...one, thiophylin, is a medication that is frequently used by patients with asthma, and another one, thiobromine, another methylxanthine is found in chocolate....in very low doses. Caffeine, and the methylxanthine's in general, act on the brain through a number of different mechanisms...one that's thought to explain its effects is antagonism of a neurotransmitter system called adenosine...and the current thinking about caffeine is that this adenosine antagonism may explain caffeine's effects in humans...as well as in other animals.

NEMA: Are there positive effects....or just negative ones associated with caffeine intake?

STRAIN: Caffeine does produce beneficial effects, when you talk about caffeine doses, most people are curious to know, "What are you talking about"? Six ounces of brewed coffee has about a hundred milligrams of caffeine. Cola typically has about 45 milligrams of caffeine....to 12 ounces. Tea has about the same concentration as a soda. Low doses of caffeine, something on the order of maybe 20, 50 milligrams in somebody who doesn't normally consume caffeine, usually will produce mild, sort of pleasurable effects. It might help them feel a little bit more alert , attend better, on some specific types of tasks that we can do, measuring performance...it might be slightly improved...not gangbusters, great, but some improvement in things. If you give somebody something like 800 milligrams of caffeine, so the equivalent of eight cups of brewed coffee at once, people don't like that. And caffeine is different from most other psychoactive substances...a lot of drugs, like alcohol, and illicit drugs, people want to get intoxicated from them...they want to use a lot of it, and report that using a lot makes them, alters them in some way and makes them feel better. Caffeine intoxication is something people avoid. When they take a lot of caffeine, they tend to feel jittery, they might have an upset stomach, they might feel nervous, they have trouble sleeping, they tend to have an increased urination...and they generally report those as not pleasurable effects. Certainly, caffeine does produce some mild, positive, subjective effects in people...but it's interesting that we tend to titrate our doses to something that's optimal, and we don't use a lot of it at once.

NEMA: Dr. Eric Strain...we'll talk again on the possible dependency on caffeine, and the best ways to reduce your caffeine intake, in another program (Part Two). I'm Steve Girard.

Transcripts:

Week: 535.2 Guest: Dr. Eric Strain, Assoc. Prof. Psychiatry/Behavioral Sciences, Johns Hopkins School of Medicine Topic: Caffeine Dependency- How to Get Off It- Part Two Producer/Host: Steve Girard

NEMA: We've been talking with Dr. Eric Strain, Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine...about caffeine and how it affects us mentally. Doctor, I had an episode in my younger days when I first began drinking coffee to do morning radio news...and I suffered some anxiety attacks, which dissipated when I stopped drinking so much of the stuff. Does caffeine exacerbate anxiety?

STRAIN: That's a great question...and there have been some studies that have tried to look at that, and they suggest that actually people with anxiety disorders tend use lower amounts of caffeine, compared to people without anxiety disorders. So, there may be some kind of titration of the amount that you're taking. And if you are predisposed to feeling more anxious, then maybe you tend not to use it...or use very low amounts of it. ....Not to imply that you have an anxiety disorder, Steve....

NEMA: What about people who really rely on caffeine to get them through the day?

STRAIN: People periodically ask, "What about being dependent upon caffeine?" There have been some studies, not many...a couple, that have looked at it and found that there are some people who seem to be dependent on caffeine, similar to the way people can be dependent on other psychoactive substances - nicotine, alcohol or whatever. And I think that's a very intriguing observation, and it just highlights how caffeine is like other substances...psychoactive substances. And you can appreciate, perhaps, some of the difficulties patients have in stopping smoking, cigarettes, or people who have used alcohol. Not that that makes it o.k. to smoke, use alcohol or illicit drugs...but it just helps us understand better some of the dilemmas people have with those other drugs.

NEMA: How does a person begin to eliminate caffeine and at the same time limit the severity of side effects?

STRAIN: A lot of people will report caffeine withdrawal headaches....those usually start anywhere from 12 and 24 hours after the last time they'd taken caffeine...but they can start as late as two or three days after they've stopped using it. And in some people the headaches can keep kind of percolating along for a week or even longer. A lot of times people experience symptoms of caffeine withdrawal but don't recognize it as that. Other things include things like depression and anxiety, and flu like symptoms often...they'll say, "Oh, I must be coming down with a cold, or the flu...I feel achy, my nose is runny, I feel a little nauseous". The thing to do if you're trying to cut down on your caffeine is probably, first of all, carefully assess how much you're actually taking...keep a diary for a week. And write down everything that you use, not just coffee, watch for sodas...some non-cola sodas have caffeine in them, and you need to pay attention to that. And there are some over the counter medications that have caffeine in them...not just the medicines to help you avoid sleep, but some analgesics as well contain caffeine. Get a realistic assessment of how much you're taking, and then try cutting back. I usually recommend people try cutting back by maybe a quarter, every three or four days....and if they notice they're getting headaches or something, then take it more gradually.

NEMA: Our thanks to Dr. Eric Strain of Johns Hopkins School of Medicine...so, whether or not we have any official conclusions about the long term effects of caffeine, the most important issue is how is it affecting you right now? If you think your coffees or colas are affecting you adversely, then start to reduce as Dr. Strain said, and get off caffeine. I'm Steve Girard.