Caffeine Challenge Induced Panic Attacks in Patients with Panic Disorder

Marlene Busko

June 22, 2007

June 22, 2007 — Patients with panic disorder or with major depression and panic attacks were more likely than control subjects to have panic attacks after drinking a high dose of caffeine, according to results of a small study by Isabella Nascimento, MD, and colleagues at the Federal University of Rio de Janeiro, in Brazil.

These findings were presented in a poster at the American Psychiatric Association 2007 Annual Meeting, in San Diego, California. The study was also published in the May-June issue of Comprehensive Psychiatry.

"Caffeine is a substance that may induce anxiety symptoms, and in patients with panic disorder, it may even induce panic attacks," Rafael C. R. Freire, MD, one of the researchers, commented to Medscape.

"Patients with depression with anxiety symptoms such as panic attacks have a predisposition to develop panic attacks with caffeine," added team member Valfrido L. de Melo Neto, MD.

The anxiogenic effects of coffee have been shown in patients with panic disorders and patients with anxiety disorders, the researchers note. They sought to determine whether patients diagnosed with panic disorder or those diagnosed with major depression with panic attacks — based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) — would react in a similar way to an oral caffeine challenge test.

The study enrolled 29 patients diagnosed with panic disorder, 27 patients with major depression with panic attacks, 25 patients with major depression without panic attacks, and 28 healthy volunteers. The study subjects underwent a 4-week period with no psychotropic drugs. Then on 2 occasions, 7 days apart, the subjects participated in a randomized, double-blind challenge with either a 480-mg caffeine solution or a caffeine-free placebo solution that looked like coffee.

Dr. de Melo Neto commented that 480-mg caffeine is equivalent to about 5 cups of Brazilian coffee, which is much stronger than American coffee.

The patients were asked to rate their anxiety levels just before and 30 minutes after the caffeine challenge.

Compared with the depressed patients who did not have panic attacks or with the control subjects, the patients with panic disorder or with major depression with panic attacks were more sensitive to caffeine and more likely to have panic attacks.

Patients Who Experienced a Panic Attack After a 450-mg Caffeine Challenge

Outcome
PD Group
(n = 29), n (%)
MDP Group,
(n = 27), n (%)

MD Group,
(n = 25), n (%)
Control Group,
(n = 28), n (%)
Panic attack
17 (58.6)
12 (44.4)
3 (12.0)
2 (7.1)
PD = panic disorder.
MDP = major depression with panic attacks.
MD = major depression without panic attacks.

No study subject had a panic attack after drinking the caffeine-free solution.

The patients with panic disorder or with major depression with panic attacks also reported feeling much more anxious after drinking 450 mg of caffeine.

SUDS Anxiety Rating* Before and After 450-mg Caffeine Challenge Test, mean ± SD
SUDS rating
PD Group
MDP Group
MD Group
Control Group
Just before
2.8 ± 2.2
2.8 ± 2.2
2.2 ± 1.9
2.5 ± 2.0
30 min after
6.5 ± 3.9
6.1 ± 3.3
2.8 ± 2.5
3.4 ± 2.6
PD = panic disorder.
MDP = major depression with panic attacks.
MD = major depression without panic attacks.
*SUDS = Subjective Units of Distress Scale; Anxiety rating from 0 (no anxiety) to 10 (maximum distress).

The team concludes that not only patients with panic disorder but also patients with major depression and panic attacks are hyperreactive to an oral high-dose caffeine challenge and have increased risk of caffeine-induced panic attacks.

The study was supported by the Brazilian Council for Scientific and Technological Development.

American Psychiatric Association 2007 Annual Meeting: Abstract NR628. May 19-24, 2007.

Compr Psychiatry. 2007;48:257-263. Abstract



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