🎧Your Caffeine Addiction Has to Go | Chapter 23

Sarah Fay

Nov 19, 2023

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I sit at the kitchen counter. Next to me is a cup of coffee in my favorite white mug. The coffee is milky-white. My leg is propped on the stool beside me. My healing-but-still-broken ankle is wrapped in a cold pack.

Caffeine consumption, which I do a lot of, should be an obvious no for anyone diagnosed with anxiety disorders, bipolar disorder, and ADHD. Caffeine-induced anxiety disorder is a subtype of a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry’s manual. Caffeine has been found to trigger manic episodes. The evidence that it helps with ADHD symptoms is contradictory, leading many to believe that it makes it worse.

There’s no number of cups of coffee or cans of Red Bull that mark the amount that will trigger its negative effects. Here’s how it works: The brain buzzes from the very first sip, which seems like a good thing, but that’s the complex effects of dopamine levels rising in the brain and levels of feel-good neurotransmitter serotonin falling. (Alertness doesn’t bring happiness.) Then comes the jitteriness in the hands, the restlessness. The heart begins to beat quickly or pound. The sweating starts. Maybe there’s a ringing in the ears, a sense of dislocation. Maybe nausea, chest pain, dizziness.

I take the ice wrap off my ankle and hobble to the kitchen. Shouldn’t quitting caffeine have been the first line of treatment my psychiatrists recommended long before any benzodiazepines or anti-anxiety meds or mood stabilizers or antipsychotics were prescribed? I’d been drinking it for years—not a lot, one cup in the morning and one in the afternoon but a lot for me. (It always hit me hard.) Before any clinician leveled a psychiatric diagnosis and told me (incorrectly) that I had a lifelong, “biological” psychiatric condition due to a “chemical imbalance,” my lifestyle should have been taken into account. How many people diagnosed with anxiety disorders and major depressive disorder and mania and ADHD regularly drink caffeine? Cut that out first and then see where we are.

The milky brown liquid splashes over the rim of the cup as I set it on the counter. If I’m going to heal from mental illness, it has to go.

I pour the coffee down the sink. A twinge in my chest—an urge for more—makes me regret what I’ve done. But I throw away the bag of coffee grounds and then my coffee maker.

I already don’t smoke or drink alcohol or take illicit drugs, which puts me at a distinct advantage when it comes to recovery. I quit drinking almost twenty years ago. It was clear to me even then that if I struggled with depression and regularly drank a depressant (alcohol), it wasn’t going to go well.

I experimented with drugs a handful of times in college; they, too, seemed like a terrible idea for someone like me. Drug use has been found to cause depression, anxiety, and psychosis. Speed (amphetamine) has been linked to a five-fold risk of psychosis. Other drugs that produce drug-induced psychosis include marijuana, psychedelic drugs like LSD, ecstasy, and MDMA. Ketamine is also known as the street drug Special K. Cocaine produces symptoms of psychiatric disorders, even in those who don’t suffer from mental illness, including agitation, paranoia, hallucinations, delusions, violence, as well as suicidal and homicidal thinking.

Knowing how hard it’s been to recover from mental illness, I’m not sure how anyone heals from co-occurring disorders (mental illness and substance use disorders). In a few years, I’ll complete a one-hundred-ten-hour training in substance abuse recovery counseling. I’ll listen to people who quit heroin and crack, a few while living on the streets. A young woman—maybe twenty—who was a meth addict will exude ferocity when she speaks of her recovery. Some will talk of hearing voices and trying to drown them out with alcohol. Their struggle and ability to recover will fill me with awe.

Once I give up caffeine completely, the panic attacks start. My chest thrums with an unsettling energy. It rises to my throat. My cheeks go numb. The room falls away. I’m not really there. I’m dying. Knowing it’s a panic attack doesn’t decrease the panic. I’m dying. Eventually, the panic settles after what feels like a very long time.

I start negotiating with the term “quitting caffeine,” attempting to outwit the milligrams of caffeine in each substance. Coffee is out, but tea is okay. Then black tea is out, but green tea is okay. Then green tea is out, but hot cocoa is okay.

At our next appointment, Dr. R leads me down the hall to his office. When he sees me, he points to the Storm-Trooper-esque medical walking boot. It isn’t until I’m tottering behind him that I notice he’s tottering too. His foot is in a short boot, the shoe-like boot I want.

It’s my first appointment with him in months. Keeping my meds as-is works well.

We sit opposite each other, each in our respective boots. I ask what happened. He shrugs and bobs his head. “Broke my toe.” He explains that he was at swimming lessons with his kids and banged his toe on a bench.

“Ouch,” I say with an empathic wince.

He shrugs, laughs. “It’s all right.”

Well, I think, he has it easy.

He asks me how I’m doing. I point to the boot as if that should explain it.

He smiles understandingly.

I tell him I’m trying to quit drinking caffeine.

He bobs his head the way he always does. “Good idea.”

My stomach sinks with disappointment. I wanted him to say, Ah, don’t worry about that. A little caffeine is okay. But he’s an excellent psychiatrist—the first to tell me that diagnoses are meaningless labels meant for physicians to use, not patients to identify with, and to present recovery to me as an option—and would never say that.

During our session, I’ll accept that no amount of caffeine is “okay.” I’ll quit again and go through the withdrawal again. It’s less caffeine the chemical than its habit-forming qualities. Giving up caffeine will be ridiculously unpleasant, but soon I’ll be calmer and sleep better than in years.

The effect of good sleep on mental health cannot be understated. I’ll go all-in, following all the nighttime hygiene practices recommended by the Sleep Foundation: blackout curtains, special light bulbs without blue light, putting away devices an hour before bed. I’ll go to bed at the same time every night and wake up at the same time every day with few exceptions.

But at that moment in Dr. R’s office, it still seems unfair, like everyone else has it easy. That’s the discouraging part about recovery. There’s so much to give up to get well.

He crosses his leg in a figure-four. His simple, shoe-like boot not limiting his range of motion. He rotates his ankle—fluidly, easily. Mine remains heavy and stiff, intractable.