Stimulants have a big impact on us, and even a simple cup of coffee or an energy drink may be contributing to your feelings of anxiety.
Stimulants & anxiety
Stimulants can cause or increase feelings of anxiety.
Many patients who come to Wells Medicine with anxiety are not aware of how much common stimulants that many of us use every day can affect their symptoms – this doesn’t seem to be regularly discussed with most providers and their patients.
Common stimulants include nicotine — such as tobacco, chewing tobacco, and vaping, — caffeine — in coffee, tea, energy drinks and chocolate, — and stimulant ADHD medications — like Adderall and Ritalin. These stimulants all increase anxiety hormones like adrenaline and cortisol, resulting in increasing heart rate, blood pressure, skin sweating, and focus. When all of these things are amped up in the body, it can feel like anxiety.
When patients come to us with anxiety, one of the first things we recommend is to look at decreasing their intake of other stimulants during the day. Some things are easier to decrease than others. If you take medication for ADHD, that might be the last thing you decrease, if at all, but other stimulants are easier to reduce or give up. All stimulants should be examined when grappling with symptoms of anxiety. This is especially true because stimulants can have an additive effect, and coffee on top of cigarettes, on top of stimulant medications (for instance) can all add to each other in a big way.
The right ‘dose’
Tolerance to the ‘focus’ effect of stimulants increases much more rapidly than tolerance to the restlessness, hypervigilance, and anxiety feelings of stimulants. So we start to lose the ‘good’ effects of taking stimulants while retaining the ‘bad’ effects. This can push us to take larger and larger amounts while feeling worse and worse.
Many of us start drinking caffeine and slowly increase the dosage as we build a tolerance, to two, three, or four cups of coffee a day (or more). You may not attribute some of your feelings of anxiety to that stimulant when it is something you’re accustomed to having every day and your dosage has been built up over time. To complicate the picture even further, tolerance to stimulants decreases as we age, making the same dose we might have had in our younger years hard to manage as we get older.
We might not even really notice how these feelings of anxiety creep up on us over time. Anxiety is not a black or white situation, but rather is often a gradual ramping of the effect until you notice symptoms of anxiety – culminating, for instance, in a panic attack.
One thing we often tell our patients is “the dose makes the poison”. In other words, the ‘dose’ of a stimulant that works for you may not be zero, but there is a good chance that it is less than the amount you are accustomed to having. It may not be that going from six cups of caffeine to zero cups a day is necessary — your ‘happy dose’ may be two cups or one cup.
Don’t go cold turkey
We don’t advise patients to go cold turkey and immediately stop their stimulant intake. If you stop all at once, you’re likely to have a couple weeks of absolute misery. We recommend a gradual weaning rather than a sudden decrease.
One reason to stop slowly is because you’ll otherwise feel miserable and hate the experience. Another reason is to have a better sense for what it actually feels like to live day-to-day on a lower dose of stimulants.
A lot of people say “I felt worse when I stopped”. However, it takes about two weeks to start to normalize from any decrease in caffeine or nicotine. If you go from six cups of coffee a day to none, you’re likely to encounter withdrawal symptoms such as lethargy, extreme fatigue, brain fog, difficulty concentrating, difficulty sleeping, difficulty exercising, a very bad headache or migraine, and feeling very hungry (or not feeling hungry at all). It is important to recognize these as withdrawal effects of caffeine, and to not conflate them with your idea of what life looks like with less caffeine.
What life looks like with less caffeine or nicotine is something you will be able to see after some time – maybe after two to four weeks of stopping, or at your new stable ‘dose’ of those substances.
You don’t need a doctor’s blessing to reduce your caffeine intake. But please note that whenever you change the dose of a prescribed stimulant, such as methylphenidate for ADHD, you should do so in consultation with your prescribing physician.
adequate substitutes
When stopping or decreasing your stimulant intake, try to find replacements that are good substitutes. If you’re used to having a warm, rich cup of coffee in the morning — don’t replace it with a cold glass of orange juice. Maybe try a cup of decaf to start with, or a cup of herbal tea with a lot of milk — a suitable, comparable, and fulfilling substitute.
Decaf coffee may be a good substitute for regular coffee. However, it can still have as much as 20% of the amount of caffeine. Be sure that you are still decreasing your overall stimulant intake, and not compensating for smaller doses of caffeine with more cups throughout the day.
If you want caffeine, but in a more relaxed or contained form, drinks such as green tea contain substances like theanine, which can make green tea both stimulating and relaxing at the same time. Green tea can provide that ‘focus’ you get from caffeine with less of the buzz, and it also contains some polyphenols and antioxidants.
Herbal teas — including herbal teas that taste like coffee such as Roastaroma and Teeccino — make a great substitute without the caffeine. Some herbal teas also have other benefits such as the calming effect you may feel with chamomile, for instance.
As with caffeine, don’t stop nicotine cold turkey. You can start by switching to a clove cigarette or by switching to a vape with less nicotine, including graduated vapes with decreasing levels of nicotine, to wean off the substance.
Knowledge Is Power
Remember that stimulants can make you feel anxious, and that more stimulants in a day can make you feel even more anxious. Use this information to your benefit, and if you struggle with anxiety, consider cutting back. You probably want to take your time when reducing your intake, and stick with the reductions for a while before you evaluate how you feel at the new, lower dose.
Adjusting your coffee habit, nicotine use, or other stimulants probably won’t single-handedly resolve all your symptoms of anxiety — especially for severe and refractory anxiety conditions — but it can help. Lifestyle modifications and a holistic perspective on your mental well-being can help make positive changes and help you maintain positive changes you’re able to make with medications, therapies, and treatments.
About Us
Wells Medicine is a Houston-based practice designed to provide meaningful care for mental health. Providing targeted interventional treatments for Depression, Anxiety, OCD, PTSD and other conditions, with Ketamine Treatments, Stellate Ganglion Blocks, TMS, and Nitrous-Oxide Treatments. Focused on comprehensive care and integration with Psychiatry, Psychology, and Support Services. We are evidence-based, patient-focused and mission-driven.
The content here is for informational purposes and should not be relied upon for medical decisions. For the details of your specific medical conditions and treatments consult your doctors or other qualified healthcare professionals.
