Withdrawal Syndrome after the Double-Blind Cessation of Caffeine Consumption

People who stop consuming caffeine may have symptoms, but the incidence and severity of caffeine withdrawal are not known. This study was performed to determine the effects in the general population of ending one's dietary intake of caffeine. We studied 62 normal adults whose intake of caffeine was low to moderate (mean amount, 235 mg —the equivalent of 2.5 cups of coffee — per day). They completed questionnaires about symptoms and tests of their mood and performance when consuming their normal diets (base-line period) and at the end of each of two two-day periods during which they consumed caffeine-free diets and under double-blind conditions received capsules containing placebo (placebo period) or caffeine (caffeine period) in amounts equal to their daily caffeine consumption. More subjects had abnormally high Beck Depression Inventory scores (11 percent), high scores on the trait scale of the State—Trait Anxiety Inventory (8 percent), low vigor scores (11 percent) and high fatigue scores (8 percent) on the Profile of Mood States, and moderate or severe headache (52 percent) during the placebo period than during either the base-line period (2, 0, 0, 0, and 2 percent, respectively; P<0.05) or the caffeine period (3, 2, 2, 0, and 6 percent; P<0.05). More subjects reported unauthorized use of medications during the placebo period (13 percent) than during the caffeine period (2 percent, P = 0.017). Performance of a tapping task was slower during the placebo period than during the base-line and caffeine periods (P<0.01). Persons who consume low or moderate amounts of caffeine may have a withdrawal syndrome after their daily consumption of caffeine ceases. (N Engl J Med 1992;327:1109–14.), HEADACHE, lethargy, and other symptoms are known to follow the discontinuation of caffeine administration (caffeine withdrawal),¹ but the relevance of these observations to the general population is unclear. The incidence and severity of caffeine withdrawal are not fully known, and caffeine withdrawal has often been considered irrelevant to clinical practice. The American Psychiatric Association states that caffeine withdrawal is usually not severe enough to warrant clinical attention and has omitted caffeine withdrawal from its list of organic mental syndromes associated with psychoactive substances.² Evidence suggests that medical professionals rarely consider caffeine use in interpreting symptoms that overlap with the caffeine…