Panic Disorder and Chronic Caffeine Use: A Case-control Study

Veruska Andrea Santos1, Silvia Hoirisch-Clapauch2, Antonio E. Nardi1, Rafael Christophe Freire1, 3, *
1 Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
2 Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil
3 Department of Psychiatry, Queen’s University, Kingston, Canada

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Creative Commons License
© 2019 Freire et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at dult Mental Health Program, Hotel Dieu Hospital, 166 Brock Street, Kingston, ON, Canada; Tel: +1 613-544-3400 Ext. 2551; Fax: +1 613-548-6095; E-mail:



Acute administration of caffeine produces panic attacks in most Panic Disorder (PD) patients, but little is known about chronic caffeine use in these patients.


To assess caffeine use in patients with PD and to ascertain if caffeine consumption is associated with sociodemographic or clinical features.


65 adults with PD and 66 healthy controls were included in the current study. Their caffeine intake within the previous week was quantified with a questionnaire and compared. Harmful caffeine use was defined as consumption above 400 mg/day of caffeine. We tested for correlations between caffeine intake, demographic and clinical features.


Patients consumed significantly more caffeine than controls (P < 0.001). 14% (N = 9) of the PD patients made harmful use of caffeine. The use of caffeine-containing medications was observed in 40% (N = 26) of the PD patients and 6% (N = 4) of controls. Consumption of energy drinks was observed in 11% (N = 7) of PD patients and in none of the healthy subjects. Patients reported sleeping significantly less than controls (P < 0.001). In PD patients, caffeine consumption was not correlated with the presence of panic attacks or comorbidity with depression. The use of benzodiazepines or sedative medications was not correlated with caffeine intake.


High caffeine consumption in PD patients could be explained by the development of tolerance with regular use of this substance. Subtypes of sensitive and non-sensitive PD patients could also explain why some of these patients are able to tolerate high doses of caffeine.

Keywords: Caffeine, Adenosine receptors, Panic disorder, Panic attacks, Sleep deprivation, Self medication.