Panic Attack or Too Much Coffee? What Caffeine Can Trigger

Key takeaways

• The signs of too much caffeine, such as a faster heart rate, palpitations, jitters and anxiety, overlap with how anxiety and panic feel.
• In placebo-controlled studies, about half of people with panic disorder had a panic attack after a high caffeine dose, and none did after placebo.
• Those studies used 400 to 750 mg at once, mostly 480 mg; little is known about smaller doses.
• There is no evidence that caffeine causes panic disorder, but it can trigger attacks in people who are prone to them.
• Chest pain, shortness of breath, fainting or palpitations that do not stop need emergency help, whatever you think the cause is.

Get urgent help first if a coffee panic attack comes with these signs

It is never wrong to get checked. Whether the cause is caffeine, panic or something else, the NHS says to call emergency services if palpitations do not go away or come with chest pain, shortness of breath, feeling faint or fainting. MedlinePlus says anyone with signs of a caffeine overdose, which can include trouble breathing, confusion, seizures, vomiting and a rapid or irregular heartbeat, should seek medical help right away.

If this is the first time anything like this has happened to you, get medical advice rather than assuming it was just the coffee. The same goes if you took caffeine pills, powder or energy shots: the FDA estimates that toxic effects such as seizures can occur with rapid intake of around 1,200 mg. In the US, Poison Help is 1-800-222-1222.

Why too much caffeine can feel exactly like panic

The FDA lists increased heart rate, heart palpitations, high blood pressure, anxiety, jitters, upset stomach and nausea among the signs of too much caffeine. MedlinePlus adds restlessness, shakiness and dizziness, and its overdose page notes that the sudden symptoms of too much caffeine and of an acute anxiety reaction can be very similar. The NHS also lists stress and anxiety alongside caffeine as common causes of palpitations.

Caffeine itself also raises anxiety. It works by blocking adenosine receptors, and researchers describe it as a mild stimulant that sometimes raises anxiety through those receptors. So a strong coffee can bring both the body sensations and the anxious feeling at once, which is why people searching for a 'caffeine panic attack' often cannot tell which came first.

What studies show about caffeine and panic attacks

The best summary is a 2022 systematic review and meta-analysis of blinded, placebo-controlled caffeine challenge studies in adults with panic disorder. Across 9 studies of panic attacks with 237 patients, 51.1% had a panic attack after caffeine and none after placebo. In 6 studies that also tested healthy volunteers, 53.9% of patients had an attack compared with 1.7% of people without panic disorder.

The doses were high: 400 to 750 mg in one go, mostly 480 mg, which the authors describe as roughly five cups of coffee. At those doses caffeine also raised anxiety in healthy adults. The authors note that little is known about doses smaller than 480 mg, so these results do not tell you what one normal cup does.

Can coffee cause panic disorder, or only trigger panic attacks?

We found no evidence that caffeine causes panic disorder or any other anxiety disorder. What the research shows is narrower: high doses can trigger panic attacks in people who already have panic disorder, and anxiety rises with dose in people without it. A review of caffeine and behaviour concluded that negative effects on anxiety show up mainly with very large amounts or in sensitive groups, such as people with anxiety disorders.

Psychiatric diagnosis does recognize caffeine-induced anxiety as a form of substance-induced anxiety. That is a judgement only a clinician can make after talking with you, not something to self-diagnose from a single bad afternoon. For the everyday version of coffee anxiety, see why coffee makes you anxious.

Clues that point toward caffeine rather than panic (in general terms)

Nobody can sort this out from a web page, but a few general clues can be worth noting down for a doctor:

• Timing. Caffeine reaches its peak blood level within about an hour, and its effects can be felt for 4 to 6 hours. Symptoms that start soon after a big drink fit caffeine; episodes that happen with no caffeine at all are worth mentioning to a doctor.
• Amount. Count everything: coffee, tea, energy drinks, pre-workout, and products the FDA says can carry added caffeine, such as energy bars, supplements and some over-the-counter medicines.
• Your history. In people diagnosed with panic disorder, the studies above found that a large dose set off an attack about half the time.
• Pattern. Episodes that keep happening, with or without caffeine, are a reason to see a doctor.

What to do during a panic attack after coffee

If you have no warning signs that need emergency care, the aim is to get through the next few minutes while the caffeine level stops rising and then falls.

• Stop all caffeine now, including any half-finished drink.
• Sit down somewhere you feel safe, and tell someone nearby how you feel if you can.
• Breathe slowly, making each out-breath a little longer than the in-breath. calmness.today has a free guided breathing reset and a step-by-step panic plan you can use in the moment.
• Avoid nicotine and alcohol, and don't try to burn the caffeine off with hard exercise: the NHS lists all three, along with caffeine, among common causes of palpitations.
• Afterwards, note what you drank, how much and when. Our guide to stopping caffeine jitters has more on the hours that follow.

Lowering the chance of another panic attack from caffeine

The panic studies support informing people with panic disorder that caffeine can trigger attacks, while admitting that smaller doses are poorly studied. In practice, that means talking to your doctor and finding the amount you tolerate, rather than guessing. If you decide to cut back, do it gradually: the FDA advises this for daily caffeine users, and in experimental studies about half of people got a headache when they stopped caffeine.

Smaller doses are the main lever. FDA figures for 12 fl oz put brewed coffee at 113 to 247 mg and green tea at 37 mg, and decaf typically has 2 to 15 mg per 8-fl oz cup. Compare brewed coffee, green tea and energy drinks like Monster before you choose.

Common questions