Effect of Excessive Coffee Consumption on the Clinical Course of a Patient With Bipolar Disorder: A Case Report and Literature Review

Abstract

Excessive coffee consumption may exacerbate the therapeutic course of bipolar disorder through its effects on the mechanisms underlying bipolar disorder itself, as well as by affecting the blood concentration of lithium.

Concentrations of selected metals (NA, K, CA, MG, FE, CU, ZN, AL, NI, PB, CD) in coffee

“…In addition, compounds contained in coffee may affect the course of treatment e.g. in bipolar affective disorder, by affecting the blood concentration of lithium (35).…”

The impact of caffeine consumption on clinical symptoms in patients with bipolar disorder: A systematic review

“…Of the 17 included studies, 10 are case reports, [12][13][14][15][16][17][18][19][20][21] 1 is a retrospective cohort study, 22 5 are cross-sectional studies [23][24][25][26][27] and 1 is a one-arm interventional study. 28 The characteristics of included studies are presented in Table 1 (cross-sectional and longitudinal studies) and Table 2 (case studies).…”

“…14,16 Elsewhere, an abrupt increase in caffeine intake over few days up to a month 15,19,20 was likely involved in the occurrence of manic episodes. In another case, duration of a heavy coffee consumption (13 to 20 cups a day) prior to the appearance of a mixed manic state was not specified, 17 making it impossible to establish if the prevalent factor was the absolute amounts or the acute rise in caffeine intake, although a combination of the two mechanisms is also possible.…”

“…In support to a possible role of caffeine in the pathophysiology of manic or mixed manic episodes, the reverse mechanism has also been reported, where symptoms improved after reducing or discontinuing caffeine intake. 17,18,20 Furthermore, a relatively old cross-sectional study found that bipolar patients with mixed affective states had a higher caffeine intake than those with an uncomplicated clinical presentation. 24 Instead, the only longitudinal study included in our review 22 found that drinking coffee was not associated with an increased risk of manic/hypomanic episodes: in fact, although coffee drinkers were initially found to experience more manic episodes per year compared to non-drinkers, this association was not sustained in multivariate analysis, which suggests the presence of confounding factors (previous suicidal behaviour, family history of suicide, smoking and alcohol use).…”

“…Indeed, given the narrow therapeutic window of lithium, this could result in decreased efficacy when caffeine intake is relatively high and increased lithium plasma levels when caffeine intake is decreased or interrupted. 14,16,17 Another study reports increased lithium side effects (e.g. tremor) upon caffeine discontinuation.…”