According to the DSM-5, caffeine intoxication may be diagnosed if five (or more) of the following symptoms develop after recent consumption of caffeine: restlessness, nervousness, excitement, insomnia, flushed face, diuresis (increased production of urine), gastrointestinal disturbance, muscle twitching, rambling flow of thought and speech, tachycardia (increased heart rate) or cardiac arrythmia, periods of inexhaustibility, and psychomotor agitation.According to the International Classification of Diseases (ICD-11), cases of very high caffeine intake (e.g. > 5 g) may result in caffeine intoxication with symptoms including mania, depression, lapses in judgment, disorientation, disinhibition, delusions, hallucinations or psychosis, and rhabdomyolysis (breakdown of skeletal muscle tissue). Energy drinks
High caffeine consumption in energy drinks (At least 1 liter or 320 mg of caffeine) was associated with short-term cardiovascular side effects including hypertension, prolonged QT interval and heart palpitations. These cardiovascular side effects were not seen with smaller amounts of caffeine consumption in energy drinks (less than 200 mg). Severe intoxication
As of 2007 there is no known antidote or reversal agent for caffeine intoxication, treatment of mild caffeine intoxication is directed toward symptom relief; severe intoxication may require peritoneal dialysis, hemodialysis, or hemofiltration. Intralipid infusion therapy is indicated in cases of imminent risk of cardiac arrest in order to scavenge the free serum caffeine. Lethal dose
Death from caffeine ingestion appears to be rare, and most commonly caused by an intentional overdose of medications.
According to a 2011 literature review, caffeine use may induce anxiety and panic disorders in people with Parkinsons disease. At high doses, typically greater than 300 mg, caffeine can both cause and worsen anxiety. For some people, discontinuing caffeine use can significantly reduce anxiety.In moderate doses, caffeine has been associated with reduced symptoms of depression and lower suicide risk. Two reviews indicate that increased consumption of coffee and caffeine may reduce the risk of depression.Some textbooks state that caffeine is a mild euphoriant, while others state that it is not a euphoriant.Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder. Reinforcement disorders
Addiction
Whether caffeine can result in an addictive disorder depends on how addiction is defined. Compulsive caffeine consumption under any circumstances has not been observed, and caffeine is therefore not generally considered addictive. However, some diagnostic models, such as the ICDM-9 and ICD-10, include a classification of caffeine addiction under a broader diagnostic model. Some state that certain users can become addicted and therefore unable to decrease use even though they know there are negative health effects.Caffeine does not appear to be a reinforcing stimulus, and some degree of aversion may actually occur, with people preferring placebo over caffeine in a study on drug abuse liability published in an NIDA research monograph. Some state that research does not provide support for an underlying biochemical mechanism for caffeine addiction. Other research states it can affect the reward system. "Caffeine addiction" was added to the ICDM-9 and ICD-10.