ADHD Experts Podcast – Episode 544

ADHD and Caffeine: Risks & Benefits of Using This Natural Stimulant

Date: February 28, 2025
Host: Nicole Carr (ADDitude)
Guest Expert: Dr. Sarah Shayette

Episode Overview

This episode explores the complex relationship between ADHD and caffeine, the world’s most widely consumed stimulant. Dr. Sarah Shayette discusses caffeine’s mechanisms in the body, its similarities and contrasts with ADHD medications, its effects (positive and negative), and its role (if any) in ADHD symptom management. The episode features scientific insights, real-life anecdotes, and engaging Q&A with listeners—covering children, teens, and adults navigating caffeine use.

Key Discussion Points & Insights

1. Is Caffeine a Medication? (02:40–05:45)

• Definition: Dr. Shayette walks through definitions of “medication,” explaining that caffeine fits because it treats symptoms like tiredness and improves alertness, focus, and mood.
• Fun Facts: Caffeine’s chemical name is 1,3,7-trimethylxanthine (C8H10N4O2), and it’s been used for millennia—origin stories range from ancient China to the Middle East.

“Caffeine…is as much of a medication as anything you find in a little bottle from your pharmacy.”
— Dr. Shayette (03:52)

2. Sources of Caffeine (05:50–08:00)

• Common sources: Coffee, tea, chocolate, energy drinks, sodas, and even some medications.
• Variability: Caffeine content varies widely—even in “decaf” items—depending on brand, processing, and preparation.
• Energy drinks: Noted for high caffeine content and sometimes sugar or other additives; reading labels is crucial.

3. Metabolism and Individual Variability (12:55–17:45)

• Every person metabolizes caffeine at a different rate, determined mostly by liver enzymes (paraxanthine).
  • Fast metabolizers may feel less effect; slow metabolizers are more sensitive and prone to side effects.
• Factors like smoking can speed up caffeine metabolism. Cycle-related changes aren’t significant.
• Analogy to ADHD meds: The same kind of variation is seen with stimulant medications (e.g., Adderall, Ritalin).

“We all know people who can drink six cups of coffee and be totally fine, and people who drink six sips and are wired, right?”
— Dr. Shayette (13:08)

4. Caffeine’s Biological Effects (17:50–25:00)

• Mechanism: Caffeine blocks adenosine receptors in the brain, which indirectly increases dopamine levels—a neurotransmitter linked to mood, alertness, and (importantly) ADHD.
• Overlap with ADHD: ADHD is believed to involve low dopamine in certain brain regions; caffeine’s dopamine effects are relevant but not as targeted as stimulant medication.
• Wider effects: Besides the brain, caffeine raises heart rate, affects kidneys (diuretic effect), and influences inflammation.

5. Cognitive and Physical Outcomes (25:10–30:00)

• Short-term benefits: Improved mental performance (vigilance, reaction speed, wakefulness) and physical endurance—for some, not all, tasks.
• Limitations: No evidence that caffeine helps with long-term memory.
• Sleep: Caffeine is detrimental for sleep, even when consumed in the morning for slow metabolizers.

“The way to fix [sleep deprivation effects] is to get more sleep. Not to have more coffee in the morning.”
— Dr. Shayette (28:42)

6. Risks & Side Effects (30:01–36:00)

• Sleep disturbance: Not just from nighttime caffeine; can affect sleep even if taken in the AM.
• Blood pressure & heart rate: Both can increase; generally small increases, but important for sensitive individuals.
• Mood and behavior: Doses over 100 mg (common in adolescents) can worsen irritability, mood, mean behavior.
• Headaches: Caffeine both causes and alleviates headaches; withdrawal headaches can be severe.
• GI effects: Possible side effects include nausea and diarrhea.

7. Caffeine vs. ADHD Medications (36:00–41:00)

• Similarities: Both increase alertness, attention, heart rate, and can affect sleep.
• Differences: Caffeine is less specific in action—more “side effects per benefit.” Stimulant meds are more targeted, need less to get mental benefits, and typically have fewer side effects.
• Combined use: If taking both, side effects can be accentuated. Lowering caffeine may improve tolerance of ADHD meds.

“If you’re taking ADHD medicine and drinking coffee and having side effects, one way to solve that is to reduce coffee (or other caffeine) and adjust medication if needed.”
— Dr. Shayette (38:50)

8. Caffeine & Non-Stimulant Medications (41:00–42:30)

• Non-stimulant ADHD meds like Strattera or Kalbri are less likely to have overlapping side effects with caffeine.

9. Caffeine & Exercise (42:32–44:30)

• Caffeine can enhance physical stamina and coordination.
• Exercise itself is highly beneficial for ADHD (and brain health), improving mood, cognition, and sleep.
• Combining caffeine and exercise is generally safe for most, but caffeine isn’t necessary to exercise.

Memorable Audience Q&A (Beginning at 42:42)

Caffeine’s “Paradoxical Calm” Effect (42:42–45:49)

• Some people (including those with ADHD) report caffeine makes them calm or even sleepy.
• Dr. Shayette: This may be due to differences in brain and heart receptor sensitivity. The phenomenon is similar to how stimulants can help some ADHDers focus and relax.

“Some people who take their stimulants…feel calmer…Caffeine can have a similar effect for a subset of people whose brain receptors are more sensitive than their heart receptors.”
— Dr. Shayette (43:10)

The “Caffeine Crash” (46:25–47:50)

• For those who crash quickly after caffeine: enzymes may metabolize caffeine rapidly.
• Options: Switch caffeine source (e.g., try tea instead of coffee), or consider ADHD medications if symptom management is the goal.

Does the “Vehicle” (Coffee, Tea, Matcha) Matter? (47:50–50:18)

• In general, 100 mg of caffeine yields similar effects regardless of source.
• Slight molecular differences exist (e.g., matcha vs. espresso), but effects are primarily about caffeine content.
• The impact of additives (e.g., sugar in energy drinks) can also play a role.

Caffeine for Children & Teens (50:18–55:27)

• Kids: No safe age for using caffeine for wakefulness or ADHD; sleep is far more beneficial.
• Teens: Pro-caffeine culture in media/gaming can glamorize use. The best parental approach is moderation and modeling healthy sleep and eating habits.

“Getting sleep is more effective than taking coffee…There’s probably no benefit to using caffeine for ADHD in kids.”
— Dr. Shayette (50:45)

Caffeine and Headaches/Migraines (55:27–57:23)

• Caffeine can both trigger and treat headaches. Withdrawal is a major cause of “morning” headaches.
• It’s included in some migraine medications, more effective if the user doesn’t have a daily caffeine habit.

Caffeine and Hunger/Weight (57:23–58:14)

• No strong evidence links caffeine to increased hunger or weight gain, though personal habits/settings (coffee + snacks) may play a role.

Tips for Reducing/Stopping Caffeine (58:14–59:17)

• Taper off gradually to prevent withdrawal headaches and mood dips.
• “Gradual reduction will help your enzymes adjust and your body get used to the lack of caffeine intake.” — Dr. Shayette (58:46)

Notable Quotes

• “Your body doesn’t know the difference between what comes in a cup and what comes in a pill…how we think about caffeine may be something we think differently about after this.”
  — Dr. Shayette (44:10)

• “Everything in moderation…teens are going to do stupid things. There’s only so much you can do.”
  — Dr. Shayette (54:13)

Timestamps for Key Segments

• 02:40 — Is caffeine a medication?
• 05:50 — Sources and variability of caffeine
• 12:55 — Metabolism & individual differences
• 17:50 — How caffeine works in the body for ADHD
• 30:01 — Side effects (sleep, anxiety, blood pressure, headaches)
• 36:00 — Stimulant medications vs. caffeine
• 42:42 — Listener Q&A: paradoxical calming effects, crashes, kids & teens, headaches, quitting caffeine

Episode Takeaways

• Caffeine and ADHD: Caffeine has some overlapping mechanisms and effects with stimulant ADHD medications, but is less specific, requiring higher doses for the same benefit (with more side effects).
• Not a substitute: Caffeine is not recommended as a primary or sole treatment for ADHD symptoms, especially in children.
• Personalization is key: Caffeine affects everyone differently; some find benefit, others side effects or worsening symptoms.
• Combination caution: If combining caffeine and ADHD meds, monitor for increased side effects, and consider reducing caffeine instead of increasing medication.
• Healthy routines: Prioritize sleep, moderation, and exercise—these have more consistent benefits for ADHD than caffeine ever could.
• Quitting caffeine: Taper gradually to avoid headaches and mood effects.

For additional resources or to download the accompanying slides, visit attitudemag.com and search for Episode 544.