By Adrienne Pastula
I recently began adding caffeine into my diet to combat my PMDD-related depression. This is directly contrary to the advice most of us see regarding links between caffeine and mood. Many of us are cutting out caffeine to better manage symptoms, but based on a hunch and some digging into the research, I was persuaded to try the opposite.
In one study, caffeine was correlated with reduced depression in women, with the population of women drinking the most coffee (4 or more cups daily) exhibiting the greatest decrease in the incidence of depression. However, there seems to be a consensus in the literature that consuming more than 400mg of caffeine on average appears to lead to the negative effects commonly associated with caffeine, including increased anxiety, headaches, sleep disturbances, and nausea.
Because PMDD is a grab bag of depression, anxiety, and rage, with a couple of other symptoms mixed in, I’m taking an approach that considers both of these findings. A little bit of caffeine could be helpful, but go overboard and you’ll likely start to feel much worse than if you’d had none at all. Similarly, most of us don’t have the hard data about our individual sensitivity to caffeine, so trial and error is typically the process for figuring out how much is too much. To mitigate my own risk, I decided to start with my best educated guess for a minimum effective dose that might both improve my symptoms and avoid side effects; I landed at 120mg, about the equivalent of a half cup of coffee.
On a related note of risk mitigation, I’m also concerned with caffeine dependence and so have decided to only take that 120mg of caffeine on days when depression is my major symptom or on every other day during my luteal phase, whichever is less frequent. While research suggests I could experiment with up to that 400mg dose of caffeine (about 4 cups of coffee) before experiencing negative symptoms, I’m more interested in being conservative with my self-experiment, given that the rate at which I personally metabolize caffeine is an unknown. In my opinion, it’s always better to start slow when you are experimenting with your own body and gradually work up to the dose that gives you an optimum effect.
Another item I’m considering regarding introducing caffeine into my self-treatment plan is pairing it with the calming benefits of the over-the-counter supplement, l-theanine. L-theanine, most notably, is found in green tea. The pairing of caffeine + l-theanine is being used by leaders in many industries to improve focus and mental acuity because l-theanine can help reduce the negative side effects of caffeine (including anxiety) while maintaining the positive benefits (higher energy and enhanced mood). In the event you’re prone to mood swings between both depression and anxiety on any given day, adding caffeine in tandem with l-theanine may offer a protective factor against unwanted side effects from caffeine.
Even with this novel plan of action, there is still one major barrier toward relying on caffeine as a prime way to manage my symptoms. Taking caffeine has been demonstrated time and time again to disrupt sleep and in turn, poor sleep strongly impairs mood, focus, and stress. Because sleep is so important to managing mood, particularly for those of us who already struggle with a mood disorder like PMDD, adding caffeine to the diet cannot be done at the expense of disrupting sleep. Because caffeine has a half-life of 5-6 hours, I know that even if I stop drinking coffee by 10am, that means there is still going to be 25% of that caffeine still in my system at 10pm available to potentially disrupt my sleep. This is important to recognize in how I’m going to approach my dosing. I have to keep in mind that even if my depression seems to be alleviated in the moment by taking my 120mg of caffeine, I also must take note if I find myself sleeping less efficiently. If I observe any sleep disruption (some apps do a decent job of tracking this so you don’t have to rely on subjective experience entirely, I like Sleep Cycle personally), then I need to find some other way to address my depressive symptoms.
Overall, this is very experimental for me. I don’t have a long history of caffeine use, and I definitely don’t recommend using my opinions on this as a way to excuse away excessive caffeine use in the event that it is a source for problems for you individually. But, hopefully, it can encourage us to think more critically about how we’re engaging with this drug and how it could be/is negatively or positively impacting our lives. For my part, the following plan is self-prescribed, self-experimental, and based on only my individual (and limited) understanding of the research available. My PMDD has been resistant enough to treatment that I’m looking for more novelty in what I can do to optimize around my baseline symptoms, but not everyone has exhausted more conservative options like therapy, traditional medicine, and dietary or exercise changes which I highly recommend before taking anything someone like me says to heart. If you’re curious, I hope you’ll do your own (extensive) research and consult with a doctor before making any changes to your current treatment plan to avoid any negative interactions. For my part, I’ll sum up the rules for my self-experiment as follows:
- Dose – Not to exceed 120 mg daily and taken in the form of a ½ tab of Vivarin (caffeine pill) or equivalent dose of coffee/energy drink
- Timing – Complete dosing prior to 10am, or earlier if possible
- Frequency – Only during the luteal phase and at a maximum of every other day; taken only on days when depression (not anxiety) is a major symptom to reduce habituation effects
- L-theanine – Pair with 100mg l-theanine if anxiety or other negative symptoms of caffeine are present
After approximately 4 months of experimentation, I found caffeine to be very helpful in mitigating depressive symptoms. I modified the dosage to 50mg caffeine+200mg L-theanine on days when I use this approach. Personally, this ratio resulted in the greatest improvement in energy, focus, and positive affect with no noticeable exacerbation of anxiety for me. I will note that on days where my depression was more severe (including significant suicidal ideations), the positive impact of caffeine was very minor and sometimes increased feelings of nausea. As an experiment, this has been worthwhile for me and will continue to be a treatment option that I use moving forward.
About the Warrior
Adrienne is a Peer Support Provider and Administrative Assistant with IAPMD. She is a freelance writer with a focus in Mental Health and Women’s Health Advocacy.