Letters
Substance‐related disorders Mental health
Volume 194 - Issue 4

Transient psychotic relapse temporally related to ingestion of an “energy drink”

Author:  David B Menkes

Med J Aust 2011; 194 (4): 206. || doi: 10.5694/j.1326-5377.2011.tb03777.x
Published online: 21 February 2011
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To the Editor: I describe two episodes of transient recurrence of psychosis temporally related to ingestion of an “energy drink” in an obese (125 kg) 27-year-old New Zealand Maori man who had been diagnosed with schizophrenia 8 years earlier. The patient had found that risperidone 6 mg/day effectively relieved persecutory ideas and auditory hallucinations. He had stopped using cannabis and alcohol to excess, but continued to drink up to 10 cups of instant coffee throughout the day for a “lift”, apparently without insomnia or other complications.

In July 2009, he consumed a 60 mL Demon Shot energy drink and enjoyed an hour-long “buzz”. Repeating the dose did not re-create the desired effect, and instead made him uneasy, irritable and paranoid; for the first time in many months, he had recurrent thoughts, lasting several hours, of people wanting to harm him. One week later, he drank three shots over 15 minutes. He again experienced a buzz and was observed to be emotionally labile — initially laughing and talkative, and later, restless, withdrawn and argumentative. He had a rapid pulse and insomnia. These symptoms subsided over the next day, and when he was back to his usual self after a further 2 days, he described having had paranoid ideas (“gangsters after me ... scared to leave the house”) over several hours after consuming the drinks. His family also associated these symptoms with the drinks, noting a striking similarity to his illness before commencing antipsychotic treatment. He has since avoided energy drinks and continued risperidone monotherapy, remaining stable for 15 months.

Demon Shot is a concentrated energy drink, widely available in Australia and New Zealand. The product’s web page describes each “insanely intense” shot as containing 200 mg caffeine, plus taurine, guarana, and B vitamins (http://www.demonenergy.com.au/products/demon-shots). As a regular smoker, the patient does have increased caffeine metabolism, and his response to consuming large amounts of coffee suggests he is not particularly sensitive to caffeine. Nevertheless, he did exceed the maximum recommended dose (two shots per day) on the second occasion, consuming at least 600 mg of caffeine (4.8 mg/kg) virtually as a single dose. The additional presence of guarana extract (48 mg per shot in Australia; unspecified in New Zealand) is probably relevant, as guarana is a further source of caffeine and may have other stimulant properties.

Caffeinated drinks are popular among patients being treated for schizophrenia,1 possibly due to partial reversal of the unpleasant effects of dopamine blockade.2 Although case reports3 and a later controlled study4 suggest that high doses of caffeine may exacerbate psychosis, this has only recently been described for energy drinks.5 This case provides naturalistic challenge–dechallenge–rechallenge evidence that some patients with treated schizophrenia may be vulnerable to exacerbation of their illness by such products.

Author

  • David B Menkes1
  • 1. University of Auckland Waikato Clinical School, Hamilton, New Zealand.

Correspondence: david.menkes@waikatodhb.health.nz

References

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