Caffeine and diazepam: separate and combined effects on mood, memory, and psychomotor performance

Pharmacokinetic and pharmacodynamic herb-drug interactions-part I. Herbal medicines of the central nervous system

Unlike conventional drug substances, herbal medicines are composed of a complex of biologically active compounds. Therefore, the potential occurrence of herb-drug interactions is even more probable than for drug-drug interactions. Interactions can occur on both the pharmacokinetic and pharmacodynamic level. Herbal medicines may affect the resulting efficacy of the concomitantly used (synthetic) drugs, mainly on the pharmacokinetic level, by changing their absorption, distribution, metabolism, and excretion. Studies on the pharmacodynamic interactions of herbal medicines and conventional drugs are still very limited. This interaction level is related to the mechanism of action of different plant constituents. Herb-drug interactions can cause changes in drug levels and activities and lead to therapeutic failure and/or side effects (sometimes toxicities, even fatal). This review aims to provide a summary of recent information on the potential drug interactions involving commonly used herbal medicines that affect the central nervous system (Camellia, Valeriana, Ginkgo, Hypericum, Humulus, Cannabis) and conventional drugs. The survey databases were used to identify primary scientific publications, case reports, and secondary databases on interactions were used later on as well. Search keywords were based on plant names (botanical genera), officinal herbal drugs, herbal drug preparations, herbal drug extracts.

Mental Performance and Sport: Caffeine and Co-consumed Bioactive Ingredients

The plant defence compound caffeine is widely consumed as a performance enhancer in a sporting context, with potential benefits expected in both physiological and psychological terms. However, although caffeine modestly but consistently improves alertness and fatigue, its effects on mental performance are largely restricted to improved attention or concentration. It has no consistent effect within other cognitive domains that are important to sporting performance, including working memory, executive function and long-term memory. Although caffeine's central nervous system effects are often attributed to blockade of the receptors for the inhibitory neuromodulator adenosine, it also inhibits a number of enzymes involved both in neurotransmission and in cellular homeostasis and signal propagation. Furthermore, it modulates the pharmacokinetics of other endogenous and exogenous bioactive molecules, in part via interactions with shared cytochrome P450 enzymes. Caffeine therefore enjoys interactive relationships with a wide range of bioactive medicinal and dietary compounds, potentially broadening, increasing, decreasing, or modulating the time course of their functional effects, or vice versa. This narrative review explores the mechanisms of action and efficacy of caffeine and the potential for combinations of caffeine and other dietary compounds to exert psychological effects in excess of those expected following caffeine alone. The review focusses on, and indeed restricted its untargeted search to, the most commonly consumed sources of caffeine: products derived from caffeine-synthesising plants that give us tea (Camellia sinensis), coffee (Coffea genus), cocoa (Theabroma cacao) and guaraná (Paullinia cupana), plus multi-component energy drinks and shots. This literature suggests relevant benefits to mental performance that exceed those associated with caffeine for multi-ingredient energy drinks/shots and several low-caffeine extracts, including high-flavanol cocoa and guarana. However, there is a general lack of research conducted in such a way as to disentangle the relative contributions of the component parts of these products.

Oxidative Stress Mediates Anxiety-Like Behavior Induced by High Caffeine Intake in Zebrafish: Protective Effect of Alpha-Tocopherol

Anxiety is a common symptom associated with high caffeine intake. Although the neurochemical mechanisms of caffeine-induced anxiety remain unclear, there are some evidences suggesting participation of oxidative stress. Based on these evidences, the current study is aimed at evaluating the possible protective effect of alpha-tocopherol (TPH) against anxiety-like behavior induced by caffeine (CAF) in zebrafish. Adult animals were treated with CAF (100 mg/kg) or TPH (1 mg/kg)+CAF before behavioral and biochemical evaluations. Oxidative stress in the zebrafish brain was evaluated by a lipid peroxidation assay, and anxiety-like behavior was monitored using light/dark preference and novel tank diving test. Caffeine treatment evoked significant elevation of brain MDA levels in the zebrafish brain, and TPH treatment prevented this increase. Caffeine treatment also induced anxiety-like behavior, while this effect was not observed in the TPH+CAF group. Taken together, the current study suggests that TPH treatment is able to inhibit oxidative stress and anxiety-like behavior evoked by caffeine.

Positive Allosteric Modulator of GABA Lowers BOLD Responses in the Cingulate Cortex

Knowledge about the neural underpinnings of the negative blood oxygen level dependent (BOLD) responses in functional magnetic resonance imaging (fMRI) is still limited. We hypothesized that pharmacological GABAergic modulation attenuates BOLD responses, and that blood concentrations of a positive allosteric modulator of GABA correlate inversely with BOLD responses in the cingulate cortex. We investigated whether or not pure task-related negative BOLD responses were co-localized with pharmacologically modulated BOLD responses. Twenty healthy adults received either 5 mg diazepam or placebo in a double blind, randomized design. During fMRI the subjects performed a working memory task. Results showed that BOLD responses in the cingulate cortex were inversely correlated with diazepam blood concentrations; that is, the higher the blood diazepam concentration, the lower the BOLD response. This inverse correlation was most pronounced in the pregenual anterior cingulate cortex and the anterior mid-cingulate cortex. For subjects with diazepam plasma concentration > 0.1 mg/L we observed negative BOLD responses with respect to fixation baseline. There was minor overlap between cingulate regions with task-related negative BOLD responses and regions where the BOLD responses were inversely correlated with diazepam concentration. We interpret that the inverse correlation between the BOLD response and diazepam was caused by GABA-related neural inhibition. Thus, this study supports the hypothesis that GABA attenuates BOLD responses in fMRI. The minimal overlap between task-related negative BOLD responses and responses attenuated by diazepam suggests that these responses might be caused by different mechanisms.

Caffeine: cognitive and physical performance enhancer or psychoactive drug?

Caffeine use is increasing worldwide. The underlying motivations are mainly concentration and memory enhancement and physical performance improvement. Coffee and caffeine-containing products affect the cardiovascular system, with their positive inotropic and chronotropic effects, and the central nervous system, with their locomotor activity stimulation and anxiogenic-like effects. Thus, it is of interest to examine whether these effects could be detrimental for health. Furthermore, caffeine abuse and dependence are becoming more and more common and can lead to caffeine intoxication, which puts individuals at risk for premature and unnatural death. The present review summarizes the main findings concerning caffeine’s mechanisms of action (focusing on adenosine antagonism, intracellular calcium mobilization, and phosphodiesterases inhibition), use, abuse, dependence, intoxication, and lethal effects. It also suggests that the concepts of toxic and lethal doses are relative, since doses below the toxic and/or lethal range may play a causal role in intoxication or death. This could be due to caffeine’s interaction with other substances or to the individuals' preexisting metabolism alterations or diseases.

Acute effects of dietary constituents on motor skill and cognitive performance in athletes

Performance in many sports is at least partially dependent on motor control, coordination, decision-making, and other cognitive tasks. This review summarizes available evidence about the ingestion of selected nutrients or isolated compounds (dietary constituents) and potential acute effects on motor skill and/or cognitive performance in athletes. Dietary constituents discussed include branched-chain amino acids, caffeine, carbohydrate, cocoa flavanols, Gingko biloba, ginseng, guarana, Rhodiola rosea, sage, L-theanine, theobromine, and tyrosine. Although this is not an exhaustive list, these are perhaps the most researched dietary constituents. Caffeine and carbohydrate have the greatest number of published reports supporting their ability to enhance acute motor skill and cognitive performance in athletes. At this time, there is insufficient published evidence to substantiate the use of any other dietary constituents to benefit sports-related motor skill or cognitive performance. The optimal dose and timing of caffeine and carbohydrate intake promoting enhanced motor skill and cognitive performance remain to be identified. Valid, reliable, and sensitive batteries of motor skills and cognitive tests should be developed for use in future efficacy studies.

A comparison of the effects of transcranial direct current stimulation and caffeine on vigilance and cognitive performance during extended wakefulness

BACKGROUND

Sleep deprivation from extended duty hours is a common complaint for many occupations. Caffeine is one of the most common countermeasures used to combat fatigue. However, the benefits of caffeine decline over time and with chronic use.

OBJECTIVE

Our objective was to evaluate the efficacy of anodal transcranial direct current stimulation (tDCS) applied to the pre-frontal cortex at 2 mA for 30 min to remediate the effects of sleep deprivation and to compare the behavioral effects of tDCS with those of caffeine.

METHODS

Three groups of 10 participants each received either active tDCS with placebo gum, caffeine gum with sham tDCS, or sham tDCS with placebo gum during 30 h of extended wakefulness.

RESULTS

Our results show that tDCS prevented a decrement in vigilance and led to better subjective ratings for fatigue, drowsiness, energy, and composite mood compared to caffeine and control in sleep-deprived individuals. Both the tDCS and caffeine produced similar improvements in latencies on a short-term memory task and faster reaction times in a psychomotor task when compared to the placebo group. Interestingly, changes in accuracy for the tDCS group were not correlated to changes in mood; whereas, there was a relationship for the caffeine and sham groups.

CONCLUSION

Our data suggest that tDCS could be a useful fatigue countermeasure and may be more beneficial than caffeine since boosts in performance and mood last several hours.

Effects of morning caffeine' ingestion on mood States, simple reaction time, and short-term maximal performance on elite judoists

PURPOSE

The purpose of the present study was to evaluate the ergogenic effect of caffeine ingestion on mood state, simple reaction time, and muscle power during the Wingate test recorded in the morning on elite Judoists.

METHODS

TWELVE ELITE JUDOISTS (AGE: 21.08 ± 1.16 years, body mass: 83.75 ± 20.2 kg, height: 1.76 ±6.57 m) participated in this study. Mood states, simple reaction time, and muscle power during the Wingate test were measured during two test sessions at 07:00 h and after placebo or caffeine ingestion (i.e. 5 mg/kg). Plasma concentrations of caffeine were measured before (T0) and 1-h after caffeine' ingestion (T1) and after the Wingate test (T3).

RESULTS

Our results revealed an increase of the anxiety and the vigor (P<0.01), a reduction of the simple reaction time (P<0.001) and an improvement of the peak and mean powers during the Wingate test. However, the fatigue index during this test was unaffected by the caffeine ingestion. In addition, plasma concentration of caffeine was significantly higher at T1 in comparison with T0.

CONCLUSIONS

In conclusion, the results of this study suggest that morning caffeine ingestion has ergogenic properties with the potential to benefit performance, increase anxiety and vigor, and decrease the simple reaction time.

Methodological considerations for the quantification of self-reported caffeine use

RATIONALE

The field of research regarding the effects of habitual caffeine use is immense and frequently utilizes self-report measures of caffeine use. However, various self-report measures have different methodologies, and the accuracy of these different methods has not been compared.

MATERIALS AND METHODS

Self-reported caffeine use was estimated from two methods (a retrospective interview of weekly caffeine use and a 7-day prospective diary; n = 79). These estimates were then tested against salivary caffeine concentrations in a subset of participants (n = 55).

RESULTS

The estimates of caffeine use (mg/day) from the interview- and diary-based methods correlated with one another (r = 0.77) and with salivary caffeine concentrations (r = 0.61 and 0.68, respectively). However, almost half of the subjects who reported more than 600 mg/day in the interview reported significantly less caffeine use in the diary.

CONCLUSIONS

Self-report measures of caffeine use are a valid method of predicting actual caffeine levels. Estimates of high caffeine use levels may need to be corroborated by more than one method.

Comparing the benefits of caffeine, naps and placebo on verbal, motor and perceptual memory

Caffeine, the world's most common psychoactive substance, is used by approximately 90% of North Americans everyday. Little is known, however, about its benefits for memory. Napping has been shown to increase alertness and promote learning on some memory tasks. We directly compared caffeine (200mg) with napping (60-90min) and placebo on three distinct memory processes: declarative verbal memory, procedural motor skills, and perceptual learning. In the verbal task, recall and recognition for unassociated words were tested after a 7h retention period (with a between-session nap or drug intervention). A second, different, word list was administered post-intervention and memory was tested after a 20min retention period. The non-declarative tasks (finger tapping task (FTT) and texture discrimination task (TDT)) were trained before the intervention and then retested afterwards. Naps enhanced recall of words after a 7h and 20min retention interval relative to both caffeine and placebo. Caffeine significantly impaired motor learning compared to placebo and naps. Napping produced robust perceptual learning compared with placebo; however, naps and caffeine were not significantly different. These findings provide evidence of the limited benefits of caffeine for memory improvement compared with napping. We hypothesize that impairment from caffeine may be restricted to tasks that contain explicit information; whereas strictly implicit learning is less compromised.

Pharmacokinetic and Pharmacodynamic Interactions Between Zolpidem and Caffeine

The kinetic and dynamic interaction of caffeine and zolpidem was evaluated in a double-blind, single-dose, six-way crossover study of 7.5 mg zolpidem (Z) or placebo (P) combined with low-dose caffeine (250 mg), high-dose caffeine (500 mg), or placebo. Caffeine coadministration modestly increased maximum plasma concentration (C(max)) and area under the plasma concentration-time curve of zolpidem by 30-40%, whereas zolpidem did not significantly affect the pharmacokinetics of caffeine or its metabolites. Compared to P+P, Z+P significantly increased sedation, impaired digit-symbol substitution test performance, slowed tapping speed and reaction time, increased EEG relative beta amplitude, and impaired delayed recall. Caffeine partially, but not completely, reversed most pharmacodynamic effects of zolpidem. Thus, caffeine only incompletely reverses zolpidem's sedative and performance-impairing effects, and cannot be considered as an antidote to benzodiazepine agonists.

Midazolam does not inhibit association formation, just its storage and strengthening

RATIONALE

Although there have been many studies examining the effects of benzodiazepines on memory performance, their effects on working memory are equivocal and little is known about whether they affect the efficacy of practice of already learned material.

OBJECTIVES

The objectives in two experiments were to examine (a) whether midazolam impairs performance on a working memory task designed to minimize mnemonic strategies such as rehearsal or chunking of information to be recalled and (b) the effect of midazolam on repeated practice of paired associates that were learned before drug administration.

MATERIALS AND METHODS

Both experiments involved subcutaneous administration of 0.03 mg of saline or midazolam per kilogram of bodyweight in within-subject, placebo-controlled designs, involving 23 subjects in (a) and 31 in (b).

RESULTS

The drug had no effect on the ability to recall the digits in serial order even though the encoding task prevented the digits from being rehearsed or maintained in an articulatory buffer. Paired associates that were learned before the injection showed a benefit of subsequent practice under saline but not under midazolam.

CONCLUSIONS

The results suggest that (a) midazolam does not affect the formation of new associations in short-term memory provided that the presentation rate is not too fast to form these associations when sedated, despite the evidence that the drug blocks long-term memory (LTM) retention of associations; and (b) the potential for over-learning with practice of learned associations in LTM is adversely affected by midazolam such that repeated exposures do not strengthen new learning.

The effect of caffeine on handwriting movements in skilled writers

In laboratory tasks, caffeine has been shown to improve psychomotor performance. The aim of the present experiment was to assess the effects of caffeine on a skilled everyday life task in habitual caffeine consumers. The assessment of handwriting movements of 20 adults was performed following the administration of 0mg/kg (placebo), 1.5mg/kg, 3.0mg/kg or 4.5mg/kg of caffeine. A digitising tablet was used for the assessment of fine motor movements. Participants were asked to perform a simple writing task. Kinematic analysis of handwriting movements showed that, in comparison to placebo administration, high doses of caffeine (i.e., 4.5mg/kg) can produce improvements in handwriting as indicated by more fluent handwriting movements as well as an increase in maximum velocity and maximum positive and negative accelerations. The results suggest that higher doses of caffeine can enhance psychomotor performance.

Diazepam-induced prospective memory impairment and its relation to retrospective memory, attention, and arousal

The amnestic effects of benzodiazepines are well documented on a variety of memory tasks. However, prospective memory (PM), or remembering to execute an action at a future time, has not been studied previously. This study examined the effect of diazepam on word list recall, PM, sustained attention, and subjective ratings of arousal. Forty-eight healthy participants, aged 19-35, received an average of 0.19 mg/kg oral diazepam or placebo in a double-blind manner. Retrospective memory and PM were assessed by free recall of unrelated word lists and by instructing participants to request a hidden belonging at the end of the session, respectively. Sustained attention was measured by multiple trials of a digit cancellation task, and subjective arousal was assessed by self-ratings of drowsiness. Diazepam impaired performance on all measures, including PM. Reduced PM performance was associated with decreased subjective arousal in the diazepam group but was unrelated to sustained attention. This is the first report of the effects of benzodiazepines on prospective remembering, and further supports the view that the arousal/attentional system is composed of partially independent subsystems that have differential relationships to memory.

Adenosine A1 receptors modulate the anxiolytic-like effect of ethanol in the elevated plus-maze in mice

The anxiolytic property of ethanol is generally accepted to be an important motivational factor for its consumption and the development of alcohol dependence. Recent studies suggest that adenosine receptors mediate important actions of ethanol, such as motor incoordination and hypnotic effects. In addition, several lines of evidence support the involvement of adenosine in anxiety. The aim of the present study was to evaluate the role of adenosine receptors in the anxiolytic-like effect of ethanol in mice. The effects of acute administration of the adenosine receptor antagonists caffeine (nonselective), 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, adenosine A1 receptor antagonist) and 4-(2-[7-amino-2-[2-furyl][1,2,4]triazolo-[2,3-a][1,3,5]triazin-5-yl-amino]ethyl)phenol (ZM241385, adenosine A(2A) receptor antagonist), together with the adenosine A1 receptor agonist 2-chloro-N6-cyclopentyladenosine (CCPA), and their interaction with ethanol in the elevated plus-maze test in mice were studied. The highest doses of caffeine (30.0 mg/kg, i.p.) and DPCPX (6.0 mg/kg, i.p.) produced an anxiogenic-like effect, while CCPA administration (0.25 mg/kg, i.p.) showed an anxiolytic-like activity. The prior administration of "non-anxiogenic" doses of caffeine (10.0 mg/kg, i.p.) and DPCPX (3.0 mg/kg, i.p.), but not ZM241385 (1.0 mg/kg, i.p.), significantly reduced the anxiolytic-like effect of ethanol (1.2 g/kg, i.p.). Moreover, anxiolytic-like response was observed by the co-administration of "non-anxiolytic" doses of CCPA (0.125 mg/kg) and ethanol (0.6 g/kg). These results reinforce the involvement of adenosine in anxiety and suggest that the activation of adenosine A1 receptors, but not adenosine A(2A) receptors, mediate the anxiolytic-like effect induced by ethanol in mice.

Reliability of the bipolar form of the profile of mood states using an alternative test protocol

The bipolar version of Profile of Mood States was completed by 124 participants (58 women and 66 men, M age 26.5, SD=3.9 yr.) on two occasions--once when the measure was self-administered according to that test protocol and once when POMS-BI items were projected onto a screen with participants being asked to provide oral responses to items. Data from both modes of administration provided similar support for the internal consistency of the measure (alpha values ranged from .78 to .90).

The neurobiology and control of anxious states

Fear is an adaptive component of the acute "stress" response to potentially-dangerous (external and internal) stimuli which threaten to perturb homeostasis. However, when disproportional in intensity, chronic and/or irreversible, or not associated with any genuine risk, it may be symptomatic of a debilitating anxious state: for example, social phobia, panic attacks or generalized anxiety disorder. In view of the importance of guaranteeing an appropriate emotional response to aversive events, it is not surprising that a diversity of mechanisms are involved in the induction and inhibition of anxious states. Apart from conventional neurotransmitters, such as monoamines, gamma-amino-butyric acid (GABA) and glutamate, many other modulators have been implicated, including: adenosine, cannabinoids, numerous neuropeptides, hormones, neurotrophins, cytokines and several cellular mediators. Accordingly, though benzodiazepines (which reinforce transmission at GABA(A) receptors), serotonin (5-HT)(1A) receptor agonists and 5-HT reuptake inhibitors are currently the principle drugs employed in the management of anxiety disorders, there is considerable scope for the development of alternative therapies. In addition to cellular, anatomical and neurochemical strategies, behavioral models are indispensable for the characterization of anxious states and their modulation. Amongst diverse paradigms, conflict procedures--in which subjects experience opposing impulses of desire and fear--are of especial conceptual and therapeutic pertinence. For example, in the Vogel Conflict Test (VCT), the ability of drugs to release punishment-suppressed drinking behavior is evaluated. In reviewing the neurobiology of anxious states, the present article focuses in particular upon: the multifarious and complex roles of individual modulators, often as a function of the specific receptor type and neuronal substrate involved in their actions; novel targets for the management of anxiety disorders; the influence of neurotransmitters and other agents upon performance in the VCT; data acquired from complementary pharmacological and genetic strategies and, finally, several open questions likely to orientate future experimental- and clinical-research. In view of the recent proliferation of mechanisms implicated in the pathogenesis, modulation and, potentially, treatment of anxiety disorders, this is an opportune moment to survey their functional and pathophysiological significance, and to assess their influence upon performance in the VCT and other models of potential anxiolytic properties.

Effects of caffeine on human behavior

The literature suggests that the following effects on behavior of adult humans may occur when individuals consume moderate amounts of caffeine. (1) Caffeine increases alertness and reduces fatigue. This may be especially important in low arousal situations (e.g. working at night). (2) Caffeine improves performance on vigilance tasks and simple tasks that require sustained response. Again, these effects are often clearest when alertness is reduced, although there is evidence that benefits may still occur when the person is unimpaired. (3) Effects on more complex tasks are difficult to assess and probably involve interactions between the caffeine and other variables which increase alertness (e.g. personality and time of day). (4) In contrast to the effects of caffeine consumption, withdrawal of caffeine has few effects on performance. There is often an increase in negative mood following withdrawal of caffeine, but such effects may largely reflect the expectancies of the volunteers and the failure to conduct "blind" studies. (5) Regular caffeine usage appears to be beneficial, with higher users having better mental functioning. (6) Most people are very good at controlling their caffeine consumption to maximise the above positive effects. For example, the pattern of consumption over the day shows that caffeine is often consumed to increase alertness. Indeed, many people do not consume much caffeine later in the day since it is important not to be alert when one goes to sleep. In contrast to effects found from normal caffeine intake, there are reports that have demonstrated negative effects when very large amounts are given or sensitive groups (e.g. patients with anxiety disorders) were studied. In this context caffeine has been shown to increase anxiety and impair sleep. There is also some evidence that fine motor control may be impaired as a function of the increase in anxiety. Overall, the global picture that emerges depends on whether one focuses on effects that are likely to be present when caffeine is consumed in moderation by the majority of the population or on the effects found in extreme conditions. The evidence clearly shows that levels of caffeine consumed by most people have largely positive effects on behavior. Excessive consumption can lead to problems, especially in sensitive individuals.

Caffeine (4 mg/kg) influences sustained attention and delayed free recall but not memory predictions

This experiment was conducted to examine the influence of a moderate dose of caffeine (4 mg/kg) on delayed memory, metamemory, and sustained attention. One hundred and forty-two volunteers ingested either caffeine or placebo during a study session which included three different memory tasks (free recall, cued recall, and recognition), and they made predictions of future memory performance. On day 2, participants again ingested either caffeine or placebo and completed memory tests. Sustained attention performance was measured on both days, and caffeine reliably improved hit rates and response latencies. A reliable drug-state interaction was detected only in the free recall test of memory. Caffeine did not affect the magnitude or accuracy of memory predictions, but there was some evidence that expectancies about caffeine were related to cognitive performance. Overall, caffeine's impact on memory and metamemory was not robust in this study. Copyright 2001 John Wiley & Sons, Ltd.

The plus-maze discriminative avoidance task: a new model to study memory-anxiety interactions. Effects of chlordiazepoxide and caffeine

The plus-maze discriminative avoidance paradigm is a new animal model of learning/memory that provides simultaneous information about anxiety. Mice are conditioned to choose between the two enclosed arms (in one of which light and noise are presented as aversive stimuli) while avoiding the two open arms of the apparatus. The test has the advantage of measuring, at the same time and in the same animals, learning/memory (by the percent time spent in aversive enclosed arm - PTAV) and anxiety (by the percent time spent in the open arms - PTO). The effects of chlordiazepoxide and caffeine on learning/memory and anxiety of mice tested in this paradigm were investigated. Chlordiazepoxide (5 mg/kg) significantly increased and caffeine (20 mg/kg) significantly decreased PTO during the training session, suggesting an anxiolytic and an anxiogenic effect, respectively. In the test session, chlordiazepoxide- or caffeine-treated mice presented higher PTAV, suggesting amnestic effects. Given together, chlordiazepoxide plus caffeine did not alter PTO, and the amnesic effect produced by each drug was no longer observed. It is concluded that learning/memory depends on an optimum emotional level. The plus-maze discriminative avoidance model appears to be a useful test to investigate this critical relationship between learning/memory and anxiety.

Clinical pharmacology of psychotropic drugs

No Abstract

Effects of a new slow release formulation of caffeine on EEG, psychomotor and cognitive functions in sleep-deprived subjects

Caffeine is a widely-consumed psychoactive substance whose stimulant effects on mood, attention and performance are largely recognised. The central nervous system pharmacodynamic profile of a single oral dose of a new slow release (SR) caffeine formulation (600 mg) was assessed in a randomised, double-blind, crossover, placebo-controlled study. Twelve young, health, male, sleep-deprived (for 36 h) subjects were studied using EEG and various measures of psychomotor and cognitive functions, including critical flicker fusion (CFF), choice reaction task (CRT), tracking, continuous performance task (CPT), Stroop test, body sway and subjective evaluation (Stanford Sleepiness Scale). Caffeine significantly ( < 0/05) antagonised the detrimental effects of sleep-deprivation on EEG (i.e. produced a significant decrease in delta and theta relative power and a significant increase in alpha and beta (12-40 Hz) relative power) and psychomotor performance (significant increase in speed of reaction on the CRT and Stroop tests, significant decrease in body sway, significant increase in accuracy of the CPT and significant reduction in subjective sedation) compared to placebo. The effect peaked 4 h after dosing and was maintained until the end of sleep deprivation (i.e. 24 h after dosing). In conclusion, the present results demonstrate that a single dose of caffeine SR possesses alerting effects which are able to reverse the deleterious effect of 36 h sleep deprivation for at least 24 h. Copyright 2000 John Wiley & Sons, Ltd.

The effect of caffeine in animal models of learning and memory

In the present investigation we studied the effect of caffeine on memory task inhibitory avoidance and habituation to a new environment. Caffeine impaired retention scores in mice submitted to inhibitory avoidance and habituation when administered 30 min before training at the doses of 10-30 mg/kg. These effects cannot be explained by state-dependency since the administration of caffeine 30 min before the test session did not reverse the effect of pre-training caffeine administration, but can more probably be explained by an impairment in the acquisition or by interference with attentional processes. On the other hand, caffeine improved the inhibitory avoidance (but not habituation) retention scores when administered immediately after the training or 30 min before the test session at the doses of 1-30 mg/kg or 3-10 mg/kg, respectively. These results suggest that caffeine differentially affects the different stages of memory processing and that this effect depends on particularities of the memory task under study.

Comparative behavioural effects of benzodiazepine and non-benzodiazepine anxiolytics in rhesus monkeys

Quantitative behavioural assessment of benzodiazepines (chlordiazepoxide, diazepam and lorazepam) and non-benzodiazepines (buspirone) anxiolytics were investigated in unrestrained rhesus monkeys (Macaca mulatta) living in social colonies. The different behaviour, categorised as social, solitary and abnormal were video recorded and analysed. Chlordiazepoxide (2.5-5 mg kg-1, p.o.), diazepam (2.5-5 mg kg-1, p.o.) and lorazepam (0.5-1 mg kg-1, p.o.) induced dose-dependent significant changes in certain social and solitary behavioural responses. Thus increases in social grooming, approach, contact, self grooming, feeding and resting with eyes open and decreased aggressiveness and vigilance. On the other hand buspirone (5-10 mg kg-1, p.o.) produced no significant alteration in social and solitary behavioural patterns. On the basis of the above findings the social and solitary behaviour protocol in non-human primates can be a useful tool for studying the effect of a new anxiolytic compound before clinical trial.

Caffeine effects on perceptual and motor processes

The effects of a single dose of caffeine on specific information processing operations were examined by using a visual selective attention task in which subjects were asked to select between a left and right hand response on the basis of two different target letters. The target was presented on a predefined position in the visual field and was either presented alone or with flanker letters, calling for the correct, the incorrect or no specific response. A dose of 3 mg/kg body weight caffeine or lactose, dissolved in a cup of decaffeinated coffee, was administered double blind and deceptively to overnight abstinence coffee drinkers. Behavioural measures were supplemented by psychophysiological measures. The present results replicated the basic findings obtained in this paradigm. The results indicated that the time to localise the target decreased and response preparation started earlier after caffeine than after placebo. These caffeine effects did not interact with the time subjects spent on the task or with the reaction time distribution, which might be due to a high level of practice.

Alprazolam, caffeine and their interaction: relating DRL performance to pharmacokinetics

Three-hour sessions of differential reinforcement of low-rate behavior (DRL 45-s) in rats were used to investigate alprazolam, caffeine, and their interactions at the onset, peak and disappearance of serum alprazolam, while caffeine level remained constant. The dose-response curve (DRC) method of Pöch permitted an extensive evaluation of the kind (additivity or independence) of interactions occurring in combined drug effects. The alprazolam and caffeine DRCs were used to derive theoretical additive and independent relations, and the observed combined effects compared to these functions. Behavior-time profiles of the combined effects were similarly compared. Serum alprazolam and caffeine concentrations correlated with their respective behavior-time profiles. No acute tolerance was observed either for the individual drugs or their combinations. Alprazolam was more potent than caffeine in disrupting DRL behavior. Because alprazolam is much shorter-lived (t1/2 = 32 min) than caffeine (t1/2 = 3 h) in rats, potency ratios between alprazolam and caffeine changed across session time (from 123 to 4), which determined the expression of the combined effects. Although the combined effects were not distinguishable in terms of additivity or independence in both the DRCs and in the behavior-time profiles, they showed neither synergism nor antagonism. The pharmacokinetics of alprazolam were not altered by caffeine, but those of caffeine were affected by alprazolam.

Mood and performance effects of caffeine in relation to acute and chronic caffeine deprivation

The mood and performance effects of caffeine deprivation (either 90 min, overnight, or at least 7 days) and ingestion (70 and 250 mg) were compared in young adults who were normally either moderate consumers (n = 49) or nonconsumers of caffeine (n = 18). Overnight caffeine deprivation produced dysphoric symptoms characteristic of caffeine withdrawal that were reduced, but still present, after longer-term abstinence. Acute caffeine intake affected the withdrawn consumers, nonwithdrawn consumers, and nonconsumers similarly. It increased jitteriness and decrease tiredness and headache. Furthermore, hand steadiness decreased as caffeine dose increased, whereas 70 mg, but not 250 mg, of caffeine was found to enhance performance on a simple reaction time task. These findings support the view that the negative effects experienced after overnight and longer-term caffeine deprivation play a significant role in influencing consumption of caffeine-containing drinks. Therefore, it would appear that to avoid the dysphoric symptoms resulting from both under- and overconsumption, regular caffeine consumers would have to regulate their caffeine intake fairly precisely.

Anxiolytic activity of adenosine receptor activation in mice

1. Purine analogues have been examined for anxiolytic- and anxiogenic-like activity in mice, by use of the elevated plus-maze. 2. The selective A1 receptor agonist, N6-cyclopentyladenosine (CPA) had marked anxiolytic-like activity at 10 and 50 microg kg(-1), with no effect on locomotor performance at these doses. 3. The A1 selective adenosine receptor antagonist, 1,3-dipropyl-8-cyclopentylxanthine (CPX) had no significant effect on anxiety-related measures or locomotor behaviour, but blocked the anxiolytic-like activity of CPA. The hydrophilic xanthine, 8-(p-sulphophenyl) theophylline did not prevent anxiolysis by CPA. 4. Caffeine had anxiogenic-like activity at 30 mg kg(-1) which was prevented by CPA at 50 micro kg(-1). 5. The A2 receptor agonist, N6-[2-(3,5-dimethoxyphenyl)-2(2-methylphenyl)-ethyl]adenosine (DPMA) had no effect on anxiety behaviour but depressed locomotor activity at the highest dose tested of 1 mg kg(-1). The A2 receptor antagonist, 1,3-dimethyl-l-propargylxanthine (DMPX) had no effect on anxiety-related measures or locomotion and did not modify the anxiolytic-like activity of CPA. 6. Administration of DPMA in combination with anxiolytic doses of CPA prevented the anxiolytic-like activity of the latter. 7. The results suggest that the selective activation of central A1 adenosine receptors induces anxiolytic-like behaviour, while the activation of A2 sites causes locomotor depression and reduces the effects of A1 receptor activation. The absence of any effect of CPX alone suggests that the receptors involved in modulating behaviour in the elevated plus-maze in mice are not activated tonically by endogenous adenosine.

The effects of different doses of caffeine on habituation of the human acoustic startle reflex

Research in this laboratory showed that caffeine (4 mg/kg) delays habituation of the acoustic startle reflex in humans. The present study examined the effects of 2- and 6-mg/kg doses of caffeine on acoustic startle habituation in moderate-high and low caffeine users. Eyeblink responses to 30 trials of 85-dB noise stimuli were measured beginning 30 min after oral ingestion of either placebo or 2 or 6 mg/kg of caffeine. The 2-mg/kg dose of caffeine delayed startle habituation in both moderate-high and low caffeine users. The 6-mg/kg dose produced no differential effects on startle responding from placebo. In moderate-high users, following habituation, startle responding was smaller in the placebo condition compared to both caffeine conditions. In low users there were no differences in posthabituation responding between doses, suggesting that this dose effect is dependent on a history of chronic caffeine usage.

Caffeine and smoking: subjective, performance, and psychophysiological effects

The effects of caffeine and smoking on cognitive performance, subjective variables, heart rate, and EEG were assessed in two sessions. In one session, subjects received caffeine (2.5 mg/kg bodyweight), while in the other they received placebo. In both sessions they smoked a cigarette (8 cued puffs) having a nicotine yield of 1.2 mg. Caffeine produced an increase in self-reported muscular tension and tended to increase anxiety and delta magnitude. Smoking facilitated performance of a paper-and-pencil math task and increased heart rate. Smoking also appeared to produce cortical activation as indexed by decreased right frontal delta, decreased right centro-parietal theta, globally increased alpha, and increased centro-occipital/decreased posterior-temporal beta 1. Smoking also increased central/decreased posterior-temporal beta 2. Smoking and caffeine did not interact for any measure, suggesting that the epidemiological link between smoking and coffee drinking may have a non-pharmacological basis.

Perceptual masking of the chlordiazepoxide discriminative cue by both caffeine and buspirone

Twelve male Sprague-Dawley rats were trained to discriminate between the interoceptive stimulus attributes of 5 mg/kg chlordiazepoxide (CDP) and saline in a two-lever operant task under a fixed-ratio 10 (FR-10) schedule of food reinforcement. Caffeine, buspirone, and Ro 15-1788 failed to engender complete generalization when tested in combination with saline. In drug interaction test sessions caffeine (56 mg/kg) blocked the discriminative stimulus properties of the training dose of CDP and shifted the CDP discriminative dose-response function to the right. This rightward shift in CDP discriminative function was paralleled by a concomitant downward shift in the rate-of-responding dose-response function. Drug interaction test sessions conducted with 3.2 mg/kg of buspirone in combination with various doses of CDP engendered a downward shift in both the discriminative and rate-of-responding dose-response functions. Because 3.2 mg/kg buspirone in combination with the training dose of CDP resulted in complete response rate suppression, additional combination tests were conducted with 3 mg/kg CDP, a dose which reliably engendered > 90% CDP-appropriate responding, and various doses of buspirone. Similar to the CDP-caffeine interactions, buspirone blocked the cueing properties of 3 mg/kg CDP with a parallel reduction in response rates. Interaction test sessions conducted with Ro 15-1788 and CDP resulted in rightward shifts in both the discriminative and rate functions of CDP. We suggest that the interactions between CDP and both caffeine and buspirone resulted from the perceptual masking of the interoceptive (subjective) effects of CDP, whereas the interaction between Ro 15-1788 and CDP reflect pharmacological antagonism.

Effects of chronic administration of adenosine A1 receptor agonist and antagonist on spatial learning and memory

Spatial memory acquisition in Morris water maze was tested in C57BL/6 mice. Animals were injected once daily with different doses of either N6-cyclopentyladenosine (CPA) or 8-cyclopentyl-1,3-dipropylxanthine (CPX). Drugs were administered for 9 days either concurrently with water maze testing (drugs injected 1 h after each trial), or prior to the entire block of trials. In the latter case, 1 day without injections preceded water maze experiments. Chronic administration of CPA resulted in a significant, dose-dependent reduction of target latencies, rapid development of spatial preference, and the absence of animals unable to perform the task. CPX treated animals did not show significant performance changes, and failed to develop spatial preference. Locomotor disturbances were not the cause of the observed effects. Our results indicate that chronic treatment with agents acting at adenosine A1 receptors results in behavioral effects that are significantly different from those observed following their acute administration. Therefore, particular caution is required in development of adenosine-based strategies targeted at neurodegenerative or cognitive disorders in which chronic treatment is advocated.

Effects of caffeine and gender on physiology and performance: further tests of a biobehavioral model

The present study extended testing of our biobehavioral model describing the effects of arousal and caffeine to include an examination of gender differences and their interactions with habitual and acute caffeine ingestion. Males and females selected as high or low habitual caffeine users were randomly assigned to receive either caffeine or a placebo and exposed to novel and repetitive recall tasks and to simple auditory stimuli. Electrodermal activity and recall task performance were recorded. The four major factors examined, including habitual caffeine use, acute ingestion, gender, and stimulus novelty, affected behavior, physiology, or both. Results showed that habitual caffeine usage systematically affected tonic arousal (skin conductance level) and improved recall task performance. Acute caffeine ingestion increased phasic arousal (skin conductance response amplitude) and reduced habituation rates. Gender interacted with other factors to significantly affect both tonic and phasic arousal, and females performed better than males on the recall tasks. These results were partially supportive of the theoretical model, and further work is needed to examine the interactions of acute and chronic caffeine intake with gender and novelty.

Caffeine reversal of sleep deprivation effects on alertness and mood

This study assessed the ability of high doses of caffeine to reverse changes in alertness and mood produced by prolonged sleep deprivation. Fifty healthy, nonsmoking males between the ages of 18 and 32 served as volunteers. Following 49 h without sleep, caffeine (0, 150, 300, or 600 mg/70 kg, PO) was administered in a double-blind fashion. Measures of alertness were obtained with sleep onset tests, the Stanford Sleepiness Scale (SSS), and Visual Analog Scales (VAS). Sleep deprivation decreased onset to sleep from a rested average of 19.9 min to 7 min. Following the highest dose of caffeine tested, sleep onset averaged just over 10 min; sleep onset for the placebo group averaged 5 min. Scores on the SSS increased from a rested mean of 1.6-4.8 after sleep deprivation. Caffeine reduced this score to near rested values. Caffeine reversed sleep deprivation-induced changes in three subscales of the POMS (vigor, fatigue, and confusion) and produced values close to fully rested conditions on several VAS. Serum caffeine concentrations peaked 90 min after ingestion and remained elevated for 12 h. This study showed that caffeine was able to produce significant alerting and long-lasting beneficial mood effects in individuals deprived of sleep for 48 h.

Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects

Caffeine is the most widely consumed central-nervous-system stimulant. Three main mechanisms of action of caffeine on the central nervous system have been described. Mobilization of intracellular calcium and inhibition of specific phosphodiesterases only occur at high non-physiological concentrations of caffeine. The only likely mechanism of action of the methylxanthine is the antagonism at the level of adenosine receptors. Caffeine increases energy metabolism throughout the brain but decreases at the same time cerebral blood flow, inducing a relative brain hypoperfusion. Caffeine activates noradrenaline neurons and seems to affect the local release of dopamine. Many of the alerting effects of caffeine may be related to the action of the methylxanthine on serotonin neurons. The methylxanthine induces dose-response increases in locomotor activity in animals. Its psychostimulant action on man is, however, often subtle and not very easy to detect. The effects of caffeine on learning, memory, performance and coordination are rather related to the methylxanthine action on arousal, vigilance and fatigue. Caffeine exerts obvious effects on anxiety and sleep which vary according to individual sensitivity to the methylxanthine. However, children in general do not appear more sensitive to methylxanthine effects than adults. The central nervous system does not seem to develop a great tolerance to the effects of caffeine although dependence and withdrawal symptoms are reported.

Selective dissociations of sedation and amnesia following ingestion of diazepam

Forty-eight healthy volunteers received 0.2 mg/kg oral diazepam or a placebo in a double-blind manner. The effect of the drug on memory was assessed by the free recall of unrelated word lists, and arousal was assessed by subjective ratings of drowsiness, multiple trials of a digit cancellation task, and the rate at which subjects rehearsed aloud items from the word lists. As expected, diazepam, depressed both memory functioning and all three measures of arousal. However, within the diazepam group, rehearsal rate was the only arousal measure that correlated with performance on the recall task. When looking at change scores, or the degree to which performance deteriorated from baseline to the diazepam condition, digit cancellation reduction was the only arousal measure that correlated with recall deterioration. Analyses also revealed that the three arousal measures did not correlate with each other. Results support the view that the arousal/attentional system is composed of partially independent subsystems with varying relationships to memory functioning.

Effects of caffeine, time of day and user history on study-related performance

The individual and interactive effects of caffeine, time of day and history of caffeine consumption on several study-related tasks were investigated in 25 subjects (6 males, 19 females). Performance was measured on short term memory (STM), mental arithmetic (MA), reading comprehension, serial search (SS) and verbal reasoning (VR). Subjects attended eight experimental sessions, at four times of day (0100, 0700, 1300 and 1900 hours), after ingesting caffeine (4 mg/kg) or placebo. Subjects were assigned to a low, moderate or high user group on the basis of a caffeine consumption questionnaire. Reading comprehension was affected by time of day, while caffeine improved performance on all mental speed-related tasks. High caffeine users performed more poorly than other groups on the verbal reasoning task. Several interactions between the three independent variables were observed on a number of tasks, supporting the contention that different processes underlying various types of cognitive performance are differentially, and often jointly, affected by caffeine, time of day and user history. Implications of caffeine usage on academic performance were discussed.

Sustained synergism by chronic caffeine of the motor control deficit produced by midazolam

To evaluate the effects of chronic caffeine on the impairment of discriminative fine motor control produced by midazolam, rats were trained to hold a force transducer steady to deliver food pellets. Chronic, daily doses of midazolam (3 mg/kg SC) led to a stable level of motor impairment. Chronic caffeine (20 mg/kg IP) alone usually produced a more moderate deficit or, for one animal, no deficit. Combined, chronic administration of these doses yielded a sustained synergism in motor performance impairment, which contrasted with the antagonism usually found between the benzodiazepines and methylxanthines when performance is evaluated by psychomotor tests not requiring fine motor control. The observed synergism was not explicable in terms of measured disposition of the drugs. The synergistic production of fine motor dyskinesia by the concurrent administration of caffeine and midazolam may be relevant to the triggering of anxiety attacks by caffeine observed in panic disorder patients.

Synergism by caffeine and by cocaine of the motor control deficit produced by midazolam

To evaluate the effects of caffeine and cocaine on the impairment of discriminative motor control produced by midazolam, rats were trained to hold a force transducer operated with a paw so that it remained between upper and lower limits of a force band for a continuous 1.5-s period to deliver each food pellet. Acute doses of 3 mg/kg midazolam SC impaired motor performance. Except for one animal, caffeine (10-40 mg/kg IP) had little or no effect on performance, while cocaine (3.75-22.5 mg/kg IP) produced dose-related impairment. When each dose of caffeine was combined with 3 mg/kg midazolam, a marked synergism in motor performance impairment occurred. Cocaine plus midazolam produced mainly an additive synergism. The conspicuous synergistic action of caffeine on the motor control deficit produced by midazolam contrasts with the typical antagonism found between the benzodiazepines and methylxanthines when performance is evaluated by psychomotor tests not requiring fine motor control.