Energy Drinks May Triple Suicide Risk, Coffee Does the Opposite

A meta-analysis of more than 1.5 million participants has suggested that coffee and energy drinks have opposing effects on suicide risk. High coffee consumption more than 60 cups per month was linked to significantly reduced suicide attempts, probably because of its stimulating and mood-enhancing properties. In contrast, even a single can of an energy drink per month was observed to increase the risk for suicidal thoughts and attempts, with a dose-dependent effect that can triple the risk at higher consumption levels.

This difference may be explained by the presence of other psychoactive ingredients in energy drinks such as taurine, guarana, and ginseng along with their high sugar content, which can trigger anxiety and mood swings, particularly in young men, who are the primary consumers.

Medscape’s French edition spoke with Guillaume Davido, MD, a psychiatrist specializing in addiction studies at Bichat-Claude Bernard Hospital in Paris, about the findings of this study.

Why do you think this study is of particular interest?

The results are quite striking: Suicide attempts were 30% lower among coffee drinkers compared with energy drink consumers.

This meta-analysis is also interesting because it encourages us to be more nuanced about the effects of caffeine and to clearly distinguish caffeinated energy drinks from coffee. It seems that coffee, despite being a stimulant, does not increase suicide risk. This is, to say the least, surprising. For me, it is almost a revelation.

Why does this protective effect of caffeine surprise you?

The idea that caffeine could improve suicide risk is quite counterintuitive. Not to mention that many publications discuss caffeine's effects in psychiatry, particularly its effect on sleep quality: The less we sleep, the more stressed and impulsive we are, and the more likely we are to develop depressive comorbidities. Depressive comorbidities imply suicidal risk. Psychiatric disorders would be more destabilized in patients who consume caffeine.

We thought it was mainly the “caffeine” aspect of energy drinks that could potentially increase these types of disorders, yet this study rather concludes a protective effect of caffeine.

However, it is not surprising that energy drinks are linked to higher suicide risk, given that their consumption is associated with more addictive and psychiatric comorbidities. Until now, there was no specific research on suicide, but this seems plausible.

Beyond caffeine, how do you explain the potential link between suicide risk and energy drink consumption?

The meta-analysis cites publications on psychiatric comorbidity risk factors and suicide risk that are aggravated by energy drink consumption. They specifically mention taurine, guarana, or ginseng, which may promote anxiety. Nevertheless, current literature remains very cautious about the real toxicity of these substances. It also seems important to keep in mind that energy drink consumption [sometimes] occurs within an overall risky lifestyle, which likely partly explains the observed associations.

What about effects on the microbiome and gut-brain axis?

It is true that coffee has antioxidant effects and benefits on the microbiome. Caffeine could positively affect mood. In contrast, other components of energy drinks, notably sugar, have a harmful effect on the microbiome. For example, one study showed that regular energy drink consumption decreased the expression of bacterial genes beneficial for mood and reduced microbial diversity in the gut.

Do you consider the coffee-vs-energy drink comparison in this study to be solid?

It is interesting but has its limits. In the meta-analysis, the amount of coffee — and by extension, caffeine — is well defined, with a threshold of 60 cups per month, whereas for energy drinks, quantities are less clear, described as one can. A cup of coffee is about 200 mL, and a can of an energy drink represents roughly two cups of coffee. We know that these drinks contain more caffeine than coffee or other conventional cola-based drinks, with content ranging from 75 to 300 mg per beverage. Moreover, energy drink enthusiasts consume large amounts, often unaware of how much caffeine they ingest.

This raises questions about the meta-analysis results: Are coffee drinkers protected by caffeine, or do they simply consume less than energy drink users? Publications highlighting psychiatric risks associated with coffee indicate that moderate consumption is generally safe. There may even be a neuroprotective effect. So having two cups of coffee per day does not seem problematic.

What about the population consuming energy drinks?

This is also a limitation noted by the meta-analysis authors. We know that people who regularly consume energy drinks do not have the same profile as “classic” coffee drinkers. They are mostly young men. Suicide risk is higher among young men, and energy drink consumers sometimes also use other substances; there is a well-established link in the literature between energy drinks and addictive substances. Patients with addictive issues also have increased suicide risk. Therefore, further exploration of this population is needed.

But for me, this is also one of the main interests of this study: It is important to understand this bidirectional link between energy drink consumers and suicidal patients. In consultations, use of energy drinks should be seen as a “red flag.” Whether in general medicine or psychiatry, if a patient consults for psychological concerns, it is relevant to assess energy drink consumption because it may indicate other issues: They may also be consuming other substances or have a risky lifestyle, which allows discussion of lifestyle habits. They may crave large amounts of sugar or have an eating disorder like binge eating. Sugar is known to be depressogenic and causes metabolic complications, which in turn lead to psychiatric complications. Identifying these behaviors helps detect other associated risks, such as metabolic syndrome or fatty liver disease from excessive sugar consumption.

Do you ask your patients about energy drink consumption?

Not enough! In sleep-focused consultations, this question should be systematically included to assess overall caffeine intake. In my practice at the hospital and psychiatric emergency unit, I do not routinely ask during the initial consultation, as we primarily manage acute crises. However, it becomes relevant during follow-up or at the end of care. The goal is not to demonize caffeine but to address it appropriately. In anxious patients, we recommend limiting stimulants and avoiding consumption after 4 PM, as it can worsen anxiety or disrupt sleep. More broadly, general practice screening for anxiety disorders should include detailed questions about caffeine and energy drink intake.

Are there potential interactions between energy drinks and psychiatric medications?

At the molecular level, interactions exist but are debatable. If you consume caffeine with an antidepressant or antipsychotic, you do not necessarily experience harmful effects, but some publications report interactions with clozapine, an antipsychotic used as a last-resort treatment for treatment-resistant schizophrenia. Caffeine may modestly increase clozapine levels.

Also, caffeine and most psychotropics share hepatic metabolism, with enzymes such as CYP1A2 involved in caffeine metabolism. But whether this results in mental effects from concomitant intake cannot be firmly stated.

Nevertheless, blood glucose and clozapine levels could be affected in heavy energy drink consumers, and monitoring may be warranted, though evidence of health impact remains unclear.

For antidepressants, no known interactions exist.

Finally, it is recommended not to consume energy drinks or coffee when taking sedatives, as it would be like pressing the accelerator and brake simultaneously. Identifying such consumption is important in patients prescribed hypnotics.

In conclusion, what do you take away from this study?

I think the authors of this meta-analysis did not necessarily intend to highlight a protective effect of coffee but rather to assess whether caffeine, in coffee or energy drinks, impacts suicide risk. They found, somewhat surprisingly, a significant difference between the two groups of consumers.

In practice, I take away that:

• Caffeine may offer a protective effect against suicide risk when consumed in moderation. In contrast, very high doses such as those found in large quantities of energy drinks may increase this risk. For example, someone consuming 15 cups of coffee per day is unlikely to experience the protective benefits, given the impact on sleep and other metabolic functions, including cardiovascular effects.

• Close attention should be paid to energy drink consumers, and patients should be questioned, as this type of consumption may be associated with multiple comorbidities, including addictive substances, metabolic syndrome, and suicidality.

Note: This article originally appeared on Medscape.