Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Thursday, January 15, 2009
The Human Experiment
There are things to do about symptomatic distress in addition to medications and therapy. I often encourage people to make themselves their own human experiments. There are a few things we can change easily: we alter our diets, sleep, exercise, and the assorted "substances" we ingest. I sometimes suggest to people that they do 2 week trials and see if something helps. Is your life better if you stop drinking for a couple of weeks, exercise mor or less, give up food additives, decrease the carbs in your diet, cut out or add caffeine? Pick a variable, change it for a time, and see if you feel better.
That being said, I've been having some trouble sleeping. I decided I'd take my own advice and change some things. Oh, but you know, I'm an impatient sort of soul, and I decided to change a few things all at once. They didn't seem like big things: I decided to cut out all alcohol and caffeine from my diet, to set the alarm for earlier in the morning and get up and exercise in the hopes of exhausting myself. I started on a Monday, not a day of the week I typically drink alcohol anyway, and also not a day I usually have time to exercise. And caffeine, well...a cup of java in the morning, maybe two, and a Diet Coke with dinner, maybe another during the day or maybe not. And I've gone months at a time without Diet Coke. I like it, but it's not the hardest thing to give up. Have I noticed that I feel better or sleep differently without soda? No. But this time, I'm giving up coffee, too.
5:45 AM, the alarm goes off, and 4 miles later, I begin my day, without coffee. No caffeine. No chocolate. No diet coke.
6:15 AM Tuesday, and this is a day I normally exercise. Only I'm dragging, and it was an uninspired work out. By afternoon, I'm feeling really lousy. My head aches. I'm tired and fatigued, and I really can't sleep that night. It's the sleep deprivation, I think, getting up earlier than I usually do, after a night when I've had trouble falling asleep. Ugh.
By Wednesday morning, my head has ached for 2 days, and while I'm caffeine & nutrisweet free, I'm now downing Tylenol and Motrin but my head still hurts. It finally occurs to me that I'm in caffeine withdrawal. But I was never addicted! How can I be withdrawing? I look this up and realize this can last for up to 9 days. Suddenly it seems sort of ridiculous that I've changed multiple variables at once, and even worse that I've given up caffeine cold turkey.
So Caffeine Withdrawal is an official DSM psychiatric diagnosis. From the Johns Hopkins Medicine:
The researchers identified five clusters of common withdrawal symptoms: headache; fatigue or drowsiness; dysphoric mood including depression and irritability; difficulty concentrating; and flu-like symptoms of nausea, vomiting and muscle pain or stiffness. In experimental studies, 50 percent of people experienced headache and 13 percent had clinically significant distress or functional impairment -- for example, severe headache and other symptoms incompatible with working. Typically, onset of symptoms occurred 12 to 24 hours after stopping caffeine, with peak intensity between one and two days, and for a duration of two to nine days. In general, the incidence or severity of symptoms increased with increases in daily dose, but abstinence from doses as low as 100 milligrams per day, or about one small cup of coffee, also produced symptoms.
Wednesday morning, I have a half a cup of coffee. Within a half hour, my headache is gone and my energy level is normal, I feel like myself again. I go for a swim and sit in the hot whirlpool for a while, ahhhhh.....
I've learned a thing or two about being my own human experiment.
Posted by Dinah on Thursday, January 15, 2009
Labels: caffeine, exercise, informed consent, sleep
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I like a cup of coffee in the morning even if just for its ritualistic feel: once I've had my coffee, my day begins. A friend served me decaf (without my knowing :P) and I enjoyed it just as much. Not sure about the effects, since it was the morning after New Year's Eve, but you could try playing with the placebo effect: indulge in the taste of coffee without the caffeine, or mix caf with decaf...
but as we all know, changing many things at once can be a bit overwhelming and counterproductive :) It also doesn't reveal much about the variables... ah, experiments! :)
Good Lord, woman! No chocolate? Are you mad?
Seriously though, I've had a time of it sleeping lately. I decided to just make a point of being in bed by 11 PM and stop with the checking email and doing this and that and just mellow out.
Either way- good luck (but, for crying out loud, don't give up chocolate)!
Perhaps one of the oldest theories of aging is called the rate of living theory. This theory states that people and other cretaures in general have a finite number of breaths and heartbeats (for the sake of this post can we please pretend that it is not out of favor)
Moderation in all things (exercise (gotta conserve those heart beats), alcohol, chocolate and Stevie Nicks) is what I say.
Moderation is also a principle of life. In ancient Greece, the temple of Apollo at Delphi bore the inscription "Meden Agan" - 'Nothing in excess'.
Walk like an ancient grecian....
Have a great day,
Ohhh and NO SMOKING.
The Greeks were busily chiseling away on this part of the inscription when the temple was destroyed by the earthquake.
sorry, but i had to giggle at a typo in your blog post:
you used the word "INpatient" instead of "IMpatient" (2ndparagraph).
...would that be a freudian slip?
And now you're all cured of that interminable headache... you've forgotten about that sleep problem...
This is what I do for whiny patients with insufficient complaint... I give them something to complain about and then their little problem doesn't seem so bad.
I think R D Laing said that.
Karla, I agree, I like the ritualism of the coffee-with-friends to start my day, part of why I don't think of myself as addicted.
Roia-- no chocolate would be a difficult absolute. This is a time-limited experiment.
Anon 1: agreed about moderation, but I think people can live in moderation and still have insomnia.
Anon 2: I don't smoke. I have had absolutely no luck suggesting to patients that they do a trial of No Smoking and see if it helps their symptoms. They just nod.
Hyperlexian: yes, thanks, a Freudian slip.
Mr. Ian: yup. I was so pleased to feel better. Insomnia does not typically cause me to feel badly during the day, at least not for the first couple of days, so the caffeine withdrawal was worse.
I have realized quite recently that I should not drink regular cola after work in the early evening. It makes me hypomanic, and although I love the hyper energized feeling, it is perplexing and out of character from my normal depressed self. That, and my family doesn't appreciate me being hyped up at night, I'm sure.
The exact same thing happened to me three years ago... I had a regular morning coffee, maybe some occasional other hot tea or the afternoon coffee, but not really so much. I quit the caffeine cold turkey one day and it took me until that first afternoon to realize I was among the addicted. I got whole body muscle aches--it felt like having the flu. It was so bad, I could barely walk down the hill outside my house... ughh!!!!
My human experiment right now is to see if cutting out ALL sugar helps my energy and mood levels. So far so good... but ALL sugar????
As someone who's "experimented" with not smoking about 200 times. I have some bad news - quitting smoking only works if your problems are sleeping too well, being too calm and focused, or not being depressed enough. Nicotine withdrawal will solve all those problems, but for everything else, it's a bust.
Nicotine's a great psychiatric drug, especially if you're addicted to it - it's just too bad it's lethal.
"Among other facets shared by the various fields of inquiry is the conviction that the process be objective to reduce a biased interpretation of the results. Another basic expectation is to document, archive and share all data and methodology so they are available for careful scrutiny by other scientists, thereby allowing other researchers the opportunity to verify results by attempting to reproduce them. This practice, called full disclosure, also allows statistical measures of the reliability of these data to be established"......sleepy yet.
Hope you feel better soon
You have a link in 101 Fascinating Brain Blogs here:
Hope that cheers you up!
Best wishes from sunny Liverpool
Dinah, have you seen this over at Dr. Shock???
"The Right Chocolate Dose"
This is Great!!!
Dinah - have you seen this one?
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