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Depression and Caffeine

From: Clinical Psychopharmacology Made Ridiculously Simple, Edition 6 by John Preston, Psy D. & James Johnson, M.D.

It is very important to note that it is common during periods of depression for patients to significantly increase their use of caffeine. Caffeine of course combats fatigue, but it also  has mild transient antidepressant actions, and thus people gravitate toward increasing use. This results in a commonly overlooked complication to treatment: caffeine amounts in excess of 250mg. per day can contribute to a decrease in slow wave (deep) sleep; slow wave sleep is already decreased in depression and the further erosion of this form of sleep can often worsen depression. Caffeine also contributes to restless sleep and frequent awakenings during the night. It is important for patients to know that this effect can occur even in the absence of initial insomnia.

With depression, ever attempt should be made to keep caffeine consumption below 250mg a day (and preferably used only in the morning).

Abby Scuito and Dr. Mallard ("Ducky"), NCIS on CBS

How do you know if you have had too much caffeine?  Here are some signals, based on the DSM-IV diagnostic criteria for caffeine intoxication.

Recent consumption of more than 250mg of caffeine (more than 2-3 cups of brewed coffee).

  • Restlessness
  • Nervousness
  • Excitement
  • Insomnia
  • Flushed face
  • An increased excretion of urine
  • Gastrointestinal disturbance
  • Muscle twitching
  • Rambling flow of thoughts and speech
  • Rapid or abnormal heart beat
  • Periods of exhaustibility

If you experience several (five or more) of these symptoms and they are disruptive to your life or feeling well, you may want to consider reducing your caffeine intake. Particularly with heart disturbances, you may want to consult a doctor if you feel these symptoms, especially if they persist in the absence of caffeine.

For fun: Caffeine Test


Working with ADHD

ADHD is a pretty hot topic with parents, teachers, schools, and the mental health field. Like many popularized conditions, ADHD is both underdiagnosed and overdiagnosed. Like many mental “disorders,” ADHD can be tricky to fully diagnose. The criteria are listed under the previous post.

If you suspect your child may have a form of ADHD (forms of ADHD), it is important to have someone well-versed in ADHD see them. There are numerous testing methods, and even more ideas about treatment. Treatment options may include medication, therapy, and psychoeducation.


Medication for ADHD is still debated, but is generally effective. The most well-known are Ritalin, Adderall, and Strattera.  These are not all of the options available, but are some of the most popular. They are stimulants that in someone with ADHD basically slow the brain down, reduces energy.  Someone without ADHD would probably find these medicines “hype them up.” You will need a doctor (physician or psychiatrist) to prescribe these medications.


In addition to or instead of medications, some people find various forms of therapy helpful. The purpose of this therapy would be to a) add an extra level of monitoring to any medication regimen, as a therapist could take note of and record behavior patterns and changes and b) probably the most important, teach techniques for coping with ADHD. ADHD does NOT  make a person less capable or less intelligent, but sometimes people who have ADHD may need other ways to help them focus or accomplish tasks. Techniques may include writing down all tasks, establishing a highly consistent routine, setting aside time to use excess energy, pacing to think, and other exercises.  These techniques can be combined with medication or used instead of medication, depending on the needs of the individual.


Psychoeducation simply means learning about the condition. This I highly recommend. You can get information for your doctor, therapist, and the great amount of literature on this condition. The more information you have, the better you can make your treatment decisions. A word of caution, however: the information available about ADHD is vast and conflicting. Some information may be inaccurate or unhelpful. Look at all information with a discerning eye. And remember- just because one person had a particular experience doesn’t mean you necessarily will. Everyone is an individual case. As with any concern, consult a licensed professional.

That probably covers ADHD for today. Have a good weekend.



Diagnostic Checklist for ADHD

From Brains That Work a Little Bit Differently by Allen D. Bragdon & David Gamon, PhD.

Diagnostic Checklist for ADHD

ADHD is characterized by inattention, hyperactivity, and impulsivity for the age and developmental level. Standard diagnosis specifies that by the time a child reaches seven years, at least six of the features listed below under “inattention” plus a combined total of at least six of those items under “hyperactivity” and “impulsivity” must all be present.

1. Inattention

  • Won’t pay attention to details, makes many careless mistakes in school work or other chores;
  • Can’t sustain attention in tasks or games;
  • Seems not to listen properly when spoken to;
  • Doesn’t follow instruction well, and often fails to complete tasks;
  • Has a hard time organizing tasks;
  • Has a hard time with activities or tasks that require sustained mental effort;
  • Frequently loses things needed for tasks or activities, such as pencils, books, toys;
  • Is easily distracted;
  • Is often forgetful in routine activities;

2. Hyperactivity

  • Fidgets or squirms excessively;
  • Leaves seat when sitting in required;
  • Runs around or climbs on things excessively;
  • Has a hard time with quiet activities;
  • Seems in constant motion;
  • Talks excessively.

3. Impulsiveness

  • Blurts out answers before the question has even been finished;
  • Has a hard time waiting to take turn;
  • Interrupts or butts in on others.

Dr. W.M. Hawkins, Ph.D, NCC

Redefining Self-Care

We all know about stress. Stress increases cortisol levels which blocks our natural immunity, causes pain, tension headaches, loss of sleep, erratic eating (less or more), and can even lead to distraction.

What we don’t know is how to routinely reduce stress. So, we get stressed. Then we stress about being stressed. We don’t have time to fix it. If we don’t keep moving forward, we’ll just end up with more stress. Or, we simply shut down to avoid stress altogether. However, that plan often leads to more stress down the road, loss of production, and sometimes even loss of self-esteem or confidence.

Stress/Production Bell Curve

In order to reduce your stress systematically, I recommend learning some self-care. Self-care is anything that gives you time for you.  It can be  a hobby, exercise, a long bath, art, music,  sports, playing with the dog, or anything that lets you clear your mind or be in the moment. Schedule in this time along with all those other obligations weighing you down. Keep this appointment with yourself just as you would any other important obligation.

Designating self-care time allows you to rejuvenate yourself. This time away from production can at first seem selfish or foolhardy- after all, it is time away from you completing all of those crucial tasks on your plate. However, the research shows that countries that provide more vacation days actually see more production from there workers because of reduced burnout. On smaller scales, this still appears to work. Studies also show that people who take a few mental health breaks through the day accomplish more during work and after, with more efficiency and accuracy.

The reason is that breaks and self-care reduce the burden on your brain. Logic tells us that if you work more efficiently, you’ll accomplish more, even if allotted less time. The key to that same efficiency often lies in not overtaxing your mind. If you never care for yourself, eventually you will give out. No one would expect a car to keep going without any maintenance or even filling up the gas tank, and it’s just as useless to expect that from yourself.

The added bonus to taking time for self-care is that you will begin to see yourself as someone deserving of care. In addition to feeling good about your production, you’ll begin to feel better about yourself in general. You’ll feel more emotionally stable, more driven, and possibly more organized.

Some suggested self-care activities, but this is by no means exhaustive:

Listening to music

Playing (any) musical instruments




Knitting/Cross-stitch/Latch-hook/Crochet, etc.


Playing a sport

Following a sports team

Playing with your kids, your friends, your pets

A long bath or shower


Going to the gym


Learning something new

Going to the spa/getting a manicure/getting a massage

Writing or journaling


If you have a self-care technique you’d like to share, please comment below!


Grief: The Final Healing

The last emotion in Healing Through the Dark Emotions is grief. Grief is one of the most complicated emotions, as it encompasses many other emotions, often at the same time. We may feel anger, sadness, despair, fear, stress, disappointment, blame, resentment, contempt, guilt, or any combination of emotions. Regardless, grief is vastly unpleasant, and may feel unbearable.

Picasso’s Guernica

Grief varies from culture to culture, but every culture has a set of rituals, beliefs, and ideas about grief, including how one should grieve and how long it should take. In the U.S. we tend to carry the view that grief should be short-lived so that people return quickly to their former lives.

Anyone who has experienced grief can see that it is not always that simple. But should it be?

The answer is: No. Actually, grief is terribly important. The premise of HTtDE is that we achieve growth through our emotions, particularly the “dark” unpleasant ones. Not only is grief no exception to this, but it serves a crucial and unique function.

When we lose a person, a job, a marriage, or home, we encounter grief. We feel a loss of who we were or thought we were. That person has in a way “died.” Grief is the process we use to separate ourselves from that former person, as well as the person, thing, or ideal that we have lost. In short, grief allows us to live. Without grief, we cannot continue with our lives as they actually are, because we cannot separate ourselves from what we have lost- we become them, and die with them.

As you can imagine, this process takes quite a lot of time to complete. It also explains all of the emotions we may experience. Hiding from these emotions, from the grief, is to simply continue with a shell, with a shadow of ourselves as we truly are and as we could be.

So, we learn to sit with grief. Sit with it from the beginning, before it grows. What grief requires is experience, expression, and time. Much like the other dark emotions, grief requires our attention. It is only by giving it it’s due attention that we move through it and grow. Therefore, grieve. Take the time to feel it, experience it. Use the time to take care of you, assess yourself and your needs. Reconnect with yourself so that you can move forward.

If you feel that talking through your experience in counseling will help, by all means, do so. However, do not think that because you go to counseling that your grief is wrong or some sort of insanity or pathology. It is a difficult time and a time where you may want some support, but you have every right to and should grieve. Take the time because it is yours.

Until next time,

More Healing

Continuing from my not-exactly-last blog about Healing Through the Dark Emotions, today I thought I would talk about fear.  What are you afraid of? Don’t say of fear itself. It’s  a cop out. The fact is, everyone is afraid of something. We should be. There are a lot of things in this world that are a threat. Fearing something threatening is not only natural, it’s the healthy response. Fear is what prepares us to use a coping skill to deal with a problem. By denying fear, we “deal” with the problem by ignoring it. By not dealing with it at all. At that point, we become unhealthy.

When we ignore our fear, it simply grows. We may develop anxiety. We may have bad dreams. We may get angry or deny that we can fear anything. In fact, we may get to the point were everything has to be fine, even when they aren’t. That’s no way to live, is it?

Instead, let’s approach our fears. There must be a reason you fear it. For example, and let’s choose something interesting and maybe a little complicated, but common. Say, fear of failure. Okay. The idea of failing makes you afraid, so you stress, insist that you must not do something where you might fail, and push yourself to do things not just right, but perfectly. If it’s perfect, how can it be a failure? Or perhaps you plan constantly, overplanning the simplest task, or on the other hand, you never plan anything. You never do anything. Perhaps you may spend a lot of time talking about how other people have failed or what their flaws are. If you look at their flaws, you don’t have to look at your own, do you? You can feel more perfect, because you see their shortcomings. You are somehow more stable for it.

In each of these cases, your fear is avoided. You don’t have to feel it so much. But look at each option: None of them are terribly functional or helpful, are they? Has your fear dissipated? Has it vanished into nothing? No. It sits there, watching, waiting on the sidelines for an opportunity. In fact, you spend all this extra energy simply avoiding it, only to have it remain unchanged.

Instead, let’s look at the fear. So you feel failure. Okay. What will happen if you fail? You face criticism or judgment. People might look down on you. Maybe it shows that you weren’t good enough. Well, good enough for what? What standard is that? Is perfection a requirement for survival? For prosperity? If you look at history or even look at the news, it doesn’t appear to be. People that have “everything” by our standards have flaws. Lots of them. If you read their biographies, they’ve probably failed. In fact, if they don’t fail at something, there story is not interesting. The American dream requires failure.

What would failure mean? You aren’t worthy of money? Status? Family? Your friends? Love? Society? Existence? Does that make sense?

Really look at your fear- why do you feel that fear? Then ask yourself, does it help? Sometimes fears do. They compel us to act. Fear of fire gets us out of a burning building safely. Some fear of failure may help you work hard at school or in your career. Those are helpful fears, and they certainly shouldn’t be avoided. How can they help if you avoid them?

If you look at your fear, you’ll learn more about yourself. Don’t judge your fear. It doesn’t make you a bad person. More importantly, don’t fear your fears. If you do, you can never learn from them. They are perfectly natural, and there is no reason to fear natural emotions. They are simply there to help you.

So, this week, what are your fears? What purposes can they serve? What can you learn about yourself by analyzing them? Give them a little attention and let them teach you. Let them speak and then subside. Learn. Find a little peace.

Until next time,

Recommended Reading

During your regular blogging, take a look at this blog on When Pigs Fly regarding domestic abuse. The blog is entitled “The Most Ubiquitous Constant” and dated July 12, 2010. Some important information available here.


Happy reading,