Caffeine: Upper or Placebo

posted Monday, 4 May 2009
Jennifer Nachbur

Ever miss your daily cup of coffee and subsequently get a pounding headache? According to reports from consumers of coffee and other caffeinated products, caffeine withdrawal is often characterized by a headache, fatigue, feeling less alert, less energetic and experiencing difficulty concentrating.

Researchers from the University of Vermont College of Medicine and Johns Hopkins School of Medicine sought to investigate the biological mechanisms of caffeine withdrawal in a paper published recently in the online edition of the scientific journal Psychopharmacology. They looked at brain electrical activity and blood flow during caffeine withdrawal to examine what was taking place physiologically during acute caffeine abstinence, including the likely mechanism underlying the common "caffeine withdrawal headache."

The group examined caffeine's effects in a double-blind study, which involved the administration of caffeine and placebo capsules. Each participant's response to the caffeine or placebo was measured using three different measures - brain electrical activity via electroencephalogram (EEG); blood flow velocity in the brain via ultrasound; and participants' self-reports of subjective effects via questionnaires.

The team demonstrated that stopping daily caffeine consumption produces changes in cerebral blood flow velocity and quantitative EEG that are likely related to the classic caffeine withdrawal symptoms of headache, drowsiness and decreased alertness. More specifically, acute caffeine abstinence increased brain blood flow, an effect that may account for commonly reported withdrawal headaches. Acute caffeine abstinence also produced changes in EEG (increased theta rhythm) that has previously been linked to the common withdrawal symptom of fatigue.

Consistent with this, volunteers reported increases in measures of "tired," "fatigue," "sluggish" and "weary." Overall, these findings provide the most rigorous demonstration to date of physiological effects of caffeine withdrawal.

The researchers also discovered a provocative and somewhat unexpected finding - that there were no net benefits associated with regular caffeine consumption.

"In addition to looking at caffeine withdrawal, this rigorous design also permitted comparison of chronic caffeine maintenance with chronic placebo maintenance, which provides unique information about the extent to which there are net beneficial effects of daily caffeine administration," said Stacey Sigmon, PhD, research associate professor of psychiatry at the University of Vermont and first author on the study. "In contrast to what most of us coffee lovers would think, our study showed no difference between when the participant was maintained on chronic placebo and when the participant was stabilized on chronic caffeine administration. What this means is that consuming caffeine regularly does not appear to produce any net beneficial effects, based on the measures we examined."

Sigmon SC, Herning RI, Better W, et al. Caffeine withdrawal, acute effects, tolerance, and absence of net beneficial effects of chronic administration: cerebral blood flow velocity, quantitative EEG, and subjective effects. Psychopharmacology (Berl). 2009;doi:10.1007/s00213-009-1489-4 [Abstract]

Refusing to Forgive by E. Goldstein

Refusing to Forgive: 9 Steps to Break FreeBy Elisha Goldstein, Ph.D. April 15, 2009

I see it every day. We all hold grudges against other people who we feel have hurt or offended us in some way or another. We even hold these grudges for people who aren’t even alive anymore. We do this with the false idea that somehow we are making them suffer by being hurt and angry with them. Now, there is nothing wrong with being angry with someone, but it is how we express this anger that makes all the difference on us and our relationships . What is a grudge anyway? May it is harboring ill feelings toward another in the need to settle a score.

Let’s try a little experiment. Think of someone in your life right now (maybe not the most extreme person) who you are absolutely holding a grudge against right now. There is no way you are willing to forgive this person right now for their actions. Picture that person and hold onto that unwillingness to forgive. Now, just observe what emotions are there; Anger, resentment, sadness? Also notice how you are holding your body right now, is it tense anywhere or feeling heavy? Now bring awareness to your thoughts; are they hateful and spiteful thoughts?

Most people who I do this with find this to be an uncomfortable experiment that elicits feelings of tension, anger, and thoughts of ill will toward the other person. This is not conjuring these feelings out of nowhere; this is just bringing to light what is already within stirring around. There is a common misperception that forgiveness means condoning the act of the other person. Forgiveness simply means releasing this cycle of torture that continues to reside inside.
Forgiving does not mean forgetting or condoning! Forgiveness is for the person who was perpetrated, not the perpetrator. It is saying, “I have already been offended against, I am going to let go of this so I don’t continue to be burdened by it.” You have already been tortured once, why continue letting this torture you by holding onto it with the erroneous belief that holding onto it is somehow hurting the other person. The practice of forgiveness has been shown to reduce stress, anger, and depression and support many aspects of well-being and happiness.
Like many things, this is easier said than done depending on the person and level of offense. In his book, Forgive for Good, Fred Luskin, Ph.D. lays out 9 steps to forgiving for you!

1. Know exactly how you feel about what happened and be able to articulate what about the situation is not OK. Then, tell a trusted couple of people about your experience.
2. Make a commitment to yourself to do what you have to do to feel better. Forgiveness is for you and not for anyone else.
3. Forgiveness does not necessarily mean reconciliation with the person that hurt you, or condoning of their action. What you are after is to find peace. Forgiveness can be defined as the “peace and understanding that come from blaming that which has hurt you less, taking the life experience less personally, and changing your grievance story.”
4. Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts and physical upset you are suffering now, not what offended you or hurt you two minutes - or ten years -ago. Forgiveness helps to heal those hurt feelings.
5. At the moment you feel upset practice a simple stress management technique to soothe your body’s flight or fight response.
6. Give up expecting things from other people, or your life, that they do not choose to give you. Recognize the “unenforceable rules” you have for your health or how you or other people must behave. Remind yourself that you can hope for health, love, peace and prosperity and work hard to get them.
7. Put your energy into looking for another way to get your positive goals met than through the experience that has hurt you. Instead of mentally replaying your hurt seek out new ways to get what you want.
8. Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused you pain power over you, learn to look for the love, beauty and kindness around you. Forgiveness is about personal power.
9. Amend your grievance story to remind you of the heroic choice to forgive.

Why You're Not Sleeping

Provided by: FORBESWritten by: Rebecca Ruiz, Forbes.com Mar. 10, 2009

The recession has forced Americans to cut back on everything from health care to groceries. According to the results of a poll released Monday, it's also driving them to give up a precious commodity that doesn't cost a cent: sleep.

More than a quarter of 1,000 Americans randomly polled by the National Sleep Foundation, a non-profit organization that promotes a greater understanding of sleep and health, reported that the economy had disturbed their sleep at least a few nights a week.
Personal finances, unemployment and health care costs are among the troubles keeping people awake. The percentage of Americans experiencing economy-related insomnia may have worsened since the telephone poll was conducted over a month-long period beginning in late September.

In Depth: Nine Ways To Conquer Insomnia
The fact that Americans are sleeping less is unsurprising; the National Sleep Foundation has been documenting the dwindling hours of shut-eye for the past decade. The increasing number of sleep aid prescriptions is also telling. In 2008, 56.3 million prescriptions were filled, a 7% growth from 2007, according to IMS Health, a health care information company.
"Sleep is a barometer of life," says Dr. Meir Kryger, chairman of the board for the National Sleep Foundation. People suffering from severe sleep problems, he says, often fail to recognize the very simple reasons they can't drift off peacefully. Anxiety born of economic woes is a major factor, but so are sleep disorders and bad habits like an unpredictable schedule, performing late-night tasks and even staying in bed when it's impossible to fall asleep.

What it Means Not to Sleep
At least 40 million Americans experience chronic sleep disorders, according to the National Institutes of Health, which recommends that adults get seven to eight hours of sleep each night. The National Sleep Foundation's poll shows that Americans routinely fall short of this goal, sleeping an average of six hours and 40 minutes per week night.

Sleep debt has a profound impact on a person's ability to function, says Dr. Carol Ash, medical director for Sleep for Life, a New Jersey-based sleep laboratory. Research has shown that it impairs judgment, focus, memory and reaction times. Eighteen hours of consecutive wakefulness is the equivalent of a blood alcohol level of .08%. The effects of sleep deprivation are cumulative, meaning that several nights of disturbed sleep can compound the ill effects of missed sleep.
There are the classic signs of sleep loss, including irritability, anxiety and depression, but less obvious, says Ash, are diminished problem-solving skills. The sleep-deprived may try pushing through fatigue to get their jobs done or developing last-minute solutions to urgent crises (think Congress). That's often the worst approach for the sleep-deprived to take.

"You'll be able to do mundane tasks," Ash says, "but you'll really start to fail when you have to think outside of the box."

Simple Sleep Solutions
With the exception of disorders that like apnea or narcolepsy, most sleep issues are caused by stress and bad habits. Spending a few nights awake, besieged by worries or because you're trying to return e-mails just before bed, for example, can teach the body a routine that is not conducive to sleep.

Dr. Eric Powell, director of research at the Clayton Sleep Institute in Missouri, often tells insomniacs to get out of bed. It sounds counterintuitive, but the strategy is based on research that has shown efforts to force the body to sleep only breed frustration.
When that cycle of sleep-related stress begins, he says, it can be hard for patients to identify obvious reasons for their insomnia. These frequently include an unpredictable schedule, a noisy or brightly lit sleeping environment or the lack of a nightly ritual. In other cases, sleep disturbances are related to a chronic disease. Diabetics, for example, experience increased discomfort as a result of damage to the nerves in the feet and legs.

Experts say that the sleep-deprived should seek professional help when the problem becomes chronic and self-imposed remedies fail. At that point, treatment may require prescription medicine or therapy.

When counseling patients affected by the economy, Kryger reminds them that the recession will pass. Tuning out anxiety not only aids with the coping process, it's also necessary for moving on.
Showing up at an interview looking ragged won't impress, he says. If nothing else, "you need your sleep to get another job."

Getting Help: Locate Services

If unsure where to go for help, talk to someone you trust who has experience in mental health—for example, a doctor, nurse, social worker, or religious counselor. Ask their advice on where to seek treatment. If there is a university nearby, its departments of psychiatry or psychology may offer private and/or sliding-scale fee clinic treatment options. Otherwise, check the Yellow Pages under "mental health," "health," "social services," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for a mental health problem, and will be able to tell you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Religious leaders/counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Social service agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies


Locate Mental Health Services in Your Area Within the Federal government, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Services Locator for mental health and substance abuse treatment programs and resources nationwide.
Centers for Medicare and Medicaid Services (CMS) CMS is the the federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance (SCHIP) and several other programs that help people pay for health care.
Locate Affordable Healthcare in Your Area Within the Federal Government, a bureau of the Health Resources and Services Administration (HRSA) provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost healthcare.
Locate NIMH Clinical Trials currently seeking participants.
Mental Health Information and Organizations from NLM's MedlinePlus (en Español)
If You Are in a Crisis and Need Immediate Help