I heard it long ago, when I was early in my training, at some big international psychopharmacology meeting so I reproduce it here. “What people really want is an on-off switch.” Most people seem to get through life pushing the envelope only minimally.  A few cups of coffee in the morning helps promote “alertness.” A drink or two with the guys after work helps to “wind down” on the way home. Neither of these decisions is harmless. Although there are indeed some beneficial compounds in some forms of alcohol, I have come to believe that civilization has taken a poor turn in validating its use for a very long time.

Read more on Addictive Drugs and Questions They Raise…


Okay, so my Continuing Medical Education Provider gave me every imaginable disclaimer on this one.

Abstracts at a meeting, so the demands were not as rigorous as for published articles. There could be confounding factors. A British study; maybe they aren’t wired the same way us yanks are. People who take a nap of at least a half hour during the day have lower blood pressure 4 mm. lower 24 hr. average systolic than folks who don’t. Espresso, on the other hand, raises blood pressure. This study was done on Italians.  Are they wired like us? Drinking enough espresso may also be increasing the incidence of type 2 diabetes, by some kind of an effect on long term glucose (sugar) metabolism. Read more on Helpful Hints From A Former Caffeine Fiend…

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People are not wired the same.

Individual differences are the spice of life and medicine.  I love people, their verbal discourses, because they are so delightfully individual.

To me, the biggest problem with medicine is something I actually never heard anybody else discuss.  I call it “norming.”

Maybe there is no other way to get started on developing a new treatment that could help many people who have similar afflictions.

But people are so different that what is life-saving for one may be poison for another. Read more on Dangers of Energy Drinks…

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I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of. 

He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care.  He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.

The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…


She was 33, blonde and attractively dressed.  She had been stable on some medications for bipolar illness for many months before seeing me for a renewal.  She told me her marital relationship was wonderful.  They ran a little boutique together in the historic part of downtown.  Not getting rich, but doing what she loved.

Coffee JittersOnly one problem — her husband said she became difficult when she drank too much coffee.  I asked for some description of the “difficult.”  She noticed she was nervous and had trouble cooling down later.  She had “panic attacks,” which had not been a problem before.

They sounded exactly like the description of that disorder in DSM-IV – the one nobody likes applied to them – the “B” word.  The things she said her husband had said about her sounded like the criteria for mania.  No sleep, loud arguing, anger, nerves, etc.  “Let’s look at cutting out the coffee,” I told her.

She normally drank as much as a half-pot in the morning at home before opening the boutique.  That may not sound like much, but others have had similar symptoms from less.  She had figured out herself that coffee in the afternoon messed up her sleep beyond description.

Caffeine has a LOT of effects on the body.  If it had been a modern discovery, instead of the old myth about some frisky goat in the near east chewing berries off a tree and surprising a young shepherd by omitting sleep, caffeine would have caused the FDA a struggle to pass it because it does so many things.

First, coffee is absolutely NOT the only beverage that has it.  There is generally more in caffeine-containing cola drinks. Read more on Caffeine As A Bipolar Trigger…

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