Do you use caffeine to treat your attention deficit disorder? Or do you avoid caffeine at night to protect your mission-critical sleep? In either case, you probably ought know how much you’re taking and when. Problem is, if you’re drinking decaf coffee, you can’t always be sure.

Excerpt from A Wake-Up Call for Coffee Drinkers, New York Times, October 25, 2007:

Coffee sleuths from Consumer Reports recently tested cups of decaf ordered at Dunkin’ Donuts, Starbucks, Seattle’s Best Coffee, 7-Eleven, McDonald’s and Burger King. They visited six locations of each chain, evaluating 36 cups of decaf in all.

A regular cup of coffee has from 85 to 100 milligrams of caffeine. Most of the 10- to 12-ounce decafs tested had less than five milligrams, the magazine reports in its November issue. But one decaf from Dunkin’ Donuts contained 32 milligrams of caffeine — about the same amount in 12 ounces of Coca-Cola Classic. A cup of Seattle’s Best was found to contain 29 milligrams of caffeine, while a tall Starbucks decaf packed 21 milligrams. Results varied at each chain, but the magazine found that the decaf at McDonald’s consistently had the lowest levels of caffeine.

Coffee beans image courtesy of iband clip art for all.

Excerpt from Caffeine: “Herbal” Treatment of ADD/ADHD, by Monroe Gross, MD

Over 60% of ADD/ADHD people who entered my medical practice came to me using substantial amounts of caffeine to fight daytime tiredness and inadequate mental focus. This tells us, of course, that many ADD/ADHD people benefit from caffeine but it also says that many give up caffeine because it offers less than adequate treatment of their ADD/ADHD brain chemistry.

Caffeine is a potent stimulant. It does reduce daytime tiredness and improves mental focus in many with and without ADD/ADHD. It may not be as powerful as the amphetamines and methylphenidate (Ritalin), but it sure can be helpful for many with ADD/ADHD when it comes to functioning at work, in school, and in society.

…For completeness, let’s keep in mind some of the major drawbacks of caffeine for treating ADD/ADHD. First of all, caffeine is a short-acting stimulant with effectiveness usually for only three to four hours after each dose. Mental focus is improved but usually not to the degree it is with the amphetamines and methylphenidate. At doses that improve mental function, many ADD/ADHD people experience irritability, feel shaky, and are emotionally edgy. Also, when the stimulatory effect wears off, sedentary (i.e., those sitting and reading) individuals usually suffer from a mental “crash” characterized by listlessness, enervation, lack of motivation, feeling cranky, and being explosive. Finally, long-term users of caffeine who suddenly stop ingesting caffeine often suffer for one to three days with severe headache.

– Dr. Monroe Gross, MD, is founder of the ADD Medical Treatment Center of Santa Clara Valley.

The FDA requires pharma manufacturers to include “New Drug Application” (NDA) data in some of their packaging inserts.  Here is an excerpt of the side effects data for Strattera:

Commonly observed adverse events in acute adult placebo-controlled trials — Commonly
observed adverse events associated with the use of STRATTERA (incidence of 2% or greater) and not observed at an equivalent incidence among placebo-treated patients (STRATTERA incidence greater than placebo) are listed in Table 2. The most commonly observed adverse events in patients treated with STRATTERA (incidence of 5% or greater and at least twice the incidence in placebo patients) were: constipation, dry mouth, nausea, appetite decreased, dizziness, insomnia, decreased libido, ejaculatory problems, impotence, urinary hesitation and/or urinary retention and/or difficulty in micturition, and dysmenorrhea.

Source: Strattera NDA 21-411 (p. 16)  The NDA also includes other conditions that prompted subjects to drop out of the test.

New York Times columnist Judith Warner wrote this week about her struggles with migraine headaches — meds help, but sometimes she hates the meds for the weight gain or other side effects. She notes that migraine sufferers aren’t the only ones who wrestle with the pros and cons of medication:

Many people who take daily medications come at some point to hate them. Teenagers with ADHD routinely rebel against their meds. Long-term users of anti-depressants risk relapse because they can no longer stand the way the drugs make them feel.

Some people do manage, through diet and exercise, or by protecting themselves from their worst “triggers,” to free themselves from their drugs. But many can’t do it. Many find they can’t accept living in the compromised condition that drug-free existence requires.

A smart high school girl I know switched a few years ago from a mainstream school, where she was struggling with dyslexia and ADHD, to a school that specializes in teaching kids with severe learning disabilities. Being there has permitted her to function without her ADHD meds. But now she’s bored. She’s dispirited by the lack of academic challenge and she wants out, because she’s afraid that, without academic challenges, she won’t be able to get into a mainstream college.

That’s the tradeoff: taking daily drugs, or living a life that feels not quite worth living.

Do you struggle with the side effects of whatever you might be taking for adult attention deficit disorder or anything else? My trials with Strattera and Provigil provided modest improvements for ADHD and anxiety, accompanied by modest weight gain and modest reduction in libido. At the moment, I’m not taking either — in part because of the “tradeoff math”, and in part because I cling to the hope that I can manage and even succeed without taking “yet another pill”. How about you?

Quote: Judith Warner, “Domestic Disturbances: The Migraine Diet“, New York Times, October 25, 2007

From the Wall Street Journal’s review of The Education of an Accidental CEO: Lessons Learned from the Trailer Park to the Corner Office

Obviously, Mr. [David] Novak’s pitchman fervor and people skills are joined to a traditionally shrewd sense of how to make a profit. Still, he seems to relish being the hyperkinetic iconoclast. He describes himself as “the one among the Brooks Brothers power suits with his shirttail sticking out.” The CEO says that he avoids working weekends if he can help it, so as to focus on family and relaxation, and it may be good for Yum that he does.

“Sometimes,” he confesses, “the worst thing that can happen to our company is me getting a free day in the office. I’m a creative guy and I can start dreaming up stuff to do when we haven’t finished what we started.”

– Richard Gibson in “Business Bookshelf: Pitchman in the Corner Office”, Wall Street Journal, October 24, 2007.

Yum Brands is one of the world’s largest restaurant companies, whose brands include KFC, Pizza Hut, Taco bell, Long John Silver’s and A&W.

Try this today: wait five minutes before sending an email request or instruction for anything.  In the five minutes that the email sits in your Drafts folder, you may discover that it needs an addition or an edit.  Or maybe that it doesn’t need to go at all!

I recently hired a graphic designer to create a direct marketing piece for one of my clients.  The designer came up with a nice first draft, which I forwarded to my client so we could review them at the same time.

My client was out of town, so I went ahead and emailed my first comments to the designer.  (“Nice color — how about a font change here?  Oh, and here’s some more copy.  And can you try it with the other proposed logo?”)  You know — I figured that the sooner we started getting her changes, the faster the whole process would go.

Two days later, the client got their comments to me.  (“Great font.  And here’s yet more copy.  And here’s a correction on one line of the original copy.  And can we try a version without the logo?”)

I emailed the comments on to the designer.  And a few moments later I realized that the client  had a typo in their correction.  So I emailed the designer with a fix to that typo (and I labeled the email “high priority” so she’d read it before implementing the client’s erroneous change).    And of course I sent it quickly.  You know, about ten minutes before I remembered that I needed to request yet one more tweak…

Only one thing kept that graphic designer from shooting me — she charges by the hour.

Lesson: no one benefits from having a hundred tweaks requested one-at-a-time as they occur to the tweaker.  My ADD wanted me to deal with each idea as soon as it hit me, and maybe that would have been fine.  But I didn’t need to make the designer deal with each idea as soon as it hit me.  I could have collected them bit by bit into one document, which I could have emailed when it was complete, after I organized and reviewed it.  I’ll do better next time — I promise!

When you feel your company is struggling to stay focused, take heart in knowing that even the biggest companies — with their monster budgets for hiring smart people — often have the same problem.

Here’s an excerpt of the Washington Post’s coverage of focus problems at Sprint Nextel

Interim Sprint CEO Sets Out To Restore Company’s Focus

[Interim CEO Paul] Saleh said the company has tried to tackle too many big changes in the past year.

Saleh’s solution: Improve customer service and simplify the business.

“We had too many things on our plate before. . . . We were doing too many things to reach too many customers too quickly,” he said. “We have to do fewer things, but do them very well.”

– Kim Hart, in Interim Sprint CEO Sets Out To Restore Company’s Focus, Washington Post, 19 October 2007. (Emphasis added.)

Photo Credit : Sprint Nextel. In case you were wondering, their 2006 revenue was $41 billion dollars. Tons of money do not guarantee smart decisions.

If you don’t think it’s strange that you have more than one meeting scheduled for the same time slot… you might have executive attention deficit disorder.

Do I contradict myself?
Very well, then. I contradict myself.
(I am large, I contain multitudes.)

– Walt Whitman, Song of Myself

Walt Whitman is as good an example as you’ll ever find for someone who knew who he was, how he was different, and where his excellence lay. He didn’t need his world to fit into a regular grid and we’re all the better for it.

Photo: Library of Congress