Should I be on meds?
September 14, 2010 8:54 AM   Subscribe

Caffeine helps me to be optimistic, positive, and productive at work. Unfortunately, it's also fantastically addictive, and disrupts basically every important bodily process that I have. Should I talk to a psychiatrist about trying some kind of prescription stimulant?

I do not need caffeine to wake up. I do not need it to help me "focus." I do not have ADD.

However, I do have a job that I'm kinda bored with. It doesn't inspire me at all, and I have a hard time being interested in it. Sadly, I think it's starting to show. People have made comments. There was a performance review where my "attitude" was mentioned.

When I drink coffee, I become a lot more positive, interested, and engaged in what I'm doing. My dull, uninspiring job suddenly becomes interesting! I show a "take charge" attitude in meetings and other contexts. I feel energized.

I don't generally have a problem focusing on things -- just things that I'm uninterested in. In fact, sometimes (especially if I drink too much coffee), coffee actually makes it easier for me to become distracted. This is why I don't think I have ADD.

The problem with caffeine is that it seriously messes with my system. It disrupts my circadian rhythm and makes it hard for me to get to sleep at night. It makes me pee so much that I get sore, and it does really bad things to my bowels. And plus, I find it to be spectacularly addictive -- my one cup a day will slowly become several cups a day, over the course of a month or so.

So I'm wondering -- would any of the wonderful prescription stimulants help me with this? I'm not interested in taking them for pleasure or anything like that. I'd be going to a psychologist and Using As Directed.

I'm pretty sure that I know what the coffee does to me. I've gone through periods where I've quit completely, and periods where I was seriously addicted. I actually just quit about 6 weeks ago, but started again this week because I got a performance review that, while it was mostly positive, made some mention of my "attitude."

And to head a couple suggestions off at the pass -- no, I'm not interested in antidepressants, and no, I'm not really at a place in my life where I can start looking for a new job. Although I may look for a new job at some point next year, I'm pretty much stuck in my current position for at least a good 6 months.
posted by Sloop John B to Health & Fitness (46 answers total) 13 users marked this as a favorite
 
psychologist psychiatrist
posted by Sloop John B at 8:56 AM on September 14, 2010


Have you tried drinking Yerba Mate tea? I find it gives me the same alertness as caffeine without the side effects.
posted by BusyBusyBusy at 9:00 AM on September 14, 2010 [1 favorite]


Anecdata- I love provigil. It does everything that caffeine does without any of the side effects. It's used for shift work and I'm not sure what the long term side effects are.
posted by TheBones at 9:01 AM on September 14, 2010


What's the rest of your life like? Are you active? How's your diet?There may be drug-free ways to handle this stuff.
posted by cmgonzalez at 9:01 AM on September 14, 2010


If you can quit coffee for a year or so, you stop needing it so much. I'm drinking it again nowadays, but this did work for me in my university days. It's a biological dependency cycle that can be broken.
posted by L'Estrange Fruit at 9:04 AM on September 14, 2010


This is a mere medical students view, but I'm fairly sure that prescribing something that is potentially harmful to someone who basically has bugger all wrong with them is classed as unethical. I don't know whether prescription stimulants are less harmful than caffeine, but even if they are, the responsibility for the prescription is on the person who prescribes it (whereas your coffee habit is in your own hands). If I knew of a doctor who would prescribe stimulants in a situation like yours, I would seriously consider reporting them to the authorities.

Short version: "I'm bored with my job" is not a medical condition, and it's not appropriate to treat it medically.
posted by Coobeastie at 9:05 AM on September 14, 2010 [11 favorites]


Do you exercise regularly?
posted by Ziggy500 at 9:06 AM on September 14, 2010


I started taking antihistamines with pseudoephedrine when my allergies got worse, and I find that it provides a bit of a mental energy boost. I don't know if it would work for someone who doesn't have allergies, but it might give you a little lift without having to drink tons of caffeine.
posted by Tehhund at 9:08 AM on September 14, 2010


Another suggestion for tea. It's not the same, of course, but perhaps you could drink tea without all the nasty bodily effects that coffee provides. Speaking from experience here. I LOOOOVE coffee, but it affects me similarly to the way you describe. I mainly drink tea now, rarely does it cause stomach problems and only keeps me up at night if I drink it later than 6pm or so. The problem is that it offers a much slighter version of the 'hello world! how about a hug' attitude or enthusiastic incandescence that coffee does.
posted by palacewalls at 9:09 AM on September 14, 2010


Concerta
posted by mecran01 at 9:14 AM on September 14, 2010


Also, I enjoy 1-2 cups of coffee per day, but of course tolerance and addiction ruin it for me after a month or two. My current system works pretty well for me - I'm allowed that much daily during the week (and never after 2 PM), and I'm allowed no caffeine on Saturdays and Sundays (exceptions made for special events where everyone is having caffeinated drinks). I don't need it for work those days, so I take a break. As much as I'd love a cup on a Saturday morning, I have to have some discipline and remember that that way lies tolerance and addiction.

Regarding sleeping: the problem may be that you drink caffeine too late. Its half-life is 6 hours - that's a long time for it to clear from your system. IANA biochemist, but I believe this is how it works: if you have a cup of coffee at 4 PM and go to bed at 10 PM, that's similar to drinking half a cup at 10 PM and then lying down. If you have a cup at 10 AM and go to bed at 10 PM (12 hours, or 2 half-lifes) there's still about 1/4 cup's worth of caffeine in your system. Which means you have to be very careful about any caffeine you have after your first cup of the day.
posted by Tehhund at 9:17 AM on September 14, 2010


If you find coffee very addicitive, you will probably see the same results from perscription stimulants. They are certainly not side effect free and the fact that you mentioned having sleep problems from caffiene indicates you may from stimulant usage.There are non stimulant drugs which may be useful, but a surefire way to increase your energy level is to work out regularly and make sure you are eating a healthy balanced diet. IANAD just some one who's dabbled in stimulants.
posted by handbanana at 9:25 AM on September 14, 2010


I'm not interested in taking them for pleasure or anything like that.

But... that's exactly what you'd be doing, since you don't have a medical condition that requires them. Also, prescription stimulants are going to mess with your sleep something fierce. Then you'll need a different one to help you sleep.

I switched from coffee to tea when I was working at a godawfulboring job because of the physical symptoms you mentioned. I also listened to podcasts. This didn't make my job WONDERFUL but it made it tolerable, and it gave me a reason to look forward to sitting at my desk. Plus, exercise will help - even short walks at lunch time.
posted by desjardins at 9:27 AM on September 14, 2010


Then you'll need a different one drug to help you sleep.
posted by desjardins at 9:28 AM on September 14, 2010


Desjardins,
The OP can visit a psychiatrist to determine if they have a 'condition' needing medication or for a diagnosis. The internet can not diagnois someone unless of course you are their DR.
posted by handbanana at 9:35 AM on September 14, 2010


There's a good chance that the side effects of any drug you are prescribed will disrupt your life as much if not more than caffeine.

As mentioned above, caffeine stays in your system longer than you expect. The half-life is on the order of 6 hours. I find cutting myself off by 4 PM in the afternoon prevents me from having issues falling asleep (at midnight). When I feel I need that late afternoon pick-me-up, a cup of decaf tea (I'm not a coffee drinker, but I drink tea the way people drink drip coffee) actually works as well. I think that the hot beverage + dash of milk and sugar prompts a sort of placebo effect.

Have you considered injesting the caffeine in non-liquid ways? Check out ThinkGeek for caffeinated mints, gum, etc.
posted by maryr at 9:45 AM on September 14, 2010


Go see a doc. Worst that happens is they say no. But I self-medicated mild depression with caffeine for a long time before it got too bad to manage that way, and getting on SSRIs was a huge improvement. (I'm not diagnosing you with depression, just to be clear; just suggesting that depending on caffeine to function and be happy could be nothing, or could be indicative of something that you could treat in a more sustainable way.)
posted by spaceman_spiff at 9:47 AM on September 14, 2010


30mg pseudoephedrine will put you in the zone.
posted by Civil_Disobedient at 9:47 AM on September 14, 2010


Before this goes any further, I should mention that I don't really know all that much about ADD. All I really know is from random conversations with people and stuff I've read on the internet.
posted by Sloop John B at 9:52 AM on September 14, 2010


You say you don't need caffeine to wake up or focus, but then you say it makes you optimistic, etc. So I just wonder - is it the caffeine, or is it the coffee?

I drank coffee for most of my life, and loved and depended on it, until suddenly I started reacting badly to it. (Getting all shaky/dizzy/weird.) So I started drinking decaf coffee instead, and found - to my great surprise - that psychologically it does the same things good things for me that regular coffee used to, without the bad physical side-effects.

If I were you I'd switch to decaf (assuming you haven't tried it already) and see if the taste, and the familiar actions of going out to get the coffee or whatever it is you enjoy about drinking it - still gives you that little bit of happiness that gets you through your day. It's worth trying at least, before you go on some potentially harmful serious medication.
posted by DestinationUnknown at 9:59 AM on September 14, 2010 [1 favorite]


For the record: I have ADD that has been formally diagnosed, and have used stimulants in the past.

If you're 'bored', I recommend exercise. Unless your job is Professional Athlete, or you are already very active, you're probably not getting enough exercise daily. If feasible, get up every couple of hours or so and take a walk around - get the blood circulating, get some fresh air, etc. That helps me quite a bit. Also, if you still want caffeine with the coffee jitters, I also recommend tea.

You don't want prescription stimulants unless a doctor determines that you genuinely need them. Not only do they have potentially bad side effects, they can be addictive and expensive to boot. Not worth it.
posted by spinifex23 at 10:08 AM on September 14, 2010


I feel like I could have written this post. I don't really ever get the normal effects of caffeine (feeling "buzzed", etc.), but drinking coffee definitely makes me feel more ok with the world. I found that sometimes it was the mere action of getting the coffee and having it in my hand that made me feel better (maybe it was a Pavlovian response to holding the cup?). I second destinationunknown's suggestion of trying decaf and I'll add that maybe you could a latte or something instead of brewed coffee (where you would get less caffeine, but still a little if you want).
posted by zorrine at 10:12 AM on September 14, 2010


Maybe you could *try* a latte...
posted by zorrine at 10:13 AM on September 14, 2010


Two things occur to me when I read your question:

1. That's pretty much what coffee is for. I'm pretty sure that's why everyone drinks coffee. Consider it the on-label usage, if you will.

2. I've heard a lot of people talking about reducing or changing their coffee dependency, but I've never heard someone bring psychiatry into the equation. That strikes me as kind of a strange place to take the conversation.

Can you unpack why, when you think about this situation, your mind reaches for "psychiatrist" first?
posted by ErikaB at 10:20 AM on September 14, 2010


ErikaB : I'm basically looking to get the same positive effects of caffeine without all the negative crap it does to my body. I figured that maybe the prescription drugs would be more ... refined?

Or maybe I do actually have some kind of problem like ADD. Hard to say, don't know that much about it.
posted by Sloop John B at 10:23 AM on September 14, 2010


--I get worse side effects from coffee than from stimulants
--Stimulants that last longer keep me functional for long enough that I'm not drinking coffee at night meaning that they don't disrupt sleep as much
--ADHD is (maybe) better described as the inability to effectively direct/control/harness you attention so it's common to be able to focus on things you like
--Caffeine kinda helps the ADHD but makes it harder to focus as well so, double-edged sword
--Don't take them together, caffeine pumps up the bad side effects of stimulants
--Anyway nothing you've said rules out ADHD, doesn't rule it in, either. Go to a psychiatrist with an open mind

--Whether or not you have a diagnosable disorder, a problem that could get you fired is A PROBLEM, perhaps a treatable psychiatric problem, and I'm disappointed to see it dismissed so cavalierly by a med student.

Non-medically, take time off from computer/tech/smart phone/i Pod on the weekend. That helps reset your need for stimulation a little bit (or at least it does for me)
posted by the young rope-rider at 10:24 AM on September 14, 2010


The only psychiatrist I know has his assistant say "under no circumstances will he prescribe any stimulants" to every new patient who calls. Be aware that the ethical side of the medical community may not be super cooperative with your plan, here. Definitely try exercise - ten jumping jacks before starting work on a project, even - and try the caffeine alternatives above, if you need to pump chemicals into your brain.

BUT, your problem is a fairly specific reaction (boredom, apathy) to a fairly specific stimulus (your job.) I think that viewing the situation in those terms may be helpful. I'm pretty confident you can find a non-stimulant solution. If all else fails, sing silly songs to yourself. A spoonful of sugar, not Folgers, helps the medicine go down.
posted by SMPA at 10:31 AM on September 14, 2010


Clarification, since I do not think I am being cavalier: if the OP believes that he may have an underlying medical condition that is causing his problems (depression and ADHD having been mentioned upthread), then having this investigated and medicated if appropriate would be the right course of action. This is not what the OP asked. The OP asked if prescription pharmaceuticals were appropriate for a non-medical problem (if we're going to medicalise all cases of 'bored and unproductive at work' then healthcare worldwide would collapse overnight), and I stand by my answer to that question.

I didn't intend to belittle anyone's problems, but to suggest that medication isn't the answer to all of them. I'm sorry if I came across as overly harsh.
posted by Coobeastie at 10:37 AM on September 14, 2010 [1 favorite]


First things first: It might be worth your while to learn a little bit more about ADHD. I'm not a doctor and would be unable to tell you if you have it, but it's probably worth your time to read through the epic ADHD Askme. If a lot of the stories in that thread sound familiar to you, there's a chance you could have it, and a prescription for stimulants may help you.

But anyway, as far as stimulants go, they're not a toy, and should not be taken unless you really need them. If you have high blood pressure, they can increase your chances for heart attack or stroke. They cause anxiety problems for a significant number of people. Some others experience difficulty managing anger. Loss of appetite and weight loss are common, and the possibility of dependence is significant. I'm saying this because these are the things a doctor should explain to you even if they feel you have a legitimate medical need for the drug.
posted by TrialByMedia at 10:51 AM on September 14, 2010 [2 favorites]


I'm basically looking to get the same positive effects of caffeine without all the negative crap it does to my body. I figured that maybe the prescription drugs would be more ... refined?

You're basically talking about trying to get some speed prescribed to you because you don't like the side effects of caffeine. I humbly suggest that this is not a good idea. Most of the prescription stimulants you head about are amphetamines and amphetamine derivatives.

Provigil (Modafanil) is moderately different but definitely can still have side effects.

I'm not interested in taking them for pleasure or anything like that.

But... but... that's exactly what you're talking about! You say you have not been diagnosed with a medical condition which would require treatment with stimulants and have no reason to suspect you have such a condition. So taking stimulants because you like the way they make you feel is by definition taking them for pleasure.

Increasing your productivity, optimism, energy, and general mood is what stimulants do. That's exactly why people take them. That you would limit yourself to dosages which are only moderately pleasurable instead of hugely pleasurable like folks you'd consider to be abusing stimulants doesn't change the fundamental basic for your choice. You want to take stimulants because they make you feel better. Hell, so do I and so does almost everyone who smokes or has a red bull or an overpriced yuppified grande latte from Starbucks.

I don't believe there's anything wrong with that but you should be honest about what you're considering in order to make a good decision. If you want some pep, hey, who am I to tell you you're wrong... but going to a doctor to fish for hardcore drug prescriptions is classic addictive behavior so I'd be really, really careful with all that. Maybe try some tea or a ton of chocolate or something.
posted by Justinian at 11:18 AM on September 14, 2010


I used to drink lots of caffeine before realizing it was my principal migraine trigger and had to stop, I found that the lift. In retrospect, I realized that the lift that I got from caffeine was in part due to that fact that the coffee was lifting off the crappy feeling that I had in the mornings from the beginnings of withdrawal.

Now that I am long since off of the daily habit, I don't have that dip to compensate for anymore. Everyone is different, but really seems like the caffeine is both the problem and the solution. For me, significant exercise and lots have water have substituted caffeine in helping me have energy and focus.
posted by umbú at 11:40 AM on September 14, 2010


Oops. Editing problem. Disregard the first "I found that the lift."
posted by umbú at 11:40 AM on September 14, 2010


Uggh. Maybe if I drank coffee, my editing would be better...
posted by umbú at 11:41 AM on September 14, 2010


Wow. Some of you are being pretty ridiculous.

Look, coffee is legal. It's perfectly legal to drink as much of it as I want. I can't believe that some of you are making me out to be some kind of thrill-seeker because I'm looking for a less-harmful alternative to this VERY LEGAL and VERY AVAILABLE substance that doesn't even have an age limit.

Oh, but the medicines I'm interested in are available by prescription only. That makes SUCH A BIG DIFFERENCE. All of a sudden, I'm William S. Fucking Burroughs trying to 'cop.'

American culture has such a hypocritical attitude towards drugs/chemicals/medicines.

So please stop it with the judginess.

I'm fairly close to giving up on this thread.
posted by Sloop John B at 12:09 PM on September 14, 2010 [1 favorite]


Have you considered that you're just taking in too much caffeine? You could try half-caf, decaf, or tea. It has a half life in your system of 6 hours or so (on average, there is a lot of variation between people), which is why most people quit drinking it by noon.

I've gone through periods where I've quit completely, and periods where I was seriously addicted.

I think you're going to have a hard time selling to any MD that they should write you stimulants for fun.
posted by a robot made out of meat at 12:15 PM on September 14, 2010


You appear to have asked a question to which you only wanted to hear the answer "yes". I would even more strongly urge caution if you read any "no" answers as hypocritical judginess which might lead you to "giving up" on your question.

because I'm looking for a less-harmful alternative to this VERY LEGAL and VERY AVAILABLE substance

You're laboring under a misconception. Stronger stimulants than caffeine aren't prescription only because they are safer, they are prescription only because they are less safe. That's why they are prescription only. Well, theoretically.
posted by Justinian at 12:17 PM on September 14, 2010


Oh, but the medicines I'm interested in are available by prescription only. That makes SUCH A BIG DIFFERENCE. All of a sudden, I'm William S. Fucking Burroughs trying to 'cop.'

Most MDs take their job somewhat seriously. That they have legal liability if drugs they write get abused forces them to. Anyone who's practiced has seen stimulant addicts and MD shoppers and watches those prescriptions carefully.
posted by a robot made out of meat at 12:18 PM on September 14, 2010


OP:
I feel yea on how some people are coming off in this thread. It is particularly alarming that people don't realize the nature of your question, and I for one don't think of this as 'drug seeking behavior'. As for the ones antecedent evidence of a psychiatrist choosing to ignore a very useful class of drugs and a med student being so dismissive of such usage is very disheartening.

Your best bet is to see a doctor and discuss your issues and go from there. Most Dr. Don't hand out speed willynilly and they can be used safely. I'm not one to judge we are a very heavy drug culture, everything from anti-depressants to lower blood pressure meds. However there are risks and to be honest coffee is MUCH safer than any form of amphetamine or derivative (not that they are particularly dangerous but they can be habit forming in the same sense caffeine is).
Work with a health care professional and go from there. Best of luck!
posted by handbanana at 12:25 PM on September 14, 2010


I've been in your position before, and have experimented with various options to
help augment / replace the amount of caffeine I was using. Some suggestions / alternatives:

- Yerba mate is a great option, but more expensive and less available than coffee is.
- Matcha tea, and/or L-theanine supplements can blunt some of the caffiene effects
  and have a very nice happy, calming effect

- Herbs:  Ginseng and Rhodiola rosea have mildly stimulating and mood lifting properties.
          Calamus root gives a focusing and stimulating effect that is also useful.
- Aminos: 5-HTP and L-Tyrosine are precursors to serotonin and dopamine available at
          vitamin shops. 5-HTP is helpful for mood, and tyrosine with fatigue and energy.
                
- Nootropics: Piracetam + ALCAR (acetyl-carnitine) wake my brain up amazingly well.

- Stimulants: Modafinil mentioned above is great, but expensive. Adrafinil is a precursor
              to Modafinil and much cheaper (but may be hard on the liver).
              Nicotine patches can be useful for mood and focus, but there is the issue
              of addiction potential (like any stimulant).

My suggestions are listed in order of increasing risk. If you choose to go down this road,
please make sure to read up on the effects, risks, and side effects. Consulting a doctor
would be a good idea. Personally, nootropics have been a boon for me - fairly low risk and 
inexpensive.


posted by pickingoutathermos at 12:28 PM on September 14, 2010


[comment removed - please do not harass people giving you free advice. Free advice givers: please try to rein in the judginess. MetaTalk is your option, metcommentary goes there. Everyone has MeMail.]
posted by jessamyn (staff) at 12:52 PM on September 14, 2010


Okay, my comment got removed, so I'll put this a different way.

Please do realize that I am not asking how to get drugs. It's not like drugs are that hard to get, anyway. I am asking if pharmacological meds would even help me. I do not have any plans on misrepresenting myself or my condition to a doctor, and I apologize if I gave that impression. My interest in seeking out a doctor would be to move from a self-medicating regimen to one that was managed by a doctor, and prescribed for an actual condition.

It's okay if you don't think the meds would help me -- that's why I'm asking the question! But please refrain from making assumptions about me and my motivations.

Thank you.
posted by Sloop John B at 1:01 PM on September 14, 2010


Maybe part of the issue is coffee's lack of standard caffeine levels? Maybe try taking some caffeine pills so you know how much you're getting.

Another thing wrt the caffeine is you can take it every other day and then you won't build up a tolerance so much.

Good luck.
posted by the young rope-rider at 1:07 PM on September 14, 2010


SJB: The issue is what you mean by "help" you. Maybe this isn't clear. If you found a doctor to write you a prescription for a strong stimulant it would almost certainly elevate your mood, make you more optimistic, increase your alertness, productivity, and energy. Because that's what stimulants do. The great majority of people, when given a stimulant, experience those things. Given your reaction to caffeine you are one of those people.

Is that "help"? I don't know. I've never been diagnosed with ADHD. If I took a 30 mg Adderall I would experience significant mood elevation, increased optimism, increased energy, significantly increased ability to focus, and so on. Does that mean that getting a prescription for Adderall or Ritalin or Desoxyn would "help" me? Does that mean it would be a good idea?

See what we're saying? It doesn't make sense to talk about stimulants "helping" you in the absence of a medical condition which is treated with stimulants. Because they would help you in the same sense that they would help almost everybody given the stimulants.
posted by Justinian at 1:24 PM on September 14, 2010


I have ADD, and have used medication (Ritalin, not Adderall) as well as caffeine in an attempt to deal with the symptoms.

Ritalin helps me concentrate, and also calms me down a whole lot. Out of curiosity, two of my non-ADD friends tried a dose to see what it did for them, and both of them experienced increased alertness and energy, but at levels that made it harder to concentrate -- they got very jittery. Two data points doesn't mean much, and I'm sure not every non-ADD person has this reaction, but if you don't have ADD, there's probably a pretty good chance that Ritalin would make you jittery and not help in the least.

ADD medications have side effects, and they are generally more severe side effects than caffeine has. So if your entire motivation is to avoid bad side effects, I think you may be barking up the wrong tree.

As an aside: Part of the reason you may be getting some pushback here is that it's hard for those of us with ADD, who use medication to solve major problems in our lives, to be level-headed about somebody that wants to use the same medication because they simply don't like caffeine. It fits into all these narratives that society has about ADD -- that many of us have tortured ourselves with -- that say we're just "making it up" and just want to drug away our problems. I'm not saying that you're saying that -- just that that context exists; and it makes it hard to respond to the question being asked without being all grar and trying to exhort you not to inadvertently feed even more into this harmful narrative.
posted by forza at 4:18 PM on September 14, 2010 [3 favorites]


I too have searched for an alternative to caffeine, because it has lots of the same negative effects on me. Can't answer your question about prescription medication because I haven't tried that option. But you might want to try - as one piece of the answer - breathing exercises. Energizing breaths, done several times a day for short periods, can do a lot to elevate your mood, lift your energy, and deal with boredom. Google energizing breath or breath of fire. Best of luck!
posted by daikon at 6:15 PM on September 14, 2010


[folks, if your comment isn't talking to the OP about his question you need to take it to email, thanks.]
posted by jessamyn (staff) at 9:47 PM on September 14, 2010


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