be healthy

Plug in and beat fatigue morning, noon, and night

There's no complicated biochemical reason for being tired now -- you worked all day! But it's early, and even if you don't have plans, falling asleep now will only screw up your body clock and leave you feeling more fatigued in the a.m. "Going to bed a couple of hours earlier than you normally do will throw off your rhythms, while consistency can really help you feel alert during the day," says Philip Gehrman, Ph.D., an assistant professor of psychology at the University of the Sciences, in Philadelphia.

Rock yourself awake. First, do not stretch out on the couch or recline in your easy chair. "Underlying sleepiness becomes more apparent when we put ourselves in sleep-conducive positions, such as lying down," says Wright. And instead of turning on the TV, power up your iPod. "To increase the perception of energy, listen to a piece of music that is upbeat and familiar, and use that song to get you going," says Andrea Scheve, director of the University of Pittsburgh medical center music-therapy program.

"Even just thinking about it and hearing it in your mind can give you a boost of energy." What you do with this newfound energy is up to you, but if you have a significant other, now actually might be the perfect time to head for bed.

It's the catch-22 of exercising in the early evening: You know that working out will leave you energized, but you don't have the energy to work out. In most cases, the problem is simply that you've forgotten a critical piece of exercise equipment: food. "If you're going into a workout when you haven't eaten since lunch, your blood sugar will be low again," says Kleiner.

Snack before you sweat. Schedule a small snack roughly an hour and a half before your postwork workout. The ideal mini meal totals 250 calories and consists of 25 to 35 grams (g) carbohydrates, 10 to 15 g protein, and up to 5 g fat, says Kleiner. Two handfuls of pretzels and two slices of cheese fits the nutritional bill, as does a Myoplex Lite bar.

Then, before you hit the locker room, grab the original energy drink: Gatorade. "It hasn't really been improved upon," says Laura Dunne, M.D., of the Sports Medicine Institute at Orthopaedic Associates of Allentown, in Pennsylvania. "The simple sugars will cause a fast spike in your blood-sugar level, so you'll have immediate energy." At the same time, you'll be addressing dehydration, another hidden cause of fatigue. "Often, that sluggish feeling has more to do with not having had enough fluid than with anything else," says Dr. Dunne.

3 P.M. -- THE AFTERNOON SLUMP

Deep down inside, you're a conflicted man. In one corner, there's your body clock, a.k.a. your circadian clock, which fights to keep you awake until bedtime. In the other corner, there's your homeostatic system, which competes to make you sleepy. And every day, between approximately 2 p.m. and 4 p.m., the homeostatic system tries to score a knockout. "We think the afternoon dip in alertness occurs because the drive from the circadian clock to stay awake is not yet strong enough to cancel out the sleep drive caused by having been awake for half the day," says Wright.

Expose yourself. As in, give yourself a shot of sunlight. The sun's rays will provide a boost to your circadian clock that should solve your afternoon slump -- if you time things right. "The key is adequate exposure to sunlight very quickly after you wake up in the morning," says Michael Terman, Ph.D., a professor of clinical psychology at Columbia University medical center. "As you move into the middle of the day, the same amount of light exposure doesn't affect the circadian clock at all."

That said, take it outside in the afternoon anyway: British researchers recently found that when people exercised during their workday -- regardless of the duration or intensity of the movement -- they were less likely to feel fatigued, and that translated into a 15 percent improvement in job performance.

1 P.M. -- THE LUNCHTIME LETDOWN

If your typical lunch consists of carbs à la starch, then you've experienced this early-afternoon brain drain. That's because a high-carbohydrate meal is the surest way to cause your insulin levels to spike -- and your concentration to crash.

"A high insulin response will rapidly take too much sugar out of your blood," says Benardot. "Then your brain doesn't have enough of its primary fuel, so you become mentally fatigued."

Order a combo meal. If you can't (or won't) limit your lunchtime carbohydrate consumption, work in extra fiber to slow your digestion and the release of insulin, says Susan Kleiner, Ph.D., R.D., owner of the consulting firm High Performance Nutrition. For example, if your noon nosh includes a baked potato, make sure you eat the skin, which is dense with a type of fiber called pectin. "Pectin slows everything down in the gastrointestinal tract," says Kleiner.

"When food passes more slowly through the intestines, absorption into the bloodstream proceeds in a more timed-release fashion." (More ways to fortify your lunch with fiber.) In those instances when you give in to a binge, snack on grapes or an apple afterward; either fruit will help stabilize your blood sugar, says Benardot.

7 A.M. -- THE MORNING FOG

You would think that if there were one time you'd feel naturally alert and energized, it would be after 8 hours of resting and recharging. Instead, your mind is mush. Why? Blame a phenomenon called "sleep inertia." When you first awaken, the parts of your brain associated with consciousness -- the thalamus and brain stem -- begin firing right away. But the prefrontal cortex, which handles problem solving and complex thought, is like a cold engine -- it needs time to warm up.

"Sleep inertia can last for up to 2 hours, although it's most severe within the first 10 minutes of waking," says Kenneth Wright, Ph.D., an assistant professor of integrative physiology at the University of Colorado. Wright and his colleagues discovered just how severe in a new study, which shows that the mental impairment caused by sleep inertia is akin to being intoxicated. Adding to your addled state is the fact that you also have a nearly empty fuel tank. "Your brain needs a continuous supply of glucose to function optimally," says Caroline Mahoney, Ph.D., a research psychologist at the U.S. Army Soldier Center.

Fill it up. Make your morning meal a bowl of instant oatmeal prepared with skim milk. Tufts University researchers recently found that people who ate one packet of instant oatmeal spiked with 1/2 cup of skim milk received a steady glucose infusion, which increased their alertness all morning and improved their ability to process information. And if you aren't already jolting yourself with java, start; a University of Pennsylvania study shows that a dose of caffeine can combat sleep inertia.

Just don't let a latte replace a real meal. "It will mask your low blood sugar by temporarily stimulating your brain," says Dan Benardot, Ph.D., R.D., an associate professor of nutrition at Georgia State University. "But you won't have done anything to satisfy the need for energy."

You're so predictable. Every day, you run out of steam, lose juice, or otherwise hit the wall at nearly the exact same times.

How do we know? Because it happens to everyone. Okay, maybe not to Kelly Ripa, but to everyone else. In fact, it's like clockwork, which actually makes sense, because your body clock is part of the problem -- when your internal chronometer is out of whack, you feel wiped out. There are other reasons, too. We detail all of them on these pages, and provide a quick fix -- or at least a work-around -- for each power suck. Consider your energy crisis solved.

SHUT IT OFF

How to flip the switch when all you need to do is sleep

It would be funny if it weren't so frustrating: You spend the entire day fighting fatigue, only to slip into bed, shut your eyes, and suddenly realize that you now have too much energy.

Fortunately, there's an explanation, and it's pure Pavlov. Do you do anything in bed besides sleep? Maybe read, watch TV, or play Sudoku? "These activities train the brain to associate the bed with excitement," says Kenneth Wright, Ph.D., an assistant professor of integrative physiology at the University of Colorado. "Some people become so sensitive to this that when they go to bed, all of a sudden their brain's aroused, because normally they're watching a basketball game or reading a favorite book."

Which means the fix is what sleep researchers have recommended all along: no books, no Leno, and definitely no laptop when you're under the covers. Sex is fine -- it is, after all, nature's perfect sleep aid.

BY

Marc Salem's Mind Control

That crankiness is just your brain's response to outside stimuli, so if you change the stimuli, you can change your mood. Here's how: Just try to remain angry with a smile on your face -- it's impossible. Visual confusion makes us uneasy, so remove jagged edges--pick clothes off the floor, remove glasses from the coffee table, make your bed. Visual confusion can work for you, too: Don't want people to linger in your office? Clutter your desk. Blue is naturally relaxing (which is why shrinks tell their patients to stare at the sky), while orange is the biggest irritant. Red and purple, by the way, suggest power. Wear them to work and act like a big shot; people will subconsciously obey. Everyone responds to sound differently, but hearing your favorite music--whether it's Zeppelin or Fresh Aire--will energize, motivate, and relax. Throw your tastebuds a change-up by putting OJ in your coffee or peanut butter on your toast. Or eat something naturally contradictory, such as sweet-and-sour chicken. Varying textures work, too--try popcorn or nuts. So underrated, nice smells (fresh fruit, a looming thunderstorm, just-mowed grass) can turn your beat around. A good cigar may seem tempting, but tobacco is a downer. Skin-to-skin (or fur) contact, perhaps not surprisingly, is a natural upper. Marc Salem stars in the one-man show Mind Games. You can find more mind-control tips at marcsalem.com.

It's easier than you think

1. Appreciate her breasts but compliment her wit.

2. Pick up the tab. What? Buy respect? Of course not--you earn it by showing it as you scoop up the bill. To your potential father-in-law: "Your daughter and I would like to treat you." On business: "Jim, it's the least I can do."

3. Try the sushi.

4. When you're spotting someone on the bench and he needs help on the last rep, make him work for it. If he complains afterward about the perceived lack of help, shrug and say, "The last rep's no freebie." Watch his face as he realizes he lifted most of the weight.

5. Never blunt the bad news.

6. Instead of throwing the first punch, just say, "Go ahead and swing. But you'll go to jail for assault, lose your house in the civil suit, and still take the beating of your life as I defend myself. Choose now."

7. If the mutt hits you before you finish the above speech, stick with the plan.

8. Stay sober when no one would blame you for drinking.

9. Nail the toast.

10. Cook for 12.

11. Become what you told people you always wanted to be.

12. When some lemon- sucker asks, "Ugh, you actually like that book?" just reply--with unwavering eye contact--"Yes."

13. Refuse a slut. (Because self-respect is the most important kind.)

14. Remain good company as your short game disintegrates and your following drive kicks up chickens the next farm over. These guys have to spend 3 more hours with you.

15. Par the 18th.

16. Say no when no's the answer. "We'll see," "I'll have to get back to you on that," and "I'm not 100 percent sure" are smoke screens for the man who's afraid to disappoint.

17. Become multilingual. Could be Spanish. Could be the secret language of the internal combustion engine. Either way, it's a life truth: A man with two tongues
is a man in demand.

18. Display a fair and consistent application of baseball pitching clich... in all dealings--meaning that you knock the bastard down when he's crowding your plate.

19. Change the blown-out diaper of a virus-laden infant without making your own stink about it.

20. Recast your ego as an invisible, internal fuel cell that drives your performance . . . instead of continuing with its current incarnation: a second-rate ventriloquist who makes you act and sound like a whiny little brat.

21. Risk being hated for doing the right thing.

22. Rack up a few years of fidelity, devotion, and presence. We mean at your job.

23. Show patience with those who can't do what you can.

24. Apply direct pressure, breathe easy, and ask someone to pick up your hand, put it in the beer cooler, and drive you both to the hospital. Please.

Some secrets are a matter of life and death--yours

Before the feds brought him down in 1996, Edwin Kokes had a pretty good racket. Mr. Kokes convinced people that he was, in fact, Dr. Kokes and had cured thousands of AIDS and cancer patients. He encouraged folks to stop their medications and buy his potions instead, including one called M-Bone. Its special ingredient? Sulfuric acid.

Even if your doctor isn't intentionally out to mislead you, we'll bet a box of tongue depressors that he is keeping you in the dark about certain things. These are secrets that can save you money, time, or even your life. Here's what you'll never hear--unless you know what to ask.

To cover their own butts, doctors sometimes take a needless trip up yours. A nationwide sample of "surveillance" colonoscopies--follow-up procedures done after polyps are removed--found that up to 50 percent of doctors recommended these tests unnecessarily. This better-safe-than-sorry mindset keeps docs safe against lawsuits, and isn't limited to colonoscopies.

Get the truth: Watch out for the most overused procedures: MRIs and CT scans, echocardiograms, and stress tests all scored high in a survey of health insurers. "When your doctor does make a recommendation that seems aggressive, ask why, and where you fit in the assigned guidelines," says Pauline Mysliwiec, M.D., author of the colonoscopy study. For a list of the most common testing guidelines for men, see the Related Articles on the right.

From deductibles to drugs, chances are your doctor visit will run more than insurance will pay. But while a Journal of the American Medical Association study showed that 79 percent of doctors think it's important to tell patients about these costs, only 35 percent actually do inform them. Their excuse? Many physicians say they're under time pressures and don't know how much patients are spending on out-of-pocket costs, says G. Caleb Alexander, M.D., the study author.

Get the truth: Tell 'em where it hurts--in your wallet. If you mention medical expenses, most doctors will work with you to lower them, says Dr. Alexander. For instance, they can prescribe a 3-month instead of a 1-month supply of a drug to help you save on the co-pay. Or they can look at the prescriptions you take and services you receive, such as physical therapy, and reevaluate which can be used on an as-needed basis.


Not the sugar-filled kind, but equally ineffective. "Forty percent of patients with colds who go to a doctor get an antibiotic," says Howard Brody, M.D., Ph.D., director of the Center for Ethics and Humanities in the Life Sciences at Michigan State University. "Doctors can spend 15 minutes explaining why the patient doesn't need medicine or take 1 minute to write a prescription."

Get the truth: Tell your doctor you hope your problem isn't so serious that it calls for medication. This lets him know you're not looking for a bottle of pills, and it may make him more likely to discuss other treatments, says Dr. Brody. And watch out if your diagnosis is sinusitis. Because it can be either bacterial or viral in nature, sinusitis is one of the top conditions for which antibiotics are unnecessarily prescribed. Ask for a C-reactive protein rapid test--a raised CRP level signals a bacterial infection. Danish researchers recently showed that doctors who gave the test to sinusitis patients prescribed 20 percent fewer antibiotics than their peers who skipped the test.

Whoever first said "An apple a day keeps the doctor away" probably wasn't an M.D. A study published in the American Journal of Clinical Nutrition found that only one in six doctors preaches to patients about nutrition's role in preventing disease, while Colorado researchers found that just 28 percent of doctors mention exercise. "We tend to be more pharmacologically oriented because of our M.D. training," says Mark Houston, M.D., author of What Your Doctor May Not Tell You about Hypertension.

Get the truth: If your doctor doesn't have answers about nutrition or exercise, he knows someone who does. Many general practitioners collaborate with nutritionists and trainers who help treat patients with lifestyle-influenced health problems, such as type-2 diabetes. Ask for a referral to discuss basic preventive health strategies.

Doctors can make $5,000 for each patient they recruit to a clinical trial, so you might receive advice colored by the promise of a kickback. That's scary, especially since clinical trials are crapshoots. "The drug is being tested precisely because we don't know how it will work," says Steven Joffe, M.D., a researcher at the Dana Farber Cancer Institute. Plus, you could end up with a placebo and not see any benefits.

Get the truth: Start by asking your doctor to explain the proven benefits of existing medications versus the potential advantages of the trial drug. Next, find out more about the study in question at clinicaltrials.gov, a clearinghouse for information on trials. Go ahead and e-mail the organizer of the trial and ask if the organization is offering physicians any recruiting "incentives." If so, mention this to your doctor and ask if he still stands by his recommendation.


If a brand-name pill costs $1.50 and an equally effective generic costs 5 cents, why would anyone prescribe the pill with the $1.45 markup? "Most doctors aren't prescribing generic medicines because there are rewards to be had from the pharmaceutical industry," says Evan Levine, M.D., author of What Your Doctor Won't (or Can't) Tell You. Federal law prohibits companies from blatantly compensating doctors, but there are loopholes. "They take the doctors to an expensive dinner or a strip club and bill it as a 'teaching' seminar," says Dr. Levine.

Get the truth: Ask and you shall receive. Doctors will acquiesce to patients who demand a generic drug (if one is available; about 40 percent of drugs on the market have generics). Don't worry about quality: Generics have to have the same potency and active ingredients as their brand-name brothers. Note: Beware of free samples. While they can save you a few bucks in the short term, they can also get you started on an expensive drug with no generic equivalent.

"In many doctors' value systems, surgery is the default," says Christopher Meyers, Ph.D., head of the Kegley Institute of Ethics at California State University. But research indicates that surgery often isn't the best option. A Baylor College of Medicine study showed that chronic knee pain didn't change after surgery, while another study found that taking a wait-and-see strategy with hernias may be as effective as going under the knife.

Get the truth: "You should always ask what the alternatives are to surgery, including an approach that most physicians feel uncomfortable offering: to do nothing," says Meyers. If your doc is still scalpel-happy, get a second opinion from a doctor of osteopathy. "These doctors take a more holistic approach and are familiar with newer literature that promotes different strategies," says Dr. Houston.

Doctors won't post signs on their office doors to inform you of their disciplinary infractions or the number of malpractice claims they've paid. But you need to know.

Get the truth: Go to docboard.org--a site with a searchable database from 15 state medical boards and links to the databases of the other 36 boards. If a practitioner you like has been reprimanded, ask him about it. "If a doctor refuses to answer questions about his background or about whether or not patients have sued him, you should run," says Dan Fee, a spokesman for Citizens for Fairness, a coalition of patients'-rights groups.

Stress is part of the job. But when tension starts turning into burnout, it's time to step in and save your psyche

Teaching seventh grade was the first job I ever had without the word "boy" in the title (shipping boy, whipping boy, and so forth). I entered my new profession with equal measures of bumptious pride and genuine determination to make a positive impact on young lives.

By spring, all vestiges of my initial idealism had rotted into laughable, bitter memories. I felt buried alive in an avalanche of spitballs and unremitting enmity from my students and their parents. I stopped preparing lesson plans altogether and slowly fobbed off my teaching responsibilities on the smartest student in the class. On rare occasions when a kid would actually ask something about the subject matter I was allegedly teaching, my stock reply became "Good question. Why don't you field that one, Devon?"

By the end of the school year, I saw myself as a complete incompetent in life. I knew in my heart that I could no longer handle any job, even the ones with "boy" in them. Much as I now detested teaching, the prospect of hobohood left me too paralyzed and fearful to quit.

Mercifully for the sake of everybody involved, the school's headmaster took the decision out of my hands.

During that singularly wretched period of my life, I had no inkling that an official psychological diagnosis existed for what I was experiencing: "job burnout." It's a simple and familiar term, but the disorder is as complex as it is devastating.

"Burnout is a syndrome that happens in response to chronic job stresses, and it's composed of three interrelated dimensions," explains Christina Maslach, Ph.D., a psychologist and the pioneering creator of the Maslach Burnout Inventory, the standard measurement tool for the disorder.

The first of these dimensions is exhaustion--mental, physical, and emotional--a trinity of straw bales that will, over time, break virtually any camel's back. "People feel completely overwhelmed and used up," says Maslach. "There's a sense that they can't handle the next thing demanded of them."

Case in point: Walter K., a divorced father and catalog marketer in Minnesota. "I'm so fried that I feel inadequate for the task of living a reasonable life," says Walter. "It would be nice to have a house that isn't a sty or put a meal on the table that doesn't come in a grease-tinged bag. But by the end of the workday, I just don't have anything left."

Burnout's second symptom is a slide into cynicism and "depersonalization." This begins as a coping mechanism: An overwhelmed worker distances himself from unreasonable job demands. But it doesn't end there. "People shift from doing their best to doing the bare minimum," Maslach says. "Not only the quality but the quantity of their work suffers."

Cynicism and hostility about the job spread to contempt for the people you need to deal with. Burned-out cops grow to assume every citizen is an opportunistic scumbag waiting for a chance to act out. E.R. physicians begin objectifying patients as whining "gomers" (for "Get out of my emergency room").

The third and final phase is a logical culmination of the first two: that is, an abiding sense of failure, and not just with regard to efficacy on the job. "There's a profound personal worthlessness," explains Pierce Johnson Howard, Ph.D., director of research at the Center for Applied Cognitive Studies in Charlotte, North Carolina, and author of The Owner's Manual for the Brain. "People feel there's no redemptive social value in what they're doing."

Even researchers accustomed to couching the disorder in clinical, objective terms concede that at its worst, job burnout becomes more than a mere psychological syndrome. "Burnout represents an erosion in dignity, spirit, and will," says Michael P. Leiter, Ph.D., a professor of psychology at Acadia University in Nova Scotia and coauthor of the upcoming Banishing Burnout. "It's an erosion of the human soul."

No one knows exactly how many of us are currently burned out--or flickering fast in that direction. Many organizational psychologists, however, suspect that the problem has risen dramatically in recent years, thanks to a battery of economic forces that keep nudging up the heebie-jeebies thermostat: global competition, downsizing, and outsourcing.

"Increasingly," says Leiter, "we work in job settings in which human values place a distant second behind economic ones. What inspires us to work well and work hard is ignored."

A model developed by Leiter, Maslach, and other psychologists during the late '90s identified six key areas that can make or break an employee's spirit. Understanding which, if any, of the six are making your cerebrum smolder may help you avoid a full-blown fire.

A crushing workload, a seemingly impossible deadline, a conspicuous lack of resources: Who among us hasn't endured occasional job emergencies that seem wildly beyond our capacity to perform? Amazingly, most of us actually come through in such situations--provided, that is, we know that the scenario is the exception, and that it will be followed by a chance to recover and recoup. But when in extremis becomes de rigueur, the odds of burnout climb fast.

Turn down the heat: Try talking to your boss (diplomatically, not breathlessly) about the amount and timing of your workload. If he's athletic, point out the analogy to weight lifting: Work your muscles nonstop and you'll stunt their growth and increase the risk of injury. But give them time to recover and you'll see that they're able to handle increasingly bigger loads. Explain that your goal is to become more productive, not less so.

It's the classic double bind: You know you're going to be held accountable for the results you produce, but you have no say in how the job is accomplished. Some control-freaky bosses, for example, second-guess every decision, to the point where a subordinate's focus understandably switches from "What could best solve this problem?" to "What's my boss going to find fault with now?"

Turn down the heat: "Managing a micromanager is an essential life skill," notes Leiter. First rule of management: Less is more, as in, lessen your expectations of your boss and you'll have more serenity when he pulls his stunts. We're not talking about "Abandon hope, all ye who enter here!" pessimism, just a nod to realpolitik pragmatism. In fact, pair this attitude adjustment with a plan to meet regularly with your boss and show him what you're up to. This will create more and earlier opportunities for course-changing input.

When it comes to acknowledging a job well done, says Maslach, money alone is not what our highly social species craves. "What we've found," she says, "is that recognition and positive feedback from others play an even more critical role. You bust your buns, you do a good job, but does anybody care?"

Turn down the heat: Oftentimes, bad managers, like uncommunicative spouses, really do appreciate your efforts--but it doesn't occur to them to tell you so. Ask for more "feedback" on your work, couching this in terms that make it clear you'll use the information to perform even better in the future. Besides drawing him out about areas where you may have fallen short, ask where you performed well. With luck, a few such fishing trips will get your boss in the habit of acknowledging your accomplishments.

Successful managers have come to understand the importance of community in the workplace and take pains to foster and reward teamwork. Even some business schools, says Howard, have begun occasionally grading teams as opposed to individuals. Despite this, dysfunctional group dynamics is hardly an endangered species in much of American business. "If your workplace is characterized by a lot of destructive competition, unresolved conflicts, and lack of support, stress levels can go way, way up," says Maslach.

Turn down the heat: If you make an honest effort to be a team player but no one else shows up for practice, consider transferring to another department. It could be that you and your coworkers are alike--in all the wrong ways. "One of the most striking things about burnout is that it occurs in pockets," says Howard. "You have a cluster of five or six people here, 10 or 12 people there." And since the cause of these clusters is usually a toxic supervisor, often the best solution is to leave the department.

Of all the potential burnout pitfalls at a workplace, a sense that the rules have been rigged for another's benefit generates the greatest resentment and hostility. "When people perceive that there's nothing they can do to make things fair," says Maslach, "they often start doing other things to get even--leaving work early, for instance, or stealing office supplies--all with the justification that the company ?owes it to me.' "

Turn down the heat: As simplistic as it sounds, one way to deal with injustice is to simply "keep your eye on the prize"--i.e., acknowledge that life is frequently unfair, but if you keep doing your best, eventually you will be rewarded. Consider the example of Carlos P., a former steel fabricator in Pittsburgh. He had a sterling work record and was first in line for a supervisory job--until, that is, his boss hired an unqualified youngster he knew personally. Carlos swallowed his bile and didn't let what happened affect his performance. The next time a supervisory job came up, he got it.

Work demands, unfortunately, do not always harmonize with our sense of right and wrong. Say, for example, you have a core belief that honesty is the best policy. But in order to meet this month's sales quota (and thus continue feeding your family), you have to shade the truth and/or omit product details. This conflict is kindling for burnout.

Turn down the heat: Aside from killing off your conscience (or, if you're being too idealistic, getting real), the best you can do is voice your concerns to your boss and then cover your butt. Articulate your ethical objections, but do so in a nonaccusatory way--and, of course, expect nothing to change. If the activity has legal ramifications, start building a file--the paper kind--containing copies of everything that shows you weren't exactly a willing participant.

As the above examples begin to indicate, there's a limit to the self-help strategies workers can use to adapt themselves to corrosive work environments. At some point, you may need to cut your losses and head for the escape hatch.

Of course, it's always prudent to line up a new job before you shove the current one. A clandestine quest for a new opportunity can, in itself, be highly therapeutic, says Howard, providing you with a sense of hope and control that serves as a powerful antidote to your current misery.

On the other hand, when things are too onerous, sometimes you can't afford to wait. "There's another consideration," adds Howard. "When people have crept into total burnout, it can take a year to recover fully."

In my own case, I haven't taught seventh grade for several decades, but I still have nightmares in which I'm back in front of a class, being heckled to death by young cannibals. So I know how hard it is to summon optimism when your brain has devolved into full scorched-earth mode. But trust me: Ashes make excellent fertilizer, and a much better life is waiting to sprout from the char.

Because a healthy penis is a happy penis

Even if you never develop skin cancer on your most valuable skin, there are other flesh maladies in that area that can cause panic attacks. Not to worry, says Adnan Nasir, M.D., Ph.D., a professor of dermatology at the University of North Carolina at Chapel Hill. You simply need to identify what you might be dealing with.

Sudden red, itchy rash: Contact dermatitis (doctor-speak for an allergic reaction). You could be allergic to the latex in your condoms, the detergent in your tighty whities, or even the lotion or perfume your girlfriend uses. One way to know for sure is to have your doctor do an allergy test. In the meantime, try a hypoallergenic detergent or a polyurethane condom, and pop an antihistamine like Benadryl or Claritin to relieve the itch.

Bright red, itchy rash where your legs meet your groin: Jock itch First, switch to boxers. (Sorry, boxer briefs are not a compromise.) Then slap on a little Gold Bond powder in the morning to keep your undercarriage dry as you sweat through the day. In more severe cases, your doctor might prescribe an antifungal cream.

Patches of yellow, greasy flakes with pinpoint bleeding when scratched: Psoriasis You might find similar patches on your elbows, knees, belly button, or scalp, and your finger- and toenails may begin to look bumpy. Swimming in salt water might clear this up. You can also use a hydrocortisone cream or a tar shampoo like Neutrogena T/Gel. Tough cases earn a prescription for a topical steroid or a nonsteroidal anti-inflammatory cream.

Redness with yellow, greasy scales, but no bleeding: Seborrheic dermatitis This can also cover your sternum, and you may develop it near your eyebrows and behind your ears. Treat it with a selenium sulfide shampoo, such as Selsun Blue, or one containing salicylic acid or ketoconazole.

Rash with white, powdery scales in the folds of the skin: Eczema It can also show up in the crooks of your elbows and on the backs of your knees. Treat it with Sarna or Aveeno anti-itch lotion or a hydrocortisone cream. Prescription remedies include Protopic and Zonalon.

Any one of the above that doesn't go away after treatment, plus irregular bumps: possible skin cancer You'll need to visit a specialist for a biopsy of the affected area.

The Girl Next Door tells all

Whenever I hear a friend complain that a man lost it long before her clitoris registered so much as a tingle, I think it must be payback for all those nights back in high school. Back then, a boy would practically wear a hole through the crotch of his Levi's dry-humping our hips--and still we wouldn't lay a finger on his goods. We'd just send the poor soul off into the night with an aching penis. Do we mind now that the tables are turned? Did you mind walking away from a date with balls that felt ready to explode?

Of course we mind. It's frustrating. It's uncomfortable. It's disappointing. And, contrary to popular belief, women are not into sex just for the freakin' intimacy. But, as you did then, we tolerate orgasmless sex because, well, there's always a next time. We just take a deep breath and put it out of our minds--which, as it happens, adult women are much more capable of than teenage boys. As long you don't come too soon too much of the time, it's not such a big deal. We might complain about it to our friends once in a while, but we won't hold a grudge or start daydreaming about screwing Sting for days on end. Wait--we will daydream about screwing Sting--but it won't have anything to do with your sexual longevity.

What I don't understand is why, after enjoying the last waves of his orgasm, every man doesn't then offer a woman his still-firm fingers to finish the job. It would be proper etiquette in that situation, no? Maybe your partner will gently push your hand away and say she just wants to cuddle, but it's more likely that she'll writhe against your fingers in ecstasy. And she won't be the only one who benefits. Putting in that extra effort for the sake of fully satisfying your woman is the kind of thing that inspires future oral sex for you. You scratch our itch, we'll scratch yours.

A new pill claims to squash depression, beat chronic pain, keep your sex life roaring--and work almost instantly. Read on to find out just how happy we should be

Abject misery may sound like a cliche--until you've felt it. Back in college, I was often unable to sleep longer than 45 minutes at a stretch. I couldn't think well, and I couldn't stop thinking. Food nauseated me, and I lost so much weight I could almost watch myself disappear in the mirror. Simply put, my depression had become intolerable, and, seemingly, incurable.

That is, until I lucked upon a medicine that, for me at least, has pretty much deserved the sobriquet "miracle drug": fluoxetine, a.k.a. Prozac. Not long after Eli Lilly's mood-boosting blockbuster hit pharmacy shelves in 1987, I was clutching a prescription and praying that Prozac would live up to all of its prerelease hype. My initial review wasn't favorable: I still felt a magnetic attraction to bridge abutments while driving. But after 5 weeks and an increase in dosage, my symptoms abated almost entirely, and I was restored to my "normal" self--neurotic, to be sure, but no longer lethally so.

I still take Prozac on a maintenance basis, to prevent relapses or reduce their severity, and because its chemical cousins--Paxil, Zoloft, Luvox, Celexa--haven't given me any meaningful reason to make a switch. Enter Cymbalta, the newest of the new antidepressants, and Eli Lilly's attempt at an encore to its greatest hit.

Widely expected to win FDA approval in late June, Cymbalta is supposed to be more effective at treating depression, anxiety, and related disorders; have a lower incidence of nasty side effects, including sexual problems; and maybe even work a little faster than the best current antidepressants, which tend to require 2 to 6 weeks minimum to kick in.

But the big news is that it could have a major impact on the treatment of depression attended by its evil twin: chronic pain.

Now that my dark moods are in check, I fantasize about freeing myself from my physical aches, as well. I'll admit I have a low pain threshold, which is probably a companion to my lifelong depression. But I've also suffered a smorgasbord of sports injuries, so something is always giving me trouble--my lower back, shoulder, hip, or some internal organ. I pop ibuprofen like Pez. So as word of Cymbalta's dual purpose filtered out, I began to wonder if I should switch from Prozac, and fix both body and soul with one swallow.


Clearly, I'm not the only person who could use a one-stop remedy. In a recent study published in the Archives of General Psychiatry, researchers at Stanford school of medicine looked at data from 18,980 men and women in five European countries and found that a whopping 43 percent of those with major depression also suffered chronic pain, especially headaches and back pain. Only 17 percent of the undepressed population ached as often.

"I was surprised by how many people who were depressed also had chronic pain," says the study's lead author, Alan Schatzberg, M.D., a professor of psychiatry and behavioral sciences at Stanford. In fact, chronic pain is so common, he believes it should be added to the standard checklist of depression symptoms (changes in mood, appetite, sex drive, and sleep patterns).

Adding chronic pain to the roster could be especially valuable in diagnosing men, says David J. Goldstein, M.D., Ph.D., an associate professor of pharmacology and toxicology at the Indiana University school of medicine. "There's clearly a large proportion of male patients who downplay feeling depressed but present instead with pain that has no obvious cause, like headaches or back pain." Often, these men will also suffer classic depression symptoms like sleep disturbance or reduced sex drive but blame this entirely on their physical pain, not their mood. "This denial can be confusing to physicians," Dr. Goldstein adds, "and often leads to misdiagnosis." The unfortunate result: Such patients aren't treated for what truly ails them.

But is Cymbalta the answer? Recently, Dr. Goldstein decided to find out. In the January/February 2004 issue of Psychosomatics, he and his colleagues published an analysis of three randomized, double-blind, placebo-controlled trials. The findings: When compared with a placebo, Cymbalta significantly reduced overall pain, back pain, shoulder pain, and time in pain while awake. Perhaps not too surprisingly, for most patients, physical improvement tended to parallel mood improvement--like dancers following each other's lead.

And while this research was funded by Eli Lilly (de rigueur for any drug in development), the science behind Cymbalta backs up the findings. Prozac and the other selective serotonin reuptake inhibitors (SSRIs) primarily target a single feel-good neurotransmitter: serotonin. Cymbalta affects both serotonin and norepinephrine, a neurotransmitter that helps to regulate alertness, energy, excitement, and concentration. In fact, the dual action of this so-called SNRI has more in common with the old tricyclic antidepressants, some of which, like Elavil, are still used to treat depression and chronic pain.

The reason doctors moved on from the tricyclics--which were helpful with mood--was their wide array of potential side effects, including urine retention, constipation, arrhythmic heartbeat, blurry vision, and a host of other unsavory problems. Cymbalta may function as a "clean" tricyclic--all the benefits, fewer side effects. Or at least, that's the hope.

"Generally, you do pay a price for taking a medication with a second mechanism of action," says Michael E. Thase, M.D., a depression expert at the University of Pittsburgh medical center. "You may see, for example, a little more dizziness, insomnia, sweating, or rapid pulse. None of these are likely to be nearly as bad as with the tricyclics. But there is no free lunch here."


Since Prozac first landed in pharmacies nearly 17 years ago, the market for antidepressants has ballooned to nearly $14 billion in the United States, says stock analyst Scott Shevick, who follows the major-pharmaceuticals sector for the investment firm Bear, Stearns & Co. Last year, more than 213 million prescriptions for antidepressants were dispensed, mostly SSRIs in one form or another. Without a doubt, a new antidepressant could prove to be a windfall for its manufacturer.

"Forecasting individual drugs is incredibly hard to do," Shevick says. "But Lilly knows the psychopharmacology market better than anybody, and they'll be throwing 5,300 reps at physicians to sell the hell out of this drug."

Indeed, in coming months, Shevick says Lilly is likely to barrage doctors and would-be patients alike, pushing Cymbalta's supposed advantages over the competition. We're likely to be barraged, too, by cautionary words and horror stories from antidepressant critics, ranging from reputable researchers to "fringe groups" like the Church of Scientology, which, Shevick says, has been lobbying to have Prozac banned since it first came on the market.

Sorting through all the hype and nuttiness won't be easy, but here are a few of the questions likely to be raised.

Will Cymbalta have the same sexual side effects as the SSRIs? "When the SSRIs first hit the market," says Joseph Glenmullen, M.D., a Harvard psychiatrist and the author of Prozac Backlash, "it was thought that incidence of sexual side effects was only 5 percent.

We now know that 60 percent of patients have some sexual problems." The rates of sexual dysfunction with Cymbalta, by comparison, have been extensively studied using rating scales, says David Dunner, M.D., director of the center for anxiety and depression at the University of Washington at Seattle. "It appears that only about 10 percent to 15 percent of men will have some kind of sexual dysfunction," he says.

Dysfunction is defined as anything from reduced sexual desire and/or trouble getting an erection to delayed orgasm, or even anorgasmia--the technical term for life without whoopee. For those men who develop erectile difficulties, Dr. Dunner adds, Viagra and its brothers can usually help. The only cure for anorgasmia, however, is lowering the antidepressant dosage or avoiding the drug entirely.

How does Cymbalta compare with Effexor? Though Cymbalta has been shown to be 5 to 10 percent more likely than SSRIs to provide complete relief from depression, the same can also be said about Effexor (venlafaxine), the other SNRI available in the United States. Effexor, however, appears to affect norepinephrine only at high dosages, which, in 10 percent to 12 percent of patients, also cause dangerously elevated blood pressure. The data from Cymbalta's clinical trials are much more reassuring: Only 1.3 percent of patients experienced increases in blood pressure. Still, such a selling point may prove short-lived. "Since Effexor XR, the extended-release form, hit the market," says Shevick, "you rarely hear about high blood pressure being a problem."

Will Cymbalta act more quickly than other antidepressants? Generally speaking, people have to take the currently available antidepressants for 2 to 6 weeks before they notice improvement. Eli Lilly claims that Cymbalta may act faster. Michael Detke, M.D., Ph.D., associate medical director for Lilly, argues that the drug's dual action allows it to simultaneously hit depression, anxiety, reduced concentration, low energy, and physical pain. Because it attacks on several fronts, he says, the patient may notice improvement faster. Anecdotally, at least, some patients corroborate this. "There's a possibility this could be true," says Dr. Thase. "But at this point, the studies that are needed to prove it have not been done."

Didn't a patient commit suicide during the testing of Cymbalta? Early last February, a 19-year-old college student serving as a "normal control" in a Cymbalta trial hung herself from a shower rod at a Lilly research lab. Investigators determined that the young woman was actually on a placebo at the time of her death, though she had earlier been receiving relatively large doses of the active medication. Lilly claims its drug played no role in the woman's death, a conclusion with which many outside observers agree. "The FDA is very risk averse," says Dr. Goldstein. "If they believed that Cymbalta caused suicide, they would stop further development."


If Cymbalta gets a thumbs-up from the FDA, guys like me will be faced with a decision:

Stay the course with medication that's already working pretty well--or embrace the promise of a potentially better remedy?

When I ask for advice from Dr. Dunner, he tells me, "One of the first things I learned in psychiatry was not to rock the boat. Depression is a complex illness, and the reasons for switching from an effective medication ought to be compelling--a less-than-full response, for example, or a deeply troubling side effect."

But Prozac works for me, and I can tolerate the side effects. In fact, the only "problem" I've endured is slightly delayed ejaculation--a problem my wife doesn't seem to mind at all.

Cost also figures strongly on the "stay the course" side of the equation. As a self-insured man, I pay for most prescriptions out of pocket. Now that Prozac is available as generic fluoxetine, it's become nearly as cheap as aspirin--and I'm in no rush to go back to pills that Shevick forecasts could cost well over $3 a pop.

"Effective" and "cheap" are two adjectives that are hard to ignore. Regardless of Cymbalta's fate, I've decided to stay with the miracle drug that's helped me so much so far. For guys who've been let down by SSRIs, or for those newly diagnosed with depression, Cymbalta could prove to be a better option.

Who knows? I may even join them one day.

"Some patients have reported that over time, a given antidepressant doesn't work quite as well anymore," says Dr. Goldstein. Practitioners refer to this as "Prozac poop-out"--though anecdotal cases have been reported with all the antidepressants, not just fluoxetine. In such cases, says Dr. Goldstein, "it might be the time to try a dual-activity antidepressant like Cymbalta."

And that's why I follow all the advances in antidepressants. As another barrier between me and abject misery, Cymbalta is already a miracle drug--even if I never end up needing to take it.

This is the story of stress. It's a long story, so let's start at the beginning, one balmy afternoon, about 28,000 B.C.

A dry twig in the jungle snaps, and our common ancestor--your father, my father, 1,500 generations ago--leaps into alert mode. Adrenaline floods his system, causing lipid cells to squirt fatty acids into his bloodstream for quick energy. His breathing becomes shallow and rapid, and his heart beats faster, increasing the flow of oxygen to his muscles, enhancing his strength and speed. His blood vessels constrict, minimizing bleeding if he's injured, and his body releases natural coagulants and painkillers. His sweat glands open, leaving his skin slippery and hard for predator to grasp. His hair stands on end, making him appear larger and more threatening. His pupils dilate, increasing his ability to scan dark jungle terrain. All this happens in less than a second, and zip, Dad's off and running, far enough ahead of the tiger to ensure that your bloodline, and mine, makes it to the next generation. Today all the tigers are locked in the zoo, and so are we. Like them, we're now captives of little boxes, kept to orderly eating schedules, told when to sleep and wake by bulbs that hang from the ceiling. Oh, we're safe from the tigers now. But no one has told our Cro-Magnon brains the good news. We still react to stress the same way, but now our physiology works to hurt us, not help. Today the twig snap comes with an innocent "Can you drop by my office?" and the lion roars via e-mail. Yet our bodies still behave as they did 300 centuries ago, flooding our systems with adrenaline every time a threat looms--whether it's physical, emotional, or financial. And because we can no longer run for safety when stress attacks (imagine how the boss might like that), our need for fight or flight is never addressed. Our bodies are built for momentary stresses, but our society delivers the long-term type. Unyielding adrenaline forces more blood through our delicate vessels, raising our risk of stroke and heart disease. To mop up the fat flood, our bodies release the hormone cortisol, which stores the fatty acids in the form of adipose tissue around our bellies. Increased muscle stimulation and digestive shutdown lead in time to back pain and ulcers; constricted blood vessels cause migraines. The maddening thing is that we're feeling all these symptoms not in the company of a ravenous predator, but rather in those lonely, wee small hours when we're awake and our partner's asleep and the bills on the kitchen table are laughing at us. And this is supposed to be nature's way of keeping us alive. Instead, it's killing us, just as surely as--perhaps even more surely than--the fat we ate for dinner or the genetic time bomb lurking in our DNA. All told, the physical symptoms of stress cost the United States an estimated $200 billion a year. But even that huge number may be too low. Stress demands action, and action is not what our orderly world is built for. Stress makes men do things they shouldn't do, because they have to do something. Stress puts a besotted, heartbroken husband behind the wheel of a car; lures a 17-year-old expectant dad into the middle of a drug bust; pushes an honest businessman across the threshold into racketeering; and makes us snap at our partners, or our kids, with words we can't take back, that start us down the path to all sorts of costly consequences.

By

Feeling on edge? Maybe it's your job. Or your wife. Or a 3-foot putt to break 90. Whatever your worry, consider it quashed

Researchers at the University of Alabama fed rats 200 milligrams of vitamin C twice a day and found that it nearly stopped the secretion of stress hormones. If it relaxes a rat, why not you? Two 8-ounce glasses of orange juice daily gives you the vitamin C you need. This is your secret reminder to take one deep breath before you answer a call, says Susan Siegel, of the Program on Integrative Medicine at the University of North Carolina school of medicine. Not only will you feel better, but you'll sound more confident. Yours or someone else's. According to research at the State University of New York at Buffalo, being around a pet provides more stress relief than being around a two-legged companion. As if we needed a study to determine that. Researchers at the University of Bristol in England discovered that when stressed-out men consumed caffeine by themselves, they remained nervous and jittery. But when anxious men caffeine-loaded as part of a group, their feelings of stress subsided. When you're facing that big-money putt, shake out your fingers, relieving the tension in your forearms, hands, and wrists and shifting your focus to the only thing you can control: your preshot routine. You won't think about making--or missing--the shot, says Alan Goldberg, Ed.D., a sports-psychology consultant in Amherst, Massachusetts. And set it to the blandest music station you can find. According to a study at Pennsylvania's Wilkes University, Muzak lowers your stress levels at work, while also reducing the risk of the common cold. We knew Celine Dion had a purpose. Freaking out about a speech? Smile, look at the audience, and keep quiet for 2 seconds, says T.J. Walker, president of Media Training Worldwide. It'll slow you down and create the impression that you're relaxed and in control. The audience will then feel more comfortable, leading you to actually be relaxed and in control. Now start talking. Unless you're a mime. In that case, as you were. To keep calm in a job interview, rest your arms on your lap, with your elbows bent slightly, and have your fingers almost touching, says Walker. This will keep your body relaxed, which will keep your tone conversational. Bike hard. Punch the heavy bag. And we don't mean your mother-in-law. A University of Missouri at Columbia study found that 33 minutes of high-intensity exercise helps lower stress levels more than working out at a moderate pace. What's more, the benefits last as long as 90 minutes afterward. In an Oklahoma State University study, those who combined sauna use with group counseling had greater stress relief, feelings of relaxation, and sense of accomplishment compared with those who only had their heads shrunk. ...name at least 30 states, or assemble the All-Time Band of Guys Named James (the James Gang doesn't count). In other words, give your mind any all-consuming challenge, as long as it has a definite finish--unending problems cause more stress, says Toby Haslam-Hopwood, Psy.D., a psychologist at the Menninger Clinic in Houston. It's a CD-ROM game that works like this: Three biofeedback sensors worn on your fingers sense your stress level and translate it into your ability to perform tasks such as levitating virtual balls or controlling birds in flight. The more you play, the more mastery you gain over your emotions. Go to CreativeLivingInstitute.org for more information. It sells for about $150. Now take a breath --and a good long look. You'll walk away from the brink with a sense of context and a bigger perspective, which will make the 5,000 things on your to-do list seem less daunting, says Allen Elkin, Ph.D., director of the Stress Management & Counseling Center in New York City. When dealing with a screaming child in a car or any other acutely stressful situation, ask yourself how long you could listen to it if someone gave you $100,000, suggests Elkin. Suddenly, it's not so awful, is it? What, now the kid is screaming on a crowded airplane? Immediately apologize to everyone around you. By acknowledging that you may have made a mistake or hurt someone else, you can help clear the air, and that will reduce your stress level, says Charles Emery, Ph.D., an associate professor of psychology at Ohio State University. Now someone else's kid is screaming on a crowded airplane? And the mom is too wrapped up in this week's People to do a thing about it? Let it go, says Carl Thoresen, Ph.D., a psychologist at Stanford University. Realizing that you can't control someone else's behavior is difficult, but it's one of the best ways to destress. Even if it takes you out of your way, it may make your ride less stressful. An Ohio State University study found that scenic drives were more calming than those involving strip malls and endless, disheartening asphalt. It's nurturing, it doesn't take up much space, and for 10 seconds, the world is not about you, which can be a huge psychological relief, says Elkin. And hang up something in a cool color like green or blue. According to Leonard Perry, Ph.D., an extension professor at the University of Vermont, cool hues are more soothing. Rather than spend the entire day anxious about an afternoon DRE, get fingered first thing in the a.m., when your cortisol levels are already naturally elevated, says David Spiegel, M.D., medical director of the Stanford Center for Integrative Medicine. Researchers at West Virginia University found that 35 participants who underwent "mindfulness meditation" saw a 44 percent reduction in psychological distress over 3 months. Just sit quietly for 10 minutes a day and focus on your breathing. Walking lessens the frustration, and having a destination keeps your mind busy, says Michael Nuccitelli, Psy.D., a psychologist in Brewster, New York. You'll also have fine-looking shoes. And if this magazine has taught you anything, it's that ladies notice fine-looking shoes.

Embrace that which is underrated, unappreciated, or simply undiscovered

Even their worst buddy movies are like bad pizza--not that bad at all.

You don't have to be on top of the action. Occasionally seeing a game from way up here can give you a new perspective.

Always has that look in her eye like she's about to give you the best sex of your life. And then cut your throat for enjoying it. Any of you guys mind? Anyone?

Bye-Bye Miss American Pie is 10:03. So what!

Made cheap through bashing, leprous through scandal . . . yet we're all still paying the phone bill every month.

One that doesn't come from a box. One you're not rushing through. One not simmering with tension from yesterday's arguments. Just a meal that someone cooked because they give a damn about you.

Don't know him? Look him up.

A couple of flesh-covered Swiss balls look great whipping around a fire pole from 50 feet away. But hands-on, the real things still rock.

Beautiful, fun, surprising, cheap. (Like that girl in '92.)

But never in the heat of the moment. A formal cheek-lashing that the naughty one knows is coming, and why it's coming. Naughty woman or naughty child? Your call.

Sometimes the worst decisions are made because you decide you have to do something.

A campfire, a dog, a beer net in the stream, and no humans for 48 hours.

Alone, you can lose yourself. With a girl, you can act and crack wise. With kids, it's painless culture, with a caf... hot dog waiting at the end.

The effectiveness of a well-timed and perfectly pitched profanity.

Getting anything done before 9 a.m. on a Saturday.

You can barely hear him on those old records, but check out Johnnie B. Bad--you'll hear why Mick and Keith brought him onstage during their most recent tour.

The car chase of sexual stunts--done a thousand times. But done well, always a crowd-pleaser.

Thousands of mutual funds, hundreds of cable channels, and scores of toothpastes are depressing the hell out of us, according to no less than five recent studies. Just line up three options and pick one.

It's common to hear tell of nagging, harping, and griping. Rare is the man who speaks of his mate's caretaking, encouraging, and giggling.

Just let the suckers grow. Muttonchops are the new mullet.

It's the one thing we all think is expendable that's not.

That morning latte or espresso may not be the pick-me-up people think it is, a study has revealed.

University of Bristol researchers say the caffeine eases withdrawal symptoms which build up overnight, but does not make people more alert than normal.
The work, presented to the British Nutrition Foundation conference, showed only people who have avoided coffee for a while will get a buzz from caffeine.
But the British Coffee Association said regular drinkers did feel more alert.

That alertness you feel is you getting back to normal
Professor Peter Rogers, Bristol University

Those who swear by their morning caffeine fix say it wakes them up, and if they missed out they would feel sluggish and unable to get on with their day.
But the Bristol researchers, who carried out a review of previous studies into the effects of caffeine, say all the drink does is counteract the mild caffeine withdrawal symptoms people are experiencing because they have gone without the stimulant overnight.
And those who drink a caffeinated drink first thing are no more alert than those who never consume one.

'Back to normal'

Professor Peter Rogers, a biological psychologist who led the research, told: "We do feel a boost from caffeine in the morning, but that's probably due to a reversal of the withdrawal symptoms.

"That alertness you feel is you getting back to normal, rather than to an above normal level.

"That morning boost is what people think is useful about caffeine, but if that doesn't happen, maybe it's not that useful after all."

Professor Rogers said caffeine did have some benefits, such as preventing cognitive decline in the elderly.
But he said it was usually be best to opt for decaffeinated drinks - although the odd coffee could help.

"If you're not a regular consumer, you might get something out of one or two drinks. But once you're a regular consumer, you're in a cycle of withdrawal reversal."

Zoe Wheeldon, of the British Coffee Association, said the research was interesting.
But she added: "There are two sides to the debate and a wealth of scientific evidence suggests that moderate coffee consumption of four to five cups per day is perfectly safe for the general population and does have a beneficial effect on alertness and performance even in regular coffee drinkers."

Head Games: Fight Off a Migraine
Here's how to fight back

Don't blame your next blinding headache on stress or your kid's music. A new study by the Headache Care Center in Springfield, Missouri, found that 80 percent of people who thought they were having sinus headaches actually had migraines. "Men are less likely to go to a doctor, and if they go, they're less likely to be diagnosed," says Richard Lipton, M.D., vice chairman of neurology at the Albert Einstein college of medicine in New York City. He developed this three-question quiz to screen for migraines:

1. in the past 3 months, have headaches limited your activities?

2. Does headache pain make you sick to your stomach?

3. Does light bother you? "If you answer 'yes' to two questions, there's a 93 percent chance you are suffering from migraines," says Dr. Lipton. Many men are unaware of the availability of treatment.

Triggers. Common culprits are red wine, nuts, bright lights, chocolate, smoke, stress, lack of sleep, irregular exercise, climate changes, and alcohol. But almost anything can set off a migraine, says Robert Kaniecki, M.D., director of the University of Pittsburgh headache center. Your doctor can narrow it down.

Treatment. "Usually a patient just has to pin down the triggers and make minor lifestyle changes," says Dr. Kaniecki. Prescription medications can stop pain soon after onset.

Fast fixes that guarantee a good reaction

Here are the tests most commonly used by conventional allergists

From Allergy Free Naturally, Prevention Health Book Drops of suspected allergens are either placed onto or injected into your skin. If you're allergic to the substance, a round wheal or flare will form on your skin after 15 to 20 minutes. These tests measure either the total amount of immunoglobulin E, or IgE, in your bloodstream or the IgE that's specific to certain allergens, such as ragweed pollen. When IgE comes in contact with an allergen, it releases chemicals such as histamine, prostaglandins, and leukotrienes. These chemicals cause the symptoms of allergies. To measure your airflow, you blow into a device called a spirometer. Then a reading is taken. If asthma is suspected, you are given a bronchodilator and are then tested again. If your airflow improves, it's a good indication that asthma is present. A piece of blotting paper is soaked with the suspected allergen, then it is taped to your skin for 24 to 48 hours. If a rash develops on the site, it's a sign of eczema. Performed only if specific allergy testing is not available, these tests require you to inhale or swallow a very small amount of the suspected allergen so that your reaction to it can be observed. Because of the risk of serious reactions, these tests must be done only under a doctor's supervision.

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As a teen, you stockpiled wood. Does your lumber still stack up?

As men age, they need to consider the heart/erection connection. "All health issues have effects on your penis," says Steven Lamm, M.D., an assistant professor at the New York University school of medicine and the author of The Hardness Factor: How to Achieve Your Best Health and Sexual Fitness at Any Age. "A 50-year-old man who is healthy is probably performing as well sexually as an out-of-shape 30-year-old who smokes and drinks."
Dr. Lamm recommends these lifestyle changes to keep your member in good standing after the teenage years.
*Achieve ideal body weight and eliminate the fat around your gut. Abdominal fat blocks the testosterone that should be available to you, which in turn affects sexual functioning. A fat gut is a bad marker for overall health--including your sexual health, says Dr. Lamm.
* Do a cardio workout daily. When you exercise, bloodflow increases--blood rushes through the endothelial cells (the lining of the blood vessels) and stimulates them to make more nitric oxide, a key chemical involved in producing erections. "The healthier a man is, the more nitric oxide he produces, and the harder his erection is," says Dr. Lamm.
* Give up butts. "Absolutely do not smoke--that just clenches down on your blood vessels and prevents them from being reactive," he says. Smoking restricts penile bloodflow and weakens erections, making smokers twice as likely to experience erectile dysfunction.
* Avoid big meals and alcohol before sexual encounters. For optimal sexual performance, give yourself 2 hours between dinner and sex. Would you eat a big meal before playing a full-court basketball game? "If all your blood is going to your gut, it's not going to go to your pelvic area," Dr. Lamm says.
* take supplemental insurance. Pop two omega-3 fatty-acid supplements daily totaling at least 300 milligrams (mg) of DHA and 400 mg of EPA as a kind of insurance policy on your heart and penis health. And consider taking the antioxidants pycnogenol (80 mg) and L-arginine (3 grams) daily. They'll shield your endothelium from harm and facilitate the use of nitric oxide.

Some people might call you highly competitive. Some might call you superfit. But a growing number of doctors would label you something else: Depressed

In 1994, at the age of 33, Raymond Britt took up running. It made him feel good. In fact, the more he pushed himself, the better he felt. So each time he went out, he pushed a little harder. It seemed to put him above the turmoil of the world and afford him some relief. Relief from what -- that wasn't so clear. His life was good. He was a successful executive. He'd married his high-school sweetheart. He had beautiful children.

But there was something odd about it all. For one thing, he had no background as a runner. He'd been a powerlifter in his 20s, benching 315. But in the summer of '94, amid a hectic schedule, he happened to see a flier for the Chicago Marathon and was seized by the impulse to run it. Never mind that there were only a few weeks left to train. Never mind that he had never run more than 3 miles at a time. He thought, I can do anything for 5 hours and 30 minutes, which was the qualifying time to receive a finisher's medal.

He became obsessed with his training.

"I was excited, I was nervous, I was alive," he says. "My mother and my wife thought I was crazy." As he reached the 18th mile of the marathon, his hopes for a life-changing experience were shattered. Beating himself up both mentally and physically, he managed to drag his body over the finish line in 4 hours and 41 minutes, as he puts it, "alone, hurt, angry, unhappy."

Rather than recover, he went out the next day to punish himself and prepare for the next marathon.

Sex Differences
The study of how mental illness affects men and women differently is new and fraught with controversy. The first comprehensive survey was conducted between 1990 and 1992. Its aim was to estimate the general prevalence of mental illness.

The research, known as the National Comorbidity Survey, was repeated, in more depth and on a larger scale, between 2001 and 2003, under the auspices of the World Health Organization and with funding from the National Institute of Mental Health. The principal investigator is Ronald C. Kessler, Ph.D., a jolly-looking, bearded professor in the department of health-care policy at Harvard University.

The numbers seem to show that men and women suffer from various mental illnesses at about the same rate, with some notable variations and exceptions. One of the differences, long accepted as gospel by the psychiatric professions, is that twice as many women as men suffer from depression. Kessler says his numbers show that a woman is twice as likely as a man to have a single episode of major clinical depression in her life. After the first episode, however, men and women don't differ in the number of episodes they'll have during a lifetime, or in whether they'll have another episode. Only the first step differs, he says. Then the statistics flatten out to equal.

But if repeat episodes of depression are equal for men and women, doesn't it stand to reason that they may be having first bouts at the same rate? Maybe the discrepancy lies not in the number of men and women who are depressed, but rather, in how depression is expressed.

According to an increasing number of experts, the diagnostic tallies don't take into account the real experience of a lot of men like Britt. They also ignore the fact that women are much more likely to report depression and seek help. Men are more likely to try to fight through their depression, using strategies ranging from hard work to extreme exercise to drinking to violence. Nearly four times more men than women kill themselves.

When women become depressed, they tend to show the classic symptoms described in the psychiatrist's handbook the Diagnostic and Statistical Manual of Mental Disorders. They feel sad and tired, and lose interest in the pleasures of life. In short, women generally get depressed in just the way that most people, including psychotherapists, think about depression.

Men tend to get angry, and that anger expresses itself in a wide variety of intense activities, such as Britt's obsessive running. Some of these men even win marathons--on the streets of Chicago or in feats of work endurance--and look like heroes, which makes it even more difficult to diagnose their depression.

Britt says, "I've always thought Lance Armstrong suffered from depression and that's where his anger came from. I saw a lot of myself in him, the way he transfers anger into action. Depression leads some of us to fight as hard as we can against it. It makes you angry. I liked my anger. I got focused and felt better, like I was leaving turmoil in the dust. But it was temporary."

Because he think of the word "depression" as fitting the woman's profile better than the man's, doctors and therapists don't tend to recognize the disease as readily in men, and men don't talk about it. William Pollack, Ph.D., a professor of psychiatry at Harvard, estimates that 50 percent to 65 percent of men suffering from what they call "covert depression" aren't diagnosed.

It seems clear that men will do just about anything to avoid admitting to having the disease. They'd rather just suffer. Some of them would rather die.

Driven
Britt raced in Chicago the next year and qualified for the Boston Marathon. Still, he needed more. He entered the Chicago Triathlon that same year and nearly drowned. ("I was a terrible swimmer.") He returned in 1996, and did well. That only fed his craving. "I wanted to take everything to the next, most impossible level I could imagine," he says. He describes himself as "driven to the margin of terror."

By 1998, he had developed a set of rules for himself: more, harder, quicker, and farther away. Three Ironman races in 7 weeks. Roth, Germany, in July for Ironman Europe. Zurich in August for Ironman Switzerland, wife and 4-month-old baby in tow. Ironman Canada again in September. "Still not enough," he says.

In 1999: four Ironman races, a 50-miler, and the Western States 100. Seven days later, he ran two 5-Ks on the same day, for "pain as punishment and proof that I was okay. I could survive the day as long as I could channel my inner turbulence into power and aggression during training. The determination, the drive, kept me afloat."

In the following years, he broke 3 hours in the marathon, qualified for the Ironman World Championships three times, won awards, gained sponsorship, and was regularly published as a cardio guru. He was a champ, a role model. "How can this be a bad thing?" he asked. "And if I'm strong enough to outlast anything, aren't I strong enough to outlast life's challenges?"

Yet his world had begun to contract. He began intentionally doing reckless things. "I took risks riding my bicycle in traffic, running at night, fighting whatever was fighting me. It felt good to be fighting."

He couldn't run, bike, and swim all day. He had to work. He had a wife and kids. So he simply pushed that much harder. "My best performances came when I was ready to rip the top off the race course. I had very aggressive feelings. I just wanted to attack."

He was winning, yes, but he also required emergency medical attention after every event. He'd come in with his blood pressure reading 90 over 50 and required up to four IV bags of fluid to counter dehydration. That didn't seem odd to him, but his wife began to worry that he was trying to kill himself. He told her he was just pushing it. He eventually did 42 marathons, 27 Ironman Triathlons, and six ultramarathons in 11 years, covering 42,000 miles, the equivalent of running, swimming, and biking around the world 1 1/2 times.

The weird thing is this: Raymond Britt isn't that unusual. His distances aren't even that huge, compared with some guys'. And the mental illness he suffers from, which drove him to battle through all those miles, is not that uncommon among men.

Steven Imparl is a lawyer in Chicago, but a look at his résumé affords a glimpse into the frantic world of a man working very hard to compensate for depression. He graduated from high school in the top 15 of his class of 550 students. He received his B.S. degree with high honors. He became an information-technology specialist working for big companies, then went on to earn his law degree and start his own firm. Along the way, he studied French, German, Slovene, and Spanish. He learned classical guitar, studied Slavic and Balkan history, and sang barbershop harmony. And he somehow found time for power walking, inline skating, volleyball, and boxing. By the fall of 2001, he was so wound up, he could hardly sleep. He became more irritable, more easily angered. After nearly getting into a fistfight while walking down a street, he decided to seek help. But when the doctor told him he was suffering from clinical depression, Imparl refused to believe it. Admitting to depression is . . . well, it's like getting your period: Guys don't do it.

Once Imparl accepted the diagnosis, he performed like any true, overachieving depressed man would: Through a program of therapy and drugs, he got better, and then he founded a successful Web site, maledepression.com, for guys like him.

Raymond Britt's crash and burn came one day in November 2004, when he set out to run himself into the ground, to transfer the pain from his soul to his body. Many miles and hours later, he found himself bloodied, exhausted, and hypothermic, but he neither displaced the internal pain nor found relief. He was forced at last to face what he'd known for decades: Depression was rampant in his family. From an early age, Britt had been determined that he wouldn't succumb. He wouldn't be weak.

Because his father had medicated his own depression with alcohol, Britt had never taken up drinking. By the fall of 2004, his father had been in therapy for a while, and was encouraging Britt to seek help. Having experienced depression himself, he was able to see the disorder in his son. He sent Britt an e-mail with his doctor's name. And then he dropped dead.

It was a few weeks later when Britt hit the wall on his last desperate run. Then he collapsed into classic symptoms of depression, which is what happens when the strategy fails: "The weight felt so heavy that it was hard to physically move," says Britt. He found himself wishing he'd be in an accident that would put him in the hospital so that he could escape. "I wanted to be taken out."

That's the point at which depressed men can slip beyond fantasy into active thoughts of suicide. Some 31,000 people in the United States commit suicide each year. More than 24,000 of them are men. And that doesn't count the deaths from alcohol or drugs. In fact, some researchers are beginning to suspect that depression causes more deaths than auto accidents do.

Britt's fantasies of having an accident scared him. He went to see his father's psychiatrist. It didn't take the doctor long to diagnose his condition. (Q: "When were you last really happy?" A: "1975.") And yet, his denial of clinical depression was so strong that he sought a second opinion.

Maybe men need a different word for depression. Or maybe the brain researchers and psychologists simply need to redefine the condition so it includes the way men experience it, too.

Cultural Cover-Up
It's understandable that women are three times more likely than men to be treated for depression; our culture has put a feminine face on the disease, so women give themselves permission to feel it and to seek help for it. Pollack puts it this way: "We have in our society a feminized view of depression, coming out of a model of hysteria that dates back to Freud."

Terrence Real, author of I Don't Want to Talk about It, and a marriage and family therapist in Massachusetts, wrote, "There is a terrible collusion in our society, a cultural cover-up about depression in men." And part of the cultural influence involves the way men are taught from early childhood to be strong, silent, independent, and resistant to suffering. As Real puts it, "Men have about a milli-second's tolerance for feeling [this type of] pain, and then they spring into action. A flight from shame into grandiosity lies at the heart of male covert depression."

Another reason men leap into action, though, whether it's through intense exercise, overwork, pounding back martinis, or some other strategy, is that it actually does relieve the symptoms of depression, at least for a time. In fact, many therapists have begun using exercise as an adjunct to therapy, as explained in books like The Joy of Running, by Thaddeus Kostrubala, and The Exercise Prescription for Depression and Anxiety, by Keith Johnsgard. And research at Duke University confirmed their hunches in 1999.

But exercise in itself doesn't treat the underlying condition. In fact, books called The Joy of Working 80 Hours a Week and The Drinking Prescription for Depression might reach a wide audience, because those strategies can effectively mask depression for years. That is, they can sort of work.

Because at the heart of what Britt and Imparl were going through was a life filled with large stretches of no feeling at all. Britt says he was constantly running, "hoping that movement would help me discover something better."

Looking back on his decades of depression, Britt saw isolated flashes of happiness--the birth of his children, laughter, friendship--but they were, he says, "bright spots on what had been a more turbulent journey than I let myself admit. The moments of happiness sustained my denial of something I had only recently begun to consider an 'invisible load.'" In other words, he'd been swimming with an anvil, and he was sinking by imperceptible increments.

Conditioning
The social conditioning that leads to men's response to depression begins in infancy. Male babies receive less of every type of nurturing, including speech, touch, and comfort when they cry. And that is only the beginning of what will be, to one degree or another, a brutal upbringing for boys.

In the 1960s, the crusading social psychologist Jeanne Block and her colleagues explored how differently parents treat boys and girls. For instance, moms and dads encourage boys to be competitive and to achieve. They don't like them to show their emotions. They encourage them to be less dependent; mothers push them away. They punish them more than they punish girls. And they are unaware that they treat boys and girls differently.

By the time boys are on their way to the teenage years, the process of disavowing what they are is complete. The book A New Psychology of Men describes research in which people were asked what it means to be feminine or masculine. Women and girls defined themselves by the ways they were connected to others, and by citing qualities like being caring or compassionate. Men and boys defined themselves by negatives: They weren't weak, dependent, or connected to their mothers.

But there is not much in our cultural definition of what it means to be a man that is inherent in maleness. Children start off surprisingly alike, whether they're boys or girls. If there's a difference, it's the opposite of what the culture seems to expect: Boys are more sensitive. They give expression to their emotions more readily than girls. They affiliate with others in the same way as girls. Then someone starts telling them it's not okay to be that way. If you act like that, you're a pussy.

As Real and others have explained, it is through this process of denial that men are primed for depression. And it is the cultural necessity of carrying out and carrying on this process that makes it so difficult for them to recognize and admit to depression when it comes. They not only don't acknowledge it to themselves, they often don't display the symptoms that psychotherapists use to diagnose depression.

The cultural training that lays the groundwork for depression in men and for their denial of it later in life involves social isolation. That means telling people the truth about yourself and trusting that they'll do the same, a concept that seems terrifying to many men.

In one case, two friends knew each other for years, commuting together, talking every day, laughing together. They would not have said they were socially isolated, yet when they happened to run into each other in the same group meeting for men suffering from depression, they had to laugh: Neither one had ever admitted it to the other, even though they were both seeking treatment for it.

Social isolation is a well-known killer of mammals. Countless studies going back to the '50s show that contact, affection, emotional communication, and genuine closeness are necessary for mammals, including humans, to maintain our health. Isolation wreaks havoc on everything from the immune system to the cardiovascular system to the brain. Conversely, staying socially connected helps protect men from mental illness, including depression.

The new research done by Kessler and others shows that single men and women look no different when it comes to most kinds of mental illness. But when they get married, they veer off in different directions. "It's a very good deal to be married if you're a man," Kessler says. "It's associated with a dramatic improvement in mental health."

Perhaps because they are forced into solitude as children, men are not as good at being alone as women are. Because of early socialization, women are better at relationships--with children, friends, and relatives. In general, women have more friends than men and are closer to those friends. This, of course, is the direct result of boys' having independence forced on them early in life, when what they need is emotional and physical contact with others.

Socialization punishes women, too. When they have children, women's mental health suffers, while that of men doesn't change at all. That's because women, in general, take care of the kids. If there's trouble in the home, or work interferes with child rearing, they'll disproportionately suffer for it.

Women also worry more than men. They care about a larger group of people who just don't appear on the emotional radar screens of men. In marriage, men share in the joys and are often protected from the pain. Just as the man will go downstairs to investigate a suspicious noise, the woman plays the role of emotional protector.

Kessler uses this example: A wife reports (to the researcher) that she's very upset, because her daughter had an abortion and had to miss a number of days of school. The husband reports that his daughter had the flu and couldn't go to school. How could this be? The explanation is simple: The daughter got pregnant and went to her mother for help, saying, "Whatever you do, don't tell Dad." So the mother helped the daughter have an abortion and told the father the girl was home sick with the flu.

The result is that the husband is exposed to less stress, while the woman is exposed to more. Not only does she have to deal with the abortion, but she also has to lie to her husband and orchestrate the protection of that lie. But throughout, her connections are reinforced and affirmed.
The studies show that when a father dies, the children grow closer to the mother. They come around more. The mother has been maintaining those relationships all along, and they pay off in a crisis. Yet when a mother dies, the children come around less. That's because for years, when they called on Sunday, they talked to the mother, not the father. By filling the social role, the wife grows closer to the kids. That's why widowhood and divorce are so much worse for men. Their protection is ripped away, and they have no social network to catch them as they fall. The person who managed their emotional life is gone.
As Kessler puts it, "You can hire someone to do most of the things the husband does in a marriage. But you can never hire someone to do what the wife does." Men can change this situation and possibly protect themselves from depression later in life by expanding the depth and breadth of their social networks.

Recovery
After undergoing treatment for bipolar disorder and chronic depression, Britt went back to compete in all the events he had run so desperately in 2004, such as the Lake Placid Ironman. To his amazement, he recognized for the first time that the run took place in a glorious natural setting. "You're literally running through fields of green," he says. Later that year, he was competing in the Ironman Wisconsin, which he'd done in such a black mood the year before, and began to wonder, Why am I hurting myself? I don't need to hurt myself anymore. For the first time in his life, he walked for an hour during the event, feeling joyous.

Britt's compulsion to run began to fade. "My race performance declined by about 5 percent in the first half of last year," he tells me, "and it really tailed off by fall. I took most of early winter off, totally. It's a healthier me all around." In other words, he now runs for fun, something he was unable to experience before.

But recovery wasn't simple or easy. Early on, when Britt was first diagnosed, he spent much of his time searching for a single moment in each day when something good happened, something he could celebrate. Gradually, those moments grew larger and more frequent. "Now," he says, "the days are filled with not only great moments, but great minutes and hours. And those make up great days, great weeks, and even great months."

When men talk about depression, one of the recurring themes is how it sucks the color and flavor out of life. The birdsong that filled you with joy as a child has no effect at all. The people you love don't make your heart sing, even though you know they should. The colors of the world are tarnished and dull. Britt ran the Boston Marathon once again, and realized at the end that although he'd run it many times, he had literally never seen the finish line; he ran right through it and focused on the next thing. "Now I can see things I never saw before--colors, scenery, people," he says. "It's almost impossible to describe, except to say that it seems like the world has visually opened up."

Depression is well known for shutting down the senses, and when it lifted, Britt was so astonished at what was around him that he took up photography just to try to capture it all. "I never cared before. I never noticed the colors of a sunset. The electricity in a lightning strike. The glow of moonrise over a lake. They've always been there. But only recently have I begun to see them. And I am amazed."