Better Managing Through Chemistry An abridged guide--and comprehensive formulary--to health and survival in the workplace.
By Mary Desmond Pinkowish

(Business 2.0) – Your boss has stopped saying hello in the morning. One of your underlings now goes to the weekly meeting that you're no longer invited to. Everybody at the office is looking tanned, fit, and relaxed--except you. You can't sleep at night, because your brain is too busy worrying about all of the above.

Is anyone not struggling with workplace pressures that seemed remote a few shortsighted years ago? Some fortunate souls seem to immunize themselves with exercise and extracurriculars. For others, professional help--including medication--is necessary to help manage such serious issues as anxiety, depression, insomnia, and obesity. Here's a two-page compendium of remedies and advice--some of which require nothing more than a change in attitude, and some of which require a note from your doctor. --MARY DESMOND PINKOWISH

ANXIETY

Do you work with someone who claims he's never anxious? Two possibilities: He's either lying or pitiably stupid. Anxiety in the workplace is inevitable for most of us. It's smart to establish some good stress-busting habits before you really need to call a doctor.

Plan A In small doses, anxiety can help you persevere in difficult situations, like prepping for a big interview. But it's best stowed away when it's not needed. A few measures for keeping it under wraps:

--Exercise. You've heard it before, you'll hear it again. Find any kind of exercise you can squeeze into your daily routine.

--Have sex. You're supposed to want it. If you're avoiding it because you're stressed, guess what: You need it.

--Laugh. Even better than sex. Or at least more readily available. You can do it anywhere, anytime, and with anyone.

--Let off steam. As Benjamin Disraeli said, "It destroys one's nerves to be amiable every day." Try taking it out on the heavy bag at the gym. If it helps, picture your boss or that snotty DSL customer-service rep.

--Get help. No, not psychoanalysis. It's called cognitive behavior therapy, in which you unlearn old patterns of thought and reactions to stress and its physical symptoms. You can learn a lot in just a few sessions.

Plan B Feel compelled to punch the next person who tells you that you need to relax? Do you obsessively anticipate personal or professional disaster? It may be time to call your doctor.

--Ativan, Klonopin, Valium, Xanax. These benzodiazepines act as muscle relaxants and target the same part of the brain as alcohol. Ativan and Xanax pack a bigger punch and wear off more quickly, but they also have harsher withdrawal symptoms.

--BuSpar. Chemically unrelated to the benzodiazepines, BuSpar has similar calming effects. Better yet, it's not habit-forming. But it takes one to two weeks for you to feel the change.

--SSRIs. These antidepressants are also used to treat persistent anxiety (see "Depression," right).

DEPRESSION

What distinguishes depression from the transient blues? Consider the proportion: Are close friends and relatives puzzled by the persistence and severity of your "down" mood? As with anxiety, good habits can stave off the Black Dog.

Plan A Don't knock positive thinking: It can serve as your emotional immune system. An important first step, according to the American Psychological Assn., is to develop caring and supportive relationships. Here are other ways to build resilience:

--Set goals. Choose a handful of achievable milestones--personal or professional--and start taking the steps you need to attain them.

--Don't avoid the unavoidable. Step in and make decisions when problems arise. Putting them off only fuels a depressive tailspin.

--Gorge on seafood. Medical studies suggest that substances called omega-3 fatty acids--present in everything from caviar and lobster to fish sticks and tuna--can alleviate depression in some people.

--One more time: Exercise. Physical activity can sometimes prevent depression, and often proves as effective as therapy.

Plan B If you suffer from symptoms of worsening depression--persistent sadness, insomnia, feelings of hopelessness, inability to make even routine decisions--you may need medical attention. Here are a few well-known prescriptions, frequently used in tandem with psychotherapy.

--Celexa, Lexapro, Paxil, Prozac, Zoloft. All are members of the selective serotonin reuptake inhibitor (SSRI) group, the first of which was Prozac. These drugs stimulate activity of the neurotransmitter serotonin, low levels of which are linked to depression.

--Effexor, Remeron, Wellbutrin. These newer antidepressants are often prescribed when SSRIs don't work. Effexor and Remeron are best for deep depression. Wellbutrin has less severe side effects.

ATTENTION DEFICIT DISORDER

Silicon Valley perpetuated the myth that, among grown-ups, only big-brained entrepreneurs suffer from attention deficit disorder. The truth is that it affects about 2 to 4 percent of the population, for life. Extreme inattention is the hallmark of attention deficit hyperactivity disorder, or ADHD, and appears to be the result of the brain's failure to inhibit its own responses to distractions.

Plan A A colleague with ADHD can be a lively presence, but that's often outweighed by a tendency to procrastinate. What steps can you take to help yourself--or someone else--perform at peak?

--Find an assistant to help you make lists, use a PDA, and color-code files.

--Employ the OHIO principle: Only handle it once. A piece of paper or an e-mail should always be filed or tossed immediately.

--Break large projects into small bites, each with its own deadline.

--Write things you need to remember in a notebook. Store different kinds of information in different sections. Keep the book with you at all times.

Plan B Try a prescribed stimulant. ADHD occurs when the portions of the brain that keep you focused fall out of sync. Drugs like Ritalin activate these areas of the brain, improving concentration. Other prescriptions include Adderall, Concerta, and Dexedrine.

More Information

Book: Driven to Distraction, by Edward M. Hallowell (Touchstone Books, 1994)

Web: Children and Adults With Attention Deficit Hyperactivity Disorder (www.chadd.org);

Attention Deficit Disorder Assn. (www.add.org)

INSOMNIA

Stress and depression are major causes of insomnia, as are smoking and ingesting caffeinated beverages too close to bedtime. Drinking alcohol can help you get to sleep, but it can cause you to wake repeatedly during the night.

Plan A Not everyone needs eight hours. If you get only six but tend to wake up refreshed and don't fall asleep in meetings, you're getting plenty of shut-eye. Insomnia is one problem you want to manage without drugs, if at all possible. A few pointers:

--No caffeine after noon. --Don't drink yourself to sleep. --No naps--especially after dinner. --Don't exercise or eat a big meal close to bedtime. --Avoid spending too much time in bed. If you're between the sheets for seven hours but actually asleep for only four, get into bed just four hours before you plan to get up. Then, gradually go to bed 15 to 30 minutes earlier every few nights until you're getting more sleep.

Plan B Several drugs are commonly prescribed to treat insomnia. But think of these as short-term fixes for acute situations. Never give up on Plan A.

--Benzodiazepines. Halcion and Versed are effective but cause some people to rise too early or wake up with a hangover. Ativan, ProSom, Restoril, and Serax may be better choices.

--Newer sleep medications. Ambien and Sonata are less likely than benzodiazepines to induce hangovers or cause dependence.

--Antihistamines. Benadryl and similar over-the-counter medications work well, but often at the price of a drowsy morning.

OVERWEIGHT/OUT OF SHAPE

Nearly 60 percent of Americans are overweight or obese--conditions that markedly increase the risk of those leading killers, diabetes and heart disease. The trick to losing weight (and keeping it off) is obvious. You want to spend more calories than you take in, which means you need to break a sweat a few times a week. Here are some additional tips:

Plan A --Look at your BMI, not the scale. Go to the Centers for Disease Control website at www.cdc.gov/nccdphp/dnpa/bmi. Fill in your height and weight to obtain your body mass index, or BMI, which is a weight-to-height ratio used to determine if you're overweight or obese. Unless you're particularly muscular, a BMI of 25.0 to 29.9 means you're overweight; 30 or greater indicates that you're obese.

--Get enough calcium. New research suggests that people who get an adequate amount of calcium in their diets (about 1,000 milligrams per day) lose weight more easily than those who don't.

--Don't sweat the details. Despite the recent press, don't expect a definitive answer to the debate over high-fat diets anytime soon. Pick a diet you can live with. Avoid extreme diets, such as those that eliminate entire food groups or rely on expensive, unproven supplements.

--Again, for emphasis: Exercise. It spends calories, and it's particularly important in helping maintain weight loss and lowering cholesterol. Start with 20 minutes of aerobic activity at least three days a week.

Plan B If your BMI comes in higher than 35 or so, you may want to consider weight-loss surgery. Yes, there are prescription drugs, such as Meridia and Xenical, that can help your regimen along. But they have modest effects at best, leading to an average increased weight loss of 5 to 22 pounds.

Surgical procedures are far more effective. The most common of these involve walling off part of the stomach so that overeating induces nausea or vomiting. Don't hurl: Postsurgical weight loss of 100 pounds or more is common. The bypass may cause nutritional deficiencies, but these are readily corrected with vitamin and mineral supplements.