stress

You are currently browsing articles tagged stress.

mouse
Excerpted from Sciencedaily.com, 9/4/08

In an effort to better understand how chronic stress affects the human body, researchers at the Yerkes National Primate Research Center and the Department of Psychiatry and Behavioral Sciences, Emory University, have created an animal model that shows how chronic stress affects behavior, physiology and reproduction.

According to lead researcher Mark Wilson, PhD, chief of the Division of Psychobiology at Yerkes, “Chronic stress can lead to a number of behavioral changes and physical health problems, including anxiety, depression and infertility.”

Via the animal model, the researchers found corticotropin releasing factor (CRF) is a key neurohormone involved in stress response. Wilson explains, “CRF is located in several different brain regions, serving different functions. Its release is important for our ability to adapt to every day stressors and to maintain our physical and emotional health.”

In response to stress, CRF levels rise; CRF levels decrease when the stressor no longer is present. Chronic stress, however, increases the length and volume of expression of CRF in areas of the brain associated with fear and emotion, including the amygdala. Such chronic stress changes the body’s response, and the resulting increased expression of CRF is thought to be the cause of such health-related stress problems including anxiety, depression and infertility.

Intuitively most people know that chronic stress wreaks havoc on their health. But until quite recently, most physicians and researchers denied such a connection between stress and disease existed at all. Thankfully, that time has passed. The new scientific discipline of “psychoneuroimmunology”, or PNI, is illuminating the mechanisms behind the stress-disease connection and revealing just how damaging chronic stress is to our health.

Stress has been shown to be a risk factor in almost every serious disease that plagues human beings, including heart disease, cancer, diabetes and depression. Stress management techniques should be a consistent, regular aspect of your preventative medicine program.

Stay tuned for some of the techniques and practices I’ve found to be most helpful.

person sleepingIn Part I and Part II of this series, we examined drug-free alternatives to treating depression including exercise, psychotherapy, light therapy, St. John’s Wort and acupuncture. We have learned that all of these treatments are at least as effective as antidepressants in the short term, and some (exercise and psychotherapy) are more effective in the long-term. All of these treatments have far fewer side effects, risks and complications than antidepressants. In fact, the only “side effects” of exercise and psychotherapy are positive ones: improved physiological and mental health!

Today we will look at other lifestyle-based approaches to treating depression without drugs. As I mentioned in the previous article, because 70% of research is funded by drug companies, many of these non-drug approaches have not been studied as extensively as antidepressant medication.

Nevertheless, there is enough data from clinical and epidemiological studies to support the following strategies – especially since they are superior to antidepressants from a “cost/risk – benefit” analysis. In other words, though some of the approaches I will propose in this article have not been exhaustively proven according to the standards of Western science, there are several lines of evidence supporting their effectiveness and without exception they have beneficial side effects and improve the quality of patient’s lives.

What’s more, all of these approaches can be combined together along with the treatments mentioned in the two previous articles to obtain the maximum effect. Based on the available evidence which we have extensively reviewed, these non-drug treatments should without a doubt be the first line of defense (as well as the second, third, fourth, etc.) in treating depression.

Nutrition

At some point in the future, I hope to dedicate an entire post (or perhaps more) to the subject of nutrition and depression. I personally believe that inadequate nutrition is a significant contributing factor to the continuously rising rates of depression in this country. Consequently, I also believe that proper nutrition can be one of the most effective treatments for depression.

For now, I will go over what I feel are the most important aspects of nutritional causes and treatment of depression, and hopefully address the subject in more detail later.

SUGAR

Diabetes is correlated with higher rates of depression. In 2005, researchers discovered a positive connection between higher levels of insulin resistance and severity of depressive symptoms in patients with impaired glucose tolerance, before the occurrence of diabetes. Based on these findings, it was suggested that insulin resistance could be the result of an increased release of counter-regulatory hormones linked to depression; however, this has not been confirmed.

Sugar can increase fasting levels of glucose and can cause reactive hypoglycemia. Sugar can also cause a decrease in your insulin sensitivity thereby causing an abnormally high insulin levels and eventually diabetes. Based on the study results above, this is one mechanism by which sugar could contribute to depression.

There is no doubt that increased sugar intake leads to hormonal changes that can lead to emotional instability. Therefore, people who are depressed (and all people, in fact) should significantly decrease their sugar consumption.

OMEGA-6 / OMEGA-3 RATIO

Anthropological evidence suggests that the intake of omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFA) during the Paleolithic era was roughly equal, whereas the present n-6 to n-3 PUFA in western countries has ben estimated to be between 10 and 25 to 1. The n-6 to n-3 PUFA imbalance has been due mainly to the increase in vegetable and seed oil use and the rise in consumption of processed foods (which contain these oils).

Two major studies have provided direct evidence for the role of the n-6 to n-3 PUFA ratio in depression. The studies found that depression is associated with significantly decreased total n-3 PUFA and increased n-6 to n-3 PUFA ratio (Maes et al. 1996; Maes et al. 1999) . A supporting study carried out in 1998 also found a significant depletion in total n-3 PUFA, and in particular DHA, in the erythrocyte membranes of depressed patients.

Epidemiological data show the trend in decreasing dietary n-3 PUFA consumption and the increasing evidence of depression, both over time and between nations (Hibbeln et al. 1995). Further investigation suggests that the significance lies in the increase in n-6 to n-3 ratio, rather than simply low n-3 intake alone, as these two fatty acids compete in binding to enzyme systems that produce chain elongation and further desaturation. A diet high in n-6 fatty acids prevents the incorporation of n-3 PUFA into cell membranes and phospholipids (Spector et al. 1985).

All polyunsaturated fatty acids – including n-3 PUFA – have been shown to make lipoproteins more vulnerable to oxidative damage (Reaven et al. 1991), and oxidative damage is a significant risk factor for heart disease, cancer and many other conditions. As mentioned above, n-6 consumption actually prevents the incorporation of n-3 into our cells. Therefore, rather than increasing our consumption of n-3 PUFA to treat depression, as is often suggested, it makes more sense to dramatically decrease our consumption of n-6 PUFA. This will help our bodies to incorporate the small, but adequate amount of n-3 PUFA we get in a whole-foods based diet. Avoiding n-6 PUFA (primarily found in vegetable and seed oils, and in animals fed vegetables high in n-6 like pigs and chickens) will not only alleviate depression, but also benefit our health in many other ways.

VITAMIN D

In a 1998 controlled experiment, Australian researchers found that vitamin D (400 and 800 IU), significantly enhanced positive affect when given to healthy individuals. Forty-four subjects were given 400 IU cholecalciferol, 800 IU cholecalciferol, or placebo for 5 days during late winter in a random double-blind study. Results on a self-report measure showed that vitamin D3 enhanced positive affect a full standard deviation and there was some evidence of a reduction in negative affect. The authors concluded: “vitamin D3 deficiency provides a compelling and parsimonious explanation for seasonal variations in mood” (Landsdowne & Provost, 1998).

In another study in 1999, the vitamin D scientist, Bruce Hollis, teamed up with Michael Gloth and Wasif Alam to find that 100,000 IU of vitamin D given as a one time oral dose improved depression scales better than light therapy in a small group of patients with seasonal affective disorder. All subjects in the vitamin D group improved in all measures and, more importantly, improvement in 25(OH)D levels levels was significantly associated with the degree of improvement (Gloth et al. 1999).

According to the Vitamin D Council:

To further strengthen the case that vitamin D deficiency causes some cases of depression, evidence should exist that the incidence of depression has increased over the last century. During that time, humans have reduced their sunlight exposure via urbanization (tall buildings and pollution reduce UVB ), industrialization (working inside reduces UVB exposure), cars (glass totally blocks UVB), clothes (even light clothing blocks UVB), sunblock and misguided medical advice to never let sunlight strike you unprotected skin.All these factors contribute to reduce circulating 25(OH)D levels.

Klerman and Weissman’s claim that major depression has increased dramatically over the last 80 years is one of the most famous (and controversial) findings in modern psychiatry. Something called recall bias (a type of selective remembering) may explain some of the reported increase, but does it explain it all?

If you suffer from depression, get your 25(OH)D level checked and, if it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment. If you are not depressed, get your 25(OH)D level checked anyway. If it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment.

Recommended intake is up to 5,000 IU per day of vitamin D through exposure to sunshine and/or supplementation. See this article on vitamin D to learn to calculate how much vitamin D is produced given a certain amount of exposure to sunlight, and to learn more about vitamin D supplementation. It is important to remember that D works synergistically with A & K2, so if you increase your intake of D you must also increase your intake of A & K2 to avoid D toxicity.

Finally, I’d like to share with you a comment I received from a reader about how he/she has cured depression with nutritional intervention. Note that I endorse just about every suggested step, with the exception of the significant increase in n-3 intake. Based on the evidence above, I suspect that his/her improvement was a result of the decrease in n-6 PUFA more than it was the increase in n-3 PUFA.

I suffered from depression, for many years–it was so bad that often I thought that the only answer for my life would be to end it. Thoughts of suicide danced through my mind frequently.

Early March 2008 I changed my diet completely:

–eliminated all processed foods

–eliminated all white foods; most important, eliminated sugar, which is the “white devil”

–eliminated all foods containing soy and corn; so I don’t eat the meat of animals that have been fed grains

–two years prior to March 2008 I stopped drinking sodas/soft drinks

–only meats that have been traditionally raised; meat from ruminants that have been grass fed; chickens that have been pastured (I get them with the head and feet); meat from pigs that have not been raised in confinement (I know the people who “produce” the pork that I eat–they feed their pigs food that is in season and local, and they allow their pigs to be pigs, and never slaughter them before their time)

–eliminated all the bad fats

–added good fats: coconut oil, palm kernel oil, [raw] butter from grass fed cows, lard (from the pigs described above), beef bone marrow fat (from grass fed and pastured cows), olive oil

–eat a tin of sardines (with the skin and bones) weekly

–eat wild Alaskan salmon weekly

–cut out grains; although, occassionally, I have a jones for those carbs, so I’ll eat some brown rice; sometimes I’ll have a bowl of steel-cut oats, which I have soaked overnight, and when I eat it, I add lots of butter and raw cream to it

–stopped eating out; I cook all of the meals that I eat

–only eat raw milk cheeses

–eggs from hens that have been pastured

–drink this mixture daily: raw milk, raw cream, 4-6 raw egg yolks, some unsulphured organic blackstrap molasses

–daily supplements of: cod liver oil, evening primrose oil, wheat germ oil, kelp powder, dessicated liver

–vegetables and fruit

–drink only when thirsty

–stopped wearing sunblock/sunscreen lotions; get out in the sun daily for 20-plus minutes

–exercise daily; I ride my bike everywhere (I live in San Francisco) or I walk

Following the reader’s advice will not only relieve depression, it will dramatically improve all aspects of your physical, emotional and mental health.

Adequate sleep and rest

Recent studies have definitively linked insomnia with depression and increased suicidal behavior. A research abstract that was presented on June 12 at SLEEP 2008, the annual meeting of the Associated Professional Sleep Societies, found a link between poor sleep and suicidal behavior among children and adolescents with depressive episodes. 83.8% of the depressed patients in the study had sleep disturbances, and there was a significant association between suicidal behavior and the presence of sleep complaints.

Another recent study confirmed the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. According to the study, 17% – 50% of subjects with insomnia lasting just two weeks or longer developed a major depressive episode reported in a later interview.

Other research has indicated that insomnia can cause depressed mood and adversely affect endocrine function (Banks 2007).

Most Americans are chronically sleep deprived. The foundation’s 2001 national “Sleep in America” poll reported that almost seven out of 10 Americans experienced frequent sleep problems, and that most were undiagnosed. The same poll in 2003 found that 67 percent of older adults had frequent sleep problems and only one in eight had been diagnosed.

This alone could explain the epidemic increase in depression over the last several decades. But when sleep deprivation is added to other factors such as increased intake of n-6 PUFA, increased stress, the use of antidepressant drugs, the breakdown of family, community and other social support structures, it isn’t difficult at all to understand why so many of us are depressed.

The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night’s sleep:

  • Follow a consistent bedtime routine.
  • Establish a relaxing setting at bedtime.
  • Get a full night’s sleep every night.
  • Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
  • Keep computers and TVs out of the bedroom.
  • Do not go to bed hungry, but don’t eat a big meal before bedtime either.
  • Avoid any rigorous exercise within six hours of your bedtime.
  • Make your bedroom quiet, dark and a little bit cool.
  • Get up at the same time every morning.

Stress Management

An increasing amount of evidence (along with common sense) indicates that chronic stress directly contributes to depression. Please see my recent article for more information about this.

I am not aware of any well-designed clinical trials examining the effects of stress reduction on depression. However, logic dictates that since stress is a cause of and contributing factor to depression, managing stress is an important aspect of treating depression.

One study published in 1995 showed that meditation can improve mood. Another small study demonstrated that mindfulness-based cognitive therapy (MBCT) significantly improved depression and reduced relapse. A series of studies and case studies have shown that biofeedback can also be effective for depression and mood disorders.

The reality is that there are many ways to manage and reduce stress, from yoga to meditation to mindfulness-based stress reduction to progressive relaxation techniques. The important thing is not which method you choose, but that you commit to something and do it on a regular basis.

Prayer & Spiritual Practice

You’re not going to see much scientific research into the role of prayer and spiritual practice in treating depression. Nevertheless, for as long as people have been “depressed” they have used their relationship with God, nature, a “higher power” or whatever guiding principles they embrace to get through difficult times.

People who are depressed often feel isolated, alienated or alone. A strong faith in God or in the interconnectedness of all life can re-establish a sense of belonging and support. Prayer and spirituality can also re-frame the depression one is experiencing in a larger and less “personal” context.

In my previous article called The Heart of Depression, we examined how cultural, religious and spiritual beliefs in these traditional societies provide a context in which symptoms of depression and other mental illness can be understood outside of the label of medical disease or pathology. Possession and rites of passage are two examples of such contexts.

The words and labels we use to “frame” our experience have tremendous power. In the U.S. today, depression is viewed as a sickness that must be cured, as a pathology, as a “biological disease”. There is little doubt that the people who seek treatment for depression are suffering. But should psychological and emotional suffering always be viewed as “something to get rid of”?

Great religious and spiritual traditions from around the world view suffering as an avenue to greater understanding of oneself, life and God. Suffering can be viewed as a signal drawing our attention to issues in our life that need to be addressed.

Spirituality and prayer can help people who are suffering to understand their experience in a more empowering and self-validating context than what is offered by mainstream medicine. When one views their suffering as an opportunity for growth and evolution, rather than as a disease requiring treatment with drugs, it is far more likely that lasting, positive change will occur.

In the next and final article (for a while, at least) in my series on depression and antidepressants, I will summarize everything we’ve covered so far and offer my recommendations for treating depression holistically.

lightboxIn the first article in this three-part series on treating depression without drugs, we established that several non-drug treatments are at least as effective in treating depression than antidepressants – with few, if any of their side effects. Specifically, we learned that both psychotherapy and exercise compare favorably with antidepressants for treating even serious depression in the short-term, and are both more effective than antidepressants in the long-term.

Today we will examine three other drug-free treatments for depression: light therapy, St. John’s Wort and acupuncture. In the final article, we will look at lifestyle-based treatments such as nutrition, adequate sleep and rest, stress management, pleasure and bibliotherapy (prayer or spiritual practice).

Light Therapy

Researchers at the National Institute for Mental Health are credited for the idea that perhaps more people are apt to become depressed during dark, dreary winter days than on bright, crisp spring days because they are not getting enough light. Since then, people around the world have begun to use “light therapy” to overcome Seasonal Affective Disorder. However, light therapy is also being used to successfully treat major depression at any time of the year.

Beginning the day sitting in front of a fluorescent light box that typically emits about 10,000 lux units of light has helped many people who might otherwise struggle with depression throughout the day. Bright light has been shown by numerous studies to act as a specific antidepressant in depressed patients. In a recent meta-analysis of published studies on light therapy and depression which appeared in the April 2005 issue of the American Journal of Psychiatry, the authors found that bright light treatment for nonseasonal depression is efficacious, with effect sizes equivalent to those in most antidepressant studies.

Once again, as was the case with both exercise and psychotherapy, the combining light therapy with antidepressants was no more effective than light therapy alone.

In contrast to exercise and psychotherapy, bright light therapy does occasionally have some side effects, including headache, eye strain, nausea and agitation. But these are very mild when compared against the side effect profile of antidepressants.

It is very important to note that some psychotropic medication (and psychotropic herbs such as St. John’s Wort) may increase sensitivity to light, so light therapy should probably not be combined with St. John’s Wort or antidepressants.

Some critics of light therapy have pointed out that it could be a placebo and there is no way to prove otherwise. It is not possible to keep someone from knowing whether they are being exposed to very bright light or the placebo (dim light). Therefore the “blind” is broken and patients will know whether they are receiving the active or “inert” treatment. Could it be that the positive effects of bright light are simply due to the assumption or expectation of the patients that they will improve, rather than a result of the bright light itself?

Sure it is. But perhaps a more important question is, “does it matter?” If we use Antonuccio’s criteria for evaluating a potential treatment (i.e. 1) first do no harm, 2) cost-benefit analysis) then it becomes clear that light therapy compares very favorably with antidepressants even if it is “merely a placebo”. As you will know if you’ve been following my blog, antidepressants could also be referred to as placebos because they have been shown to be no more effective than placebo in treating depression. The criteria for whether a drug gets approved or not by the FDA is that it must outperform placebo; otherwise, it is simply considered a placebo itself.

Although light therapy may have some side effects, they pale in comparison to those of antidepressants and, unlike antidepressants, light therapy poses no significant risks or long-term complications. A typical light therapy device costs between $200-$300, so over the long-term it is much more cost-effective than medication. Finally, light therapy is just as effective as pharmacotherapy for treating depression.

When all of this is taken together, light therapy is superior to antidepressants – even if it is a placebo.

St. John’s Wort

St. John’s Wort (Hypericum) is an herb that can be used to make tea, or the “active ingredients” with the herb that can be extracted and put into capsules. In Europe SJW is widely prescribed as an antidepressant, but in the U.S., it is available over-the-counter.

St. John’s Wort has repeatedly been shown to work as well as or better than antidepressants in double-blind, placebo-controlled studies. For example, compared to Paxil, depression scores fell more (56.6% vs. 44.8%) and side effects were less (Szegedi et al. 2005). Similar results were found for Prozac (Schulz 2002). A comparison with both Zoloft and Celexa found St. John’s Wort again performed as well as the antidepressant drug without as many side effects (Gastpar 2005; Gastpar 2006).

While St. John’s Wort is clearly as effective as antidepressants, the number of adverse effects is ten times less – being essentially equivalent to taking a placebo. The most common adverse events (1 per 300,000 treated cases) concern reactions of the skin exposed to light (due to potential increased photosensitivity caused by SJW and other psychotropic substances).

Please do note that St. John’s Wort is contraindicated for concurrent use with certain medications, including antidepressant drugs, coumarin-type anticoagulants, the immunosuppressants cyclosporine and tacrolimus, protease and reverse transcriptase inhibitors used in anti-HIV treatment and with certain antineoplastic (cancer) agents.

However, these potential interactions can be easily avoided with proper supervision from a health-care professional who is experienced with the use of St. John’s Wort.

Once again, to be accurate we must point out the possibility that St. John’s Wort is merely a placebo. If it is roughly as effective as antidepressants, and antidepressants are themselves placebo, then it follows that St. John’s Wort may also be a placebo. However, the same analyses that we used for light therapy applies here. The question is, how does St. John’s Wort compare against the primary treatment for depression – antidepressants? As we have seen, SJW is just as effective as antidepressants with only a fraction of the side effects, so there is absolutely no reason not to choose it over a synthetic antidepressant.

Before we move on to acupuncture, nutrition, rest and other lifestyle-based treatments for depression, I want to briefly discuss the criteria we’ve used so far for evaluating the effectiveness of a treatment. As I’m sure you’ve noticed, I am primarily basing the determination of the effectiveness (or lack thereof) of a treatment on well-designed, placebo-controlled, double-blind scientific studies.

I obviously have great respect for this method of inquiry and it has led (and continues to lead) to many important advances in medicine. However, it must be pointed out that this standard of proof has limitations. For example, 2/3 of medical research is funded by pharmaceutical companies. This means that the lines of investigations most often pursued in scientific research are those that are likely to lead to new therapies that can be monetized by the drug companies. There is little incentive for a drug company to dedicate research dollars to a study on how nutrition affects depression, unless there’s a product they can imagine marketing based on the study results. The result is that there are relatively few studies evaluating the effect of nutritional intake on depression.

Another limitation of double-blind, placebo-controlled research is that it is difficult (if not impossible) to maintain that standard with treatment modalities that depend on the unique interaction that happens between a practitioner and a patient. Western science is often skeptical, of course, that this interaction that occurs influences the treatment in any way. They do not understand how the interaction could influence the treatment, and what Western science does not understand, is often dismissed as “new-age fluff”.

What is remarkable about this is not just the arrogance of such a position, but also the ignorance it demonstrates. Over the last two decades, research into the placebo effect and growing understanding of how the nervous, endocrine and immune systems are inter-related have proven beyond a shadow of a doubt – according to the most rigorous Western scientific standards – that the interaction between a doctor or clinician and their patient absolutely influences the outcome of the treatment. In fact, many studies have shown that this interaction may be more important than the treatment itself; or, perhaps more accurately, the interaction is the treatment.

With this in mind, it becomes clear that the efficacy of acupuncture as a treatment for depression – or anything else – can never be accurately measured in a double-blind, placebo-controlled study. As much as Western science hates to admit this, we are not machines that respond in entirely an predictable manner given the same circumstances. There is no way to “standardize” the interaction that happens between an acupuncturist (or any healing professional) and a patient, because each person and, therefore, each relationship is unique.

Acupuncture

Considering all of the caveats above, can acupuncture help with depression? According to the Cochrane Database Systematic Review (the gold standard for medical research reviews today), “there is no evidence that medication was better than acupuncture in reducing the severity of depression.” In many of the studies they reviewed, acupuncture and electro-acupuncture either cured or remarkably improved depression scores, performing just as well as synthetic antidepressants.

However, it must also be noted that the studies were few in number, often poorly designed and did not have enough subjects to draw definitive conclusions. The authors of the review concluded that there was “insufficient evidence to determine the efficacy of acupuncture compared to medication”.

And of course, we always have the issue of placebo. It is possible that the benefit the patients are receiving comes from the interaction with the practitioner and their expectation that they will improve – rather than as a result of the needles themselves.

Once again, though, if we evaluate acupuncture based on a “cost-benefit” analysis, it compares very well against antidepressants. It has been shown to be at least as effective as medication in many studies as noted above, and the side effects are minimal when compared with antidepressants. Acupuncture has also been shown to be effective in treating other conditions that may occur alongside of depression, such as pain and stress.

Stay tuned for the third-part of this series which will consider lifestyle-based treatments such as nutrition, adequate sleep and rest, stress management, pleasure and prayer.

stressed woman

In the last few articles in my series on antidepressants and depression, I have presented evidence demonstrating that – despite popular belief – depression is not caused by a deficiency of serotonin in the brain.

However, this of course does not suggest that depression is completely divorced from biochemical processes in the body. The brain is a “living orchestra” of complex, interconnected systems that are in continuous relationship with one another. Everything from the food that we eat to the chemicals we’re exposed to in our environment to the hormones we produce effects the functioning of the brain.

This will likely come as no surprise to you. It’s simply common sense. But as you may have noticed, in the world of scientific research common sense must first be proven according to the established standards of scientific proof before it is accepted.

Such has been the case with the link between stress and depression. I’ll wager that if I asked ten people on the street whether chronic stress caused depression, probably all ten of them would say “yes”. However, scientific proof of the causal link between chronic stress and depression has only begun to emerge over the past few years. It has been known for much longer that depressed people have elevated levels of cortisol (an indicator of chronic stress), but it was not known whether those elevated levels were the result or cause of depression.

In 2006 Ardyfio & Kim published a study indicating that chronic hypercortisolemia (elevated cortisol levels in the blood) causes anxiety-related behavior in mice. These results suggest that elevated cortisol levels may contribute to the symptom profile of depression rather than simply being a consequence of it.

Ardyfio & Kim’s study also confirmed the results of other studies which suggest that while acute stress is adaptive (helps us adjust to our changing circumstances), chronic stress has detrimental effects on the brain and behavior. Indeed, chronic stress has been linked to a wide variety of modern diseases, including (but not limited to) heart disease, cancer, diabetes, autoimmune disease, irritable bowel syndrome and fibromyalgia.

In a more recent study published in 2007, work stress was demonstrated to precipitate diagnosable depression and anxiety-related disorders in previously healthy, young individuals. The authors point out that stressful work conditions predict poor mental health, and that currently as many as 40% of people are exposed to work stress. (That’s funny, I would have thought the number to be closer to 100%).

The relationship between psychological job demands and the risk of depression and anxiety was graded; in study members exposed to high psychological job demands the risk was two times higher than in those with low demands. The combination of multiple work stressors conferred an even higher risk, especially in men.

Once again, this probably does not come as a surprise to you. It makes sense that high stress at work may cause depression and anxiety. But, believe it or not, this is relatively recent news to the mainstream scientific establishment.

Finally, in a study published today, researchers have shown how cortisol (one of the stress hormones) regulates brain neurotransmission in both the short and long term and enables neuronal connections to adapt.

In the short term, cortisol increases the mobility of receptors found on the surface of neurons, thus allowing synaptic connections to adapt more effectively to the demands of brain activity. The stress hormone might be considered as an “alarm” that mobilizes the receptors for action. This behavior is adaptive, as it helps the organism (us) prepare and mobilize for action when faced with stress (a threat).

However, in the case of prolonged stress (which is the type of stress most prevalent in modern life) cortisol actually reduces synaptic plasticity. Lack of receptor mobility contributes to a lack of adaptation, which of course, is bad news for us.

The relevance to all of these studies to our recent discussion about depression and its treatment is this: stress is likely a significant contributing factor to depression for most people, and stress-management should play an important role in the treatment of depression.

Stress-management strategies are drug-free, non-invasive, cost-effective and have a wide range of beneficial “side effects” such as happiness, relaxation, improved sleep, more energy, improved libido, increased productivity, and protection from the legion of diseases that have been linked to stress.

In short, there is absolutely no reason not to include stress management in your treatment regimen for depression, or in your daily life even if you are currently healthy and free of disease.

There are many ways to reduce stress, including meditation, prayer, gentle movement (yoga, tai chi, Feldenkrais), exercise, deep relaxation techniques, spending time in nature, listening to music. What’s most important is that you find something that works for you and stick with it.

Mindfullness-Based Stress Reduction (MBSR), created by Dr. Jon Kabat-Zinn, is a very successful approach that has been clinically proven in well-designed studies to reduce pain and stress and improve health. I recommend his book Full Catastrophe Living, as well as the CD recordings of the techniques.

I also recommend a system of gentle movement and breathing exercises called “mini-moves”. Although they are marketed as a treatment for insomnia, the creator (Michael Krugman) of the system believes (quite correctly) that the best way to cure insomnia is to manage daytime stress successfully. You can download the “Secrets of Sounder Sleep” audio here. They are very simple and can be performed in as little as 5-15 minutes at a time.

I’ve used both of these systems myself with great success.

Next week will be the final article in the depression series (for now): drug-free alternatives to treating depression. Until then…

gramophoneThere’s no doubt that optimal nutrition plays a significant role in supporting our health and well-being. But nutrition, as important as it is, obviously isn’t the only factor that influences our physiology.

Over the past several years, an increasing amount of research has focused on the role of emotions, behavior and beliefs in contributing to both health and disease. In fact, an entirely new discipline called “psychoneuroimmunology” (say that three times fast!) has emerged to study the connection between the mind and the body. In short, what has been revealed is that the separation we make between “the mind” and “the body” is largely an illusion. Mind and body exist in a continuous and interrelated web of connections that is only now beginning to be discovered by western science.

But though the idea that our thoughts and emotions can directly influence our physiology is new to modern biomedicine (just ten years ago it was dismissed by most physicians and researchers as so much “New Age” fluff), it has been deeply ingrained in our cultural paradigm for centuries. It is embedded in our language; consider the phrases “worried sick” or “scared to death”, and you’ll know what I mean. I’m sure all of you have had the experience of becoming ill after a particularly stressful period at work, or feeling moody and perhaps depressed while you are physically ill. These are both prime examples of how interconnected our mental and emotional health is.

In their book Feeling Good Is Good For You, researchers Carl J. Charnetski and Francis X Brennan set out to review the emerging evidence that pleasure can boost our immune systems and lengthen our lives. According to the authors,:

“In every way, stress is the antithesis of pleasure. It jangles your nerves, juggles a whole host of your body’s hormones, elevates your blood pressure, and makes your pulse race… It also weakens your immune system’s ability to resist illness and disease.”

If stress is the antithesis of pleasure, then it follows that pleasure is the antithesis of stress. And the best way to fight stress, say Charnetski and Brennan, is with pleasure. Our bodies secrete chemicals called endorphins when we experience pleasure. Animal research has revealed, for example, that endorphin levels are up to 86 times higher after animals experience multiple orgasms! But endorphins are also released, albeit at lower levels, in more mundane daily activities such as playing with a pet, watching a funny movie, listening to our favorite music, visiting a favorite place or connecting with loved ones.

The chemicals released when we experience pleasure do more than counteract stress hormones and improve mood. Consider these additional effects:

  • They improve immune function by producing an antibacterial peptide
  • They enhance the killer instincts and abilities of various immune components, including B cells, T cells, NK cells, and immunoglobulins.
  • They enable certain immune cells to secrete their own endorphins as a way of improving their disease-fighting capacity

Charnetski and Brennan examine several “pleasure inducing” experiences that have been scientifically proven to promote health and well-being.

  • Music
  • Touch
  • Pets
  • Humor
  • Positive attitude and insight

Most of us are already aware of the healing power of those things listed above – at least on some level. But in this culture, there is also an overwhelming reliance on medicine, surgery, diet and other physiological interventions to treat disease. Though we may pay lip service to the idea that stress causes illness and pleasure can prevent it, how many of us actually attribute the same importance to listening to music or watching a funny movie as we do to taking a pill? The lesson in this book is that our thoughts, beliefs, emotions and behavior are all capable of inducing the same physiological changes in our bodies as foods, supplements, pills and even surgery are.

If you doubt that this is true, consider the placebo effect. It has been proven over and over again that pharmacologically inert substances like sugar pills can have identical or even greater therapeutic effects than drugs in certain cases. Even more impressive are the trials that have shown that sham surgery (when small incisions are made to convince the patient they have had the operation, but no surgery is performed) is at times as effective as the actual surgery.

Clearly this points to the power we all have to heal ourselves. If only the suggestion or belief that we will heal is enough to induce the physiological changes that lead to healing, without the presence of any “active” pharmacological substance or surgical intervention, then clearly our thoughts, beliefs and emotions have the potential to be powerful medicine.

Bad Behavior has blocked 1411 access attempts in the last 7 days.