| Mental Health by Andrew Weil, MD Three of the major challenges to our mental health today are stress, anxiety and depression. Fortunately, there are any number of simple steps we can take in our daily lives to regain a sense of balance, feel better and live calmer more satisfying lives. Stress Stress – we all experience it at many points throughout our lives. It’s an unavoidable part of life. What sets us apart is how we respond to it. It isn’t always easy to find effective ways to manage the daily stressors we face in life. But it’s important to try to find a healthy way to manage stress because when we cannot, we feel its damaging impact through anger, depression, and a multitude of health problems. There are some situations that rate high on the stress scale: divorce, death, illness, a move or a change of job. But, interestingly, the stress we feel is as much a product of how we react to certain situations as it is the situations themselves. In other words, each of us has the ability to manage most stressful situations by altering the way we respond to them. If we try to manage or control all the people, events and places in our lives that place demands on us, our stress level goes up. We would be better off learning to manage how we deal with stress by understanding the phenomenon of “being stressed.” Here are some facts about how stress impacts our lives: Stress has been linked to all the leading causes of death, such as cardiovascular disease, cancer, accidents and suicide. Almost 90% of all visits to primary health care providers are due to stress-related problems. Nearly one-half of all adults suffer adverse effects from stress. It is estimated that 1 million Americans miss work due to stress related complaints. Workplace violence has been attributed to stress. Homicide is the second leading cause of fatal occupational injury. What is Stress? Stress can be defined as an individual’s mental and physiological response to a particular event, place or person. Stress is classified into two types - acute (short-term) and chronic (long-term). People experience acute stress when they are dealing with a dangerous situation, such as being threatened. Humans have a built-in mechanism that is commonly referred to as the “fight or flight” response because of the way our bodies react to a stressful event. Hormonal changes, such as increased adrenaline and cortisol, prepare the body for this “fight or flight” response by increasing blood pressure, heart rate and respiration. In fact, blood flow can increase 300-to-400% in order to prepare the legs, brain and lungs for the added demands. Conversely, other major body systems such as the digestive system are shut down short-term as they are considered non-essential during a stressful event. These physical changes were vital for our ancestors’ survival in prehistoric times. This response can still be important today when we are in a dangerous situation or even during an athletic event or a competition where a “revved up” system can enhance the way we perform. Chronic stress occurs when we deal with stress over a period of time. If we have not learned to manage our stress effectively, a constant exposure or accumulation of stressors will eventually cause our brain, heart, muscles and lungs to become overloaded or under-activated, leading to both physical and psychological harm. Chronic stress can lead to a variety of problems such as anxiety, depression, drug dependence, heart disease, digestive problems or even suicide. What are some of the physical consequences of stress? Heart Disease – Mental stress can cause angina or even increase one’s risk for a fatal heart attack. Stress causes the blood to thicken, which increases the risk of developing a blood clot in the arteries. Sudden increases in blood pressure can damage the inner lining of the artery walls, leading to atherosclerosis. Chronic stress can also cause a decrease in estrogen levels in women, which is an important hormone for the prevention of heart disease. Stroke -- Prolonged or frequent episodes of stress can worsen high blood pressure, thickening the arteries that lead to the brain. A blockage in blood flow to the brain can lead to a stroke. Depressed Immune System – Prolonged exposure to stress can blunt the immune system response, increasing the risk for colds and more serious infections. Weight and Body Fat Changes – Chronic stress can cause either a loss in appetite and weight loss, or increase the cravings for fat, sugar and salt -- leading to weight gain. A recent study with women suggested that chronic stress can cause abdominal fat accumulation in otherwise thin women. The researchers attributed this fat accumulation to an increased secretion of the hormone cortisol – a hormone released during stress. It seems that some people secrete more cortisol than others, or react the same way each time they are faced with a particular stressor instead of adapting to it. Central distribution of fat increases one’s risk for certain diseases such as heart disease, diabetes and stroke. Insomnia -- Chronic stress makes it difficult for people to get a restful night’s sleep, which prevents the body from recovering and repairing itself. A lack of sleep can also worsen psychological stress and keep one from facing the stressor and dealing with it rationally. Migraines – Studies have suggested that migraine attacks occur when one is under increased levels of stress. Irritable Bowel Syndrome (IBS) – A strong correlation has been associated between stress and IBS. Is stress always bad for your health? Not all stress is bad. In fact, if you learn how to manage it, you can experience many of its positive effects, such as:
Increased energy and motivation Use these steps to help manage your stress more effectively: 1. Determine what is causing stress in your life. There may be particular situations, people or events that make you feel nervous, anxious or fearful. 2. Keep a diary to record the events or situations that are causing your stress. Record your physical symptoms and emotions. 3. Open up. Learn how to express your thoughts and feelings. 4. Don’t be afraid to say “no” when someone asks you to do something. Learn your limits. You can’t do it all and you shouldn’t feel guilty about it. 5. Learn how to express your anger appropriately by not insulting or hurting others. Say “I feel angry” instead of “you make me feel angry.” This will help improve relationships with all the people in your life. 6. Simplify your life. This means restructuring your priorities. Evaluate what activities are most important, and get rid of the ones that aren’t. You will feel less worn out and more rested. You’ll also have more free time to spend with family, friends or even to be by yourself. 7. Recognize that drugs and alcohol are not effective methods to solve problems. If you feel that you are relying on drugs or alcohol to escape from your problems, seek the advice of a mental health counselor or community health service about special programs for stress management. 8. Improve lifestyle habits. Increasing physical activity and eating healthy can do wonders for your ability to manage stress. Regular physical activity and a healthy diet can improve weight, energy levels, self-confidence, and overall health and well-being-making it much easier for you to handle daily stressors. 9. Strengthen your support system. Most people who are able to cope with stress have strong social support networks with family, friends, and even pets. 10. Reduce stress at work. Seek out support from your Human Resources department, or a sympathetic coworker or manager. Learn how to communicate your needs in a non-confrontational manner, such as giving suggestions on how to improve working conditions to help increase productivity. 11. Develop a sense of humor. Did you know that laughter is one of the most effective ways to reduce stress? No matter how bad things are, for a variety of reasons laughing dissolves tension and seems to help brighten the situation. Try not to take things too seriously – a negative mood only adds to your level of stress. Another plus -- laughter seems to help boost your immune system, in turn making you less prone to developing colds and other infections. Anxiety Disorders Anxiety is a normal reaction to certain situations, such as feeling tense when speaking in front of a large group or experiencing a racing heart beat when faced with a dangerous situation. This physiological response helps prepare you to react to a threatening situation, or gets you charged up to perform well on a test. Anxiety disorders actually illicit the opposite effect by impairing your ability to cope in your daily life. Anxiety disorders are actually the most common form of all mental disorders. Anxiety disorders are true illnesses, stemming from a combination of life experiences and biological factors. People may feel anxious all of the time without any apparent reason, have such extreme feelings of anxiety that they have to avoid certain everyday activities, or may become completely immobilized from an intense feeling of terror. There are several different types of anxiety disorders, but this section deals only with generalized anxiety disorder. Generalized Anxiety Disorder Generalized anxiety disorder (GAD) is a chronic and exaggerated feeling of worry and tension. GAD is more common among women than in men, and tends to run in families. People with GAD tend to fret excessively about certain situations, such as family members, their health or their job, although the source of worry is not always evident. They have a hard time relaxing and falling or staying asleep. What are the symptoms? Physical symptoms include muscle tension, headaches, trembling, restlessness, sweating, abdominal upsets, dizziness and irritability. Yet people with GAD are rarely impaired from their disorder and usually do not avoid situations because of their anxiety. Only in severe cases is GAD a debilitating disease, making every day activities difficult to execute. How is it diagnosed? The onset of GAD is gradual, usually affecting people in their childhood or adolescence. A diagnosis is confirmed when a person experiences excessive worrying about every day situations for at least six months. What are the treatments? Treatments include anti-anxiety medication, cognitive-behavioral therapy, relaxation techniques and biofeedback. Depression It is not uncommon to experience feelings of sadness or frustration at times, but true depression is an actual disorder. Depression is one of the most common types of mental disorders, affecting about 340 million people in the world. Interestingly, about half of all cases of depression go undiagnosed and untreated – yet depression is the most treatable form of mental illness. Depression occurs in all age groups, social classes and cultures. It is far more common in women, affecting 25 percent of women versus about 10 percent of men. Additionally, depression also affects one out of every 20 teenagers. What are the symptoms? The main symptoms of depression include a sullen mood feeling of hopelessness, guilt and anxiety, loss of interest in things that used to be pleasurable, change in appetite, change in sleeping patterns, inability to concentrate and a lack of energy or feeling rundown. What causes depression? Depression can be triggered by a recent loss or other sad event, but it becomes out of proportion to the situation and persists longer than what is deemed appropriate. The actual causes of depression are still unclear, but one of the most probable explanations is an imbalance of a neurotransmitter (chemical messengers) in the brain called serotonin. It seems that a deficiency in serotonin can cause depression. Serotonin is considered the brains’ mood-elevating and tranquilizing drug, and low levels have been found to have a profound effect on mood and feelings of well-being. In addition, there are also several factors that can precipitate depression: Familial tendency – Those with depression in their family can have a 25 percent chance of developing the illness themselves. A recent loss or sad event – such as the loss of a job, bereavement, or social isolation - Side effects of certain drugs Infections -- such as AIDS, mononucleosis, and viral hepatitis - Pre-menstrual syndrome - Rheumatoid arthritis - Certain types of cancer. Neurological disorders -- such as stroke, multiple sclerosis, and Parkinson’s disease - Nutritional deficiencies of B-12 or B-6. What can I do to help treat depression? Follow a well-balanced diet – and include a multi vitamin/mineral supplement to ensure you are meeting your nutritional needs of all the essential nutrients. Exercise -- Numerous studies have shown that exercise is a very effective method for decreasing depression as it helps to improve your mood and boosts self-confidence. Seek professional help – Find a mental health counselor who can help you get to the root of your depression and facilitate recovery. Anti-depressant medications – Speak to your physician to determine if you are a candidate for anti-depressant medication. Nutritional Supplements and a Healthy Mind: B vitamins - The B vitamins, especially folic acid and vitamin B6, help support the clearing of the stress hormones by the liver. St. John's Wort - St. John's Wort is an herbal remedy that has been used in Europe as a treatment for mild depression. It should not be taken with antidepressant medications, especially SSRI's like Prozac or Celexa, anti-retroviral medications or birth control pills. Fish oil - Recent preliminary studies suggest that omega-3 fatty acids found in fish oil may be helpful in helping to maintain a healthy mind. We think that reasonable doses of fish oil supplements might be useful with mild temporary depression. Fish oil is an excellent source of docosahexaenoic acid (DHA), the most common fatty acid in nerve and brain tissue. Folic acid - Recent studies have been confirming the link between this important B vitamin and a healthy mind.
More about Dr. Andrew Weil, MD may be found in our SMR Wellness Center links. Information provided on the SMR site is presented in summary form that covers various diseases, ailments, physical conditions and possible alternatives and treatments. This information is not comprehensive and should not be used as a substitute for a conference with your physician or other health care provider.
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