Stress / Depression

Stress / Depression


What is Stress? We are all familiar with the word "stress". Stress is when you are worried about getting laid off from work, or worried about having enough money to pay your bills, or worried about your mother or father when the physician says she or he may need an operation. In fact, to most of us, stress is synonymous with worry. If it is something that makes you worry, then it is stress.



Your body, however, has a much broader definition of stress. To your body, stress is synonymous with stress. Anything that causes a change in your life causes stress. It doesn't matter if it is "good" change, or a "bad" change, they are both stress. When you find your dream apartment and get ready to move, that is stress. If you break your leg, that is stress. Good or bad, if it is a change in your life, it is stress as far as your body in concerned.

Even imagined change is stress. (Imagining changes is what we call "worry.) If you fear that you will not have enough money to pay your rent, that is stress. If you worry that you may get fired, that is stress. If you think that you may receive a promotion at work, that is also stress (even though this would be a good change). Whether the event is good or bad, imagining changes in your life is stressful. Anything that causes change in your daily routine is stressful. Anything that causes change in your body health is stressful. Imagined changes are just as stressful as real changes. The problem is overstress or the amount of stress expected.



What people should do, of course, is to lower their stress levels! If one can lower one's stress level enough to be out of overstress, the body will rebalance itself. But, most people in overstress never think of reducing their stress levels. They don't even realize they are suffering from too much stress. They have been in overstress for so long that they think this is what everyone feels like. So they do the best they can, medicating themselves with Pick-Me-Up's, and wondering why they "feel lousy" most of the time. They go to doctors who tell them that there is "nothing wrong," or that they are "depressed," or having "anxiety attacks” or that they are "alcoholic". It is a very frustrating experience for these people. So they continue to use coffee, sugar and other Pick-Me-Up's to try to feel normal again. But in doing so, they just make the roller coaster ride steeper, faster, and wilder. Overstress results from one's inability to deal with change due to limited resources and/or one's vulnerability to stress.



In modern society, most of us can't avoid high levels of stress or change. But we can learn to behave in ways that lessen its effects. Researchers have identified a number of factors that affect one's vulnerability to stress - among them are eating and sleeping habits, caffeine and alcohol/drug intake, and how we express and deal with our emotions, including the resources we have and how we use them. Unresolved overstress can lead to depression.



How the Body Adapts to Stress: A generally accepted physical model of the effects of prolonged stress at different stages on the human body, called the general adaptation syndrome (GAS) are three stages 1) Alarm Stage; 2) Resistance Stage; and 3) Exhaustion Stage.



Stage 1: Alarm reaction: The first stage of the general adaptation stage, the alarm reaction, is the immediate reaction to a stressor. In the initial phase of stress, people exhibit a "fight or flight" response, which causes one to be ready for physical activity. However, this initial response can also decrease the effectiveness of the immune system, making the person more susceptible to illness during this phase.

Stage 2: Stage of resistance: Stage 2 might also be named the stage of adaptation, instead of the stage of resistance. During this phase, if the stress continues, the body adapts to the stressors it is exposed to. Changes at many levels take place in order to reduce the effect of the stressor. For example, if the stressor is starvation (possibly due to anorexia), the person might experience a reduced desire for physical activity to conserve energy, and the absorption of nutrients from food might be maximized.

Stage 3: Stage of Exhaustion: At this stage, the stress has continued for some time. The body's resistance to the stress may gradually be reduced, or may collapse quickly. Generally, this means the immune system, and the body's ability to resist disease, may be almost totally eliminated. Patients who experience long-term stress may succumb to heart attacks or severe infection due to their reduced immunity. For example, a person with a stressful job may experience long-term stress that might lead to high blood pressure and an eventual heart attack.



Stress and Depression:

There appears to be a complex relationship among stressful situations, our mind and body's reaction to stress, and the onset of clinical depression. It is clear that some people develop depression after a stressful event in their lives. Events such as the death of a loved one, the loss of a job, or the end of a relationship are often negative and traumatic and cause great stress for many people. Stress can also occur as the result of a more positive event such as getting married, moving to a new city, or starting a new job. It is not uncommon for either positive or negative events to become a crisis that precedes the development of clinical depression.



Whether stressful events can actually cause a person to become depressed is not fully known. There are times when we all must struggle with very painful situations in our lives. More times than not these changes do not result in a person becoming clinically depressed. In fact, sometimes people become depressed even when there seems little or no stress in their lives and everything seems to be going very well. And, no single stressful event will cause depression to develop in every person. The same type of stressor may lead to depression in one person, but not another.



If a stressful experience causes a person to become depressed, it may happen indirectly. In other words, if a young woman with a family history of major depression suffers the death of a loved one, she may become clinically depressed. In this situation it is not necessarily the traumatic loss itself that caused the development of depression, but the combination of a genetic predisposition with the stressful event that made her vulnerable to becoming depressed. For those who struggle with more chronic depression, the effects of stress may be more complicated. A stressful event such as a job or the death of a loved one is more likely to come before a fist or second depressive episode. After that, further depressive episodes may develop spontaneously. It is not certain why stress may lead to depression in this way.



However, researchers have theorized an explanation called the "kindling effect," or "kindling-sensitization hypothesis." This theory surmises that initial depressive episodes spark changes in the brain's chemistry and limbic system that make it more prone to developing future episodes of depression. This may be compared to the use of kindling wood to spark the flames of a campfire. Since early episodes of depression make a person more sensitive to developing depression, even small stressors can lead to later depressive episodes.

Some people may become depressed as a result of having to struggle chronic stress. These constant difficulties may come in the form of having to juggle multiple roles at home and work, making major changes in lifestyle, being in an abusive environment, etc. They may also come with important and normal transitions in life such as late adolescence and early adulthood when many people separate from their families to establish their own independence. Middle age may require adjustment in changes in fertility and virility, children leaving the home, concern about job advancement, and a re-evaluation of accomplishments in life. Retirement is another time of major change as some people struggle with a reduction of position and finances. If a person is under continuous stress, a single difficult event may be more likely to induce a depressive episode. For instance, if a middle-aged woman is in an unhappy marriage, she may be more likely to become depressed after her youngest child leaves home. The event of her child leaving home may not by itself have been enough to lead to depression, but the constant stress of an unhappy marriage combined with this event may be enough to trigger clinical depression.



In studying how stressful events may lead to depression, researchers have developed a theory called, "learned helplessness." This theory states that when people experience chronic or repeated stressful events, they learn to feel helpless. This feeling of helplessness is strengthened when a person believes he or she has no control over the stressful situation. Although the research to support this theory was initially done with animals, the effects of learned helplessness may be seen in depressed humans. People who are depressed, very often have negative beliefs about their ability to manage aspects of their lives based on perceived failures of the past.. For example, imagine an adolescent girl living in a home with verbally abusive parents who tell her that she is stupid and cannot do anything right. Overtime the young girl may believe her parents and come to doubt her abilities and self-worth. She may begin to feel helpless and believe that most things are beyond her control. This feeling of helplessness may make her vulnerable to developing clinical depression at some point in her life.



Part 2

Types of Depression:

Major Depressive Disorder: This illness impairs a person's ability to work, sleep, eat, and function as he or she normally would. It keeps people from enjoying activities that were once pleasurable, and causes them to think about themselves and the world in negative ways. Major depression is often disabling and may occur several times in a person's lifetime.

Dysthymic Disorder: A milder yet more enduring type of major depression. People with dysthymia may appear to be chronically mildly depressed to the point that it seems to be a part of their personality. When a person finally seeks treatment for dysthymia, it is not uncommon that he/she has struggled with this condition for a number of years. I see dysthymia in almost all addicts/alcoholics.



Bipolar Disorder: Also known as manic-depressive or manic-depressive disorder. This condition is characterized by mood that alternates between periods of depression and periods of elation and excitable behavior known as mania. For people who have bipolar disorder, the depressions can be severe and the mania can seriously impair one's normal judgment. When manic, a person is prone towards reckless and inappropriate behavior such as engaging in wild spending sprees or having promiscuous sex. He or she may not be able to realize the harm of his/her behavior and may even lose touch with reality.



Cyclothymic Disorder: A milder yet more enduring type of bipolar disorder. A person's mood alternates between a less severe mania (known as hypomania) and a less severe depression.



Mood Disorder Due to a General Medical Condition: Depression may be caused or precipitated by a known or unknown physical medical condition such as hypothyroidism.

Substance-Induced Mood Disorder: Depression may be caused or precipitated by the use or abuse of substances such as drugs, alcohol, medications, or toxins.

Seasonal Affective Disorder (SAD): This condition affects people during specific times or seasons of the year. During the winter months individuals feel depressed and lethargic, but during other months their moods may be normal.



Postpartum Depression: A rare form of depression occurring in women within approximately one week to six months after giving birth to a child.



Premenstrual Dysphoric Disorder: This is an uncommon type of depression affecting a small percentage of menstruating women. It is a cyclical condition in which women may feel depressed and irritable for one or two weeks before their menstrual period each month.



Helping Yourself When You Are Depressed-----------------------------

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the situation. Negative thinking fades as treatment begins to take effect. In the meantime: *Set realistic goals and assume a reasonable amount of responsibility. *Break large tasks into small ones, set some priorities, and do what you can as you can. *Try to be with other people and to confide in someone; it is usually better than being alone and secretive. *Participate in activities that make you feel better. *Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help. *Expect your mood to improve gradually, not immediately. Feeling better takes time. *It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition - change jobs, get married or divorced - discuss it with others who know you well and have a more objective view of your situation. *People rarely "snap out of" a depression. But they can feel a little better day by day. *Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment. *Let your family and friends help you.



Helping Someone Else Who Might Be Depressed: The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the clinician or physician. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication.



The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.



"Stress Hormone" Levels Abnormal: Both persons under stress and those suffering from depression may have abnormally elevated cortisol levels. Cortisol is produced in and secreted by the adrenal glands in response to control signals from the pituitary gland and hypothalamus of the brain. While cortisol itself has many important functions for the body including regulation of the metabolism and blood pressure, its role in the body stress response has earned it the nickname of "stress hormone." Cortisol secretion is increased in response to physical and psychological stress of any kind. When the stressful event or situation is over, cortisol levels return to normal. While prolonged increases of cortisol levels can lead to changes in mood, a causal relationship between elevated cortisol levels and depression has not been firmly established. Clinical depression is a complex condition likely resulting from a combination of inherited, biochemical, and environmental factors. Elevation of cortisol through a prolonged stress response is only one factor that may be related to mood changes associated with depression.



Supplementation with nutrients that have been proven to overcome any increase in cortisol levels that occurs with stress and age. Phosphatidylserine, DHEA, and ginkgo biloba all have been shown to reduce the amount of cortisol produced during stressful events, and these stress fighters can help retard the negative consequences of this hormone. Another factor should be taken into consideration as well - one's lifestyle and approach to handling everyday stress. Simple, age-old methods such as breathing exercises, biofeedback, massage, and meditation can help put life's travails in proper perspective, helping to remove the underlying stress that causes excessive cortisol production in the first place. While some life situations are largely unchangeable, others can be modified with a bit of effort and the will to improve one's quality of life. Considering the questions regarding vulnerability to stress, at minimal, it seems reasonable to: *Eat a balanced diet daily which means at least three meals. Optimally, four or five smaller meals may be far less stressful. *Get at least 7 or 8 hours of sleep everyday. Sleeping more could be a sign of depression. *Give and receive affection as a part of your daily routine (love and be loved). *Make sure you have and use at least one close friend for objective support regarding personal issues. *Make certain you exercise regularly (at least twice a week) and preferably more often as a part of an established routine. *Avoid smoking and using drugs and/or alcohol. *Maintain an optimal weight for your body type. *Insure that you are living well within your means. *Do not neglect to feed your mind and spirit as a part of your routine. *Engage in a social routine with friends. *Speak openly of problems and issues in order to resolve them in your life. *Make sure you are having fun as a regular part of your routine. *Avoid dietary stimulants that add to your stress level. *Make sure you are taking care of your self with your own routine of private time or time to your self alone on a regular basis.