Anxiety, Depression, Stress and Insomnia: Definition |
Anxiety is a feeling of apprehension, fear, uncertainty, or doubt that is chronic (lingers over a long period of time). The source of these feelings is not always known by the sufferer, which may add to the distress. The condition can feed upon itself, and can escalate over time if not correctly managed or treated.
Alternative names for Anxiety:
Stress; Tension; Apprehension; Panic Attack.
In the United States, close to 19 million people have depression,
reports the National Institute of Mental Health. There is significant data that links life stress to the subsequent development of depression.
Stress is not a disease, but rather is a normal part of everyone’s life. The noted researcher, Hans Selye, called stress the "spice of life". Stress, like salt, in small quantities is good: it makes life more interesting and palatable. It makes us more productive. As an example, the fear of earning a bad grade can make a student study more effectively.
However, too much stress (like too much salt) is both unhealthy and counterproductive. The same student, if he or she was recently attacked physically, or perhaps is struggling with the sudden death of a friend, will not be able to study as well.
Stress that is chronic (persists over time) is called anxiety.
Anxiety is an emotion that is often accompanied by numerous troublesome physical symptoms. These symptoms may include twitching or trembling, muscle tension, headache, sweating, dry mouth, or difficulty in swallowing. Some people occasionally report dizziness, rapid or irregular heart rate, increased rate of respiration, diarrhea, or frequent need to urinate when they are anxious. Fatigue, irritable mood, insomnia and sleeping difficulties, decreased concentration, sexual problems, and nightmares are also commonly reported by people who are suffering from anxiety.
Sometimes a medical condition or disease may masquerade as anxiety.
Different people can tolerate different amounts of stress before becoming ill. Some people are more sensitive to stress and are more likely to develop anxiety disorders. This can be caused either by genetic predispositions to anxiety, or by previous (particularly early childhood) exposure to certain stressful circumstances. Certain tumors of the adrenal gland (pheochromocytoma), may cause anxiety and tension by causing the release of cortisol, a stress hormone (this condition is rare).
Common and Uncommon Causes of Anxiety and Stress:
Immediate danger: very often stress is an appropriate reaction to actual danger. This is called the appropriate "fight or flight response".
Possible Causes of Anxiety:
Emotional stress such as grief and depression often lead to anxiety
Physical stress such as a medical illness
Medication side effects
Drugs including caffeine, cold remedies (Cough/Cold Combinations - oral), sympathomimetics, decongestants (Antihistamines and Decongestants - oral), bronchodilators, tricyclic antidepressants, and thyroid supplements
Withdrawal from drugs or addictive substances (including prescription drugs, alcohol, caffeine and nicotine)
Poor diet (deficiency of Vitamin B12)
Thyroid problems (primarily hyperthyroidism)
Low blood sugar (hypoglycemia)
Tumor of the adrenal gland (pheochromocytoma), in rare cases.
Call your health care provider if you are unable to work because of anxiety, there is a sudden feeling of panic (panic attack), or the cause of the anxiety is unknown.
If self-treatment has failed, or problems cannot be resolved seek professional help. Always be sure to discuss any proposed changes in your nutritional supplements, or radical changes in your diet with your health care provider before you make them.
Your primary health care provider is a valuable resource. He or she can determine with you if your anxiety would be best evaluated and possibly treated by a mental health care professional.
Health Impact of Anger, Stress and Hostility:
In the 1920s, Walter Cannon was the first to describe the "fight or flight" response, and in the following decade, Wilhelm Raab, demonstrated the effects of, and risks associated with adrenaline and cortisol during this response. 10 In 1939, Alexander 350 theorized that anger and anxious emotional states could lead acutely to blood pressure elevations, and chronically to established hypertension. In 1956, Hans Seyle popularized the term "stress" and increased the general public awareness of the detrimental effects of stress on human health in his widely-read book, The Stress of Life. 58 Seyle called stress "the salt of life", and defined it as the nonspecific response of the body to any demand. 145, 146, 147 He demonstrated that stress contributed to illness and death in animals, and postulated that the same effects may occur in humans. Friedman and Rosenbaum were some of the first researchers to demonstrate and publish proof of this association in their 1974 work, Type-A Behavior and Your Heart. 57 They defined "Type-A behavior" as verbal and non-verbal behavior characterized by impatience, anxiety, and hostility. In 1980, a scientific panel convened by the National Institutes of Health concluded that Type-A behavior is a risk factor equal to, or greater than any other risk factor for coronary artery disease. 10 Eliot and co-workers 148, 149 demonstrated that "hot reactor" patients who had exaggerated responses to mental stress (as evidenced by significant increases in total peripheral vascular resistance, and accompanied by no change or a decrease in cardiac output) were at high risk for severe cardiovascular disease. Verrier and Dickerson 741 have demonstrated in animal studies that in the presence of coronary stenosis, heart rate acceleration secondary to psychological responses of fear or anger is associated with substantial increases in coronary vascular resistance and a decrease in coronary artery blood flow, and numerous other researchers have identified subsets of patients suffering from CAD who display exaggerated heart rate, blood pressure, cardiac output, and vasomotor responses to mental stress. 700, 714, 735, 737, 738 In an investigation of 63 patients with coronary artery disease, L'Abbate and co-workers 737 determined that psychological stress significantly increased myocardial oxygen demand (by increasing heart rate and blood pressure), while simultaneously decreasing myocardial oxygen supply (by increasing coronary vasomotor tone and reducing coronary blood flow at the level of the microcirculation). Ansel Keys, in a 23-year prospective study, 150 demonstrated that an exaggerated hypertensive response to environmental stress (a cold-pressor test) was the best single predictor for the future development of CAD.
Coronary artery disease may leave an individual more susceptible to the damaging effects of uncontrolled rage and emotional stress. 495 In a recent study reported in the American Journal of Cardiology, researchers asked patients undergoing cardiac catheterization to recall incidents that angered them. Researchers were angiographically able to document a significant narrowing of diseased coronary arteries during the anger recall. Healthy arteries with undamaged intima and without visible atherosclerotic narrowing showed no significant response to anger. While stress can hasten the development of CAD, unresolved anger may be one of the trigger mechanism which predisposes atherosclerotic coronary vessels to vasospasm and possible myocardial infarction. Thus, while smoking, lack of exercise, and the effect of a poor diet may take decades to exert their detrimental effect on coronary health, unresolved anger has the potential for more immediate and acute effects.
Because individual differences in perception and coping skills vary greatly, it is difficult to define any particular set of conditions as inherently stressful, and many clinical studies structured to detect associations between stress and certain cardiovascular risk factors have been unsuccessful due to differences in coping styles among subjects. 736 In a 1992 review of the clinical literature, Niaura and Goldstein 351 documented a strong correlation between poor anger coping styles and the presence of hypertension. These researchers also noted a high degree of correlation between the presence of hypertension and an individual's unsuccessful attempts to actively cope with stressors not within his or her control. Sommers-Flannagan and Greenburg, in their 1989 review 353 of the relationship between psychosocial variables and hypertension, reported a strong and consistent relationship between the degree of anger and subsequent blood pressure elevation. Markovitz and co-workers 250 examined a large cohort of men and women from the extensive Framingham Heart Study database who were normotensive at baseline, and followed this group for as long as two decades. Their research suggested that long-term anxiety, rather than a tendency to explosive anger itself, was most predictive of the future development of hypertension.
In an on-going study conducted at Johns Hopkins University by M.J. Klag et al of over 1,000 men who were enrolled at age 22 and followed for up to 46 years, those young men who were identified as having the hottest tempers upon enrollment were three times more likely to suffer myocardial infarction or stroke during their middle age than their calmer counterparts. Research has confirmed that emotional stress is associated with angina and silent myocardial ischemia, 351, 692, 714, 718, 737, 768, 770, 771, 772, 773 coronary atherosclerosis, 688, 689, 690, 739 myocardial infarction, 688, 689, 690, 706, 707, 711, 713 left ventricular hypertrophy, 701 transient left ventricular dysfunction, 351, 774 arrhythmias, 225, 351, 493, 700, 738, 775, 776, 777, 778, 779 and sudden death. 225, 351, 493, 738, 776, 777, 780 Stress causes metabolic changes which can increase cardiovascular risk, 10, 145, 148, 149, 150, 225, 495, 688, 689, 690, 691, 692, 693, 694, 695, 696, 697 and these changes are mediated largely by increases in cortisol or serum catacholamines. 225, 351, 492, 493, 494, 495, 697, 699, 700, 741 Stress also has a direct effect on the initiation and continuance of other known (and possible) coronary risk behaviors such as cigarette smoking, 225, 246, 493, 496, 736, 755, 756, 764 poor nutrition, 739 depression, 225 inhibition of immune system response, 281 inability to schedule or avoidance of exercise, excessive alcohol consumption (contributing to loss of critical electrolytes such as magnesium and potassium, alcoholic cardiomyopathies, and cardiac arrhythmias), 493, 738, 764 drug abuse, excessive coffee consumption (contributing to increased risk of cardiac arrhythmias through increased catecholamine release and electrolyte loss resulting from diuresis), 207 and obesity. 10, 80 According to the March of Dimes Birth Defects Foundation, stress experienced by couples who are attempting pregnancy may decrease the chance of a healthy pregnancy and delivery.
Freeman and colleagues 229 demonstrated that cardiac patients under stress experienced significantly more asymptomatic ischemia, and those with higher levels of urinary cortisol and norepinephrine had a significantly greater number of ischemic episodes. Similarly, Rozanski and co-workers 714 found that silent or painful myocardial ischemia was easily induced by mental stress testing among patients with CAD. Coumel and Leenhardt 700 suggested that strong emotion and panic produce a powerful adrenergic stimulation capable of producing cardiac arrhythmias in patients with underlying heart disease. This finding has been supported by other research. 351, 493, 714, 735, 738 Even patients without underlying CAD may respond to stress with increases in catacholamines, heart rate, and subsequent changes in the electrical irritability of the heart which may predispose to sudden death. 230 Researchers at the Stanford University school of medicine and in Montreal, Canada have demonstrated that training to relieve feelings of anger and hostility can reduce the risk of repeat myocardial infarctions. 1110
The stress hormones epinephrine (adrenaline), norephinephrine, and cortisol are beneficial in fight or flight situations which threaten life or safety. During these (or any psychological stress situation) the brain floods the circulatory system with these chemicals to prepare the body to vigorously confront the threat or to rapidly flee from it. Even in the absense of external stimulation, the body can elicit these reactions in response to the self-talk, or internalized dialogue within our minds.1138 Heart rate increases and vasoconstriction (the body's mechanisms to increase energy and strength and to reduce blood loss in the event of injury) can serve to increase risk of cardiovascular events in susceptable individuals. Chronic stressful situations or lifestyles can result in high levels of circulating stress hormones which may ultimately lead to hypertension or cause damage to the heart muscle in the form of contraction band necrosis (which can predispose an individual to a significantly greater risk of sudden death). 10 Chronic levels of stress and agitation can also do damage to the immune system. 1110 Numerous scientific studies have demonstrated that individuals who where classified by researchers as "most hostile," or who had less support of friends and family or had poor social networks had significantly lower natural killer cell activity, reduced immune function, were more likely to fall prey to viral infections, and suffered from higher rates of mortality from the diseases they contracted.
Hostile individuals are significantly more likely to abuse alcohol, smoke, and over-eat than are the more sedate personalities, all of which may contribute to the increased risk of cardiovascular disease or death among persons exhibiting high levels of hostility. 742
Environmental stressors can also increase cardiovascular risk. 145, 170, 234, 238 In epidemiologic studies, an association between environmental noise (traffic noise, aircraft take-offs and landings) and blood pressure elevations has been demonstrated. 145, 170 Harburg et al 234 found that hypertension was more prevalent among blacks living in the most high-stress areas of urban Detroit than among blacks living in areas with lower levels of crime and civil unrest. In a nine-year follow-up study by Berkman and co-workers, 238 which compared an area of poverty with an affluent area, the incidence of hypertension was 50% higher in the poor area, regardless of social interaction, availability of medical care, smoking or other identified CAD risk factors. Among a group of more affluent people who chose to live in the poverty area, the pattern of hypertension was more closely related to that seen within the poor area, rather than to that of a group with a similar income living in the affluent area. Interviews with these individuals revealed fears of robbery, injury and violence, and there was evidence that the distribution of hypertension correlated directly with the number of police, ambulance, and fire department calls. Epidemiologic studies and anecdotal reports suggest that hypercholesterolemia, and menopausal symptoms frequently respond well to a regimen of stress reduction.
The link between psychological stress and depression has been understood for centuries. Almost a millenia before the birth of Christ, Solomon wrote: "Anxiety in the heart of man causes depression, but a good word makes it glad." (Proverbs 12:25) One out of every four Americans experiences some degree of clinical depression or mood disorder at some time in their life. Depression effects persons of all ages and races, and studies in the United States have shown that at any given time, as much as 5% of the population may be diagnosed as having major depression. According to researchers, between 10 and 25 percent of Americans will experience major clinical depression at some point in their life. Depression is the most common mental affliction suffered by Americans, and is experienced more frequently by women than by men. Depression is a psychologic, physiologic, biochemical, genetic, or metabolic disorder which results in a neurochemical imbalance and is often a symptom of other underlying disease. Decreased levels of serotonin are more common in the elderly, and have been associated with increased depression and psychological stress.
Epidemiologic studies or anecdotal reports suggest that depression frequently responds well to a regimen of dietary modification, nutritional supplementation, stress reduction, and regular aerobic exercise. There is a substantial body of medical evidence which demonstrates that depressed persons are significantly more prone to to early death from myocardial infarction 688, 689, 690, 706, 707, 711, 713 and cancer than those persons whose moods are elevated, and report that they are serene or happy regardless of their medical circumstances. In 1993, the Archives of General Psychiatry reported that California researchers demonstrated that group psychotherapy (addressing clinical depression) was associated with increased survival among patients suffering from malignant melanoma.
Diet: A new study published in 2005 in Biological Psychiatry found that eating foods like walnuts and salmon may help ease depression. Walnuts and salmon both contain Omega-3 fatty acids, compounds which have been studied for possible protection against many diseases including: stroke, heart disease and arthritis. These important “healthy fats” may be helpful for depression as well. Researchers in this study found that after animals were faced with a challenging task, they performed better and did not become as discouraged after receiving Omega-3 fatty acids, uridine, or both. It took about 30 days for the Omega-3 fatty acids to kick in, about the same time it takes prescription depression medications like Prozac to work, reported researchers.
Depression can play a role in the development of arthritis. At the Stanford University School of Medicine, a study found that arthritis patients who underwent psychological intervention for depression reported less pain and suffered less joint swelling than did patients who did not receive any intervention. An individual's emotions or psychological state may positively or negatively influence their risk of developing a disease and how they may respond to treatment for that disease. Medical research has demonstrated that certain immune system cells, involved in combatting disease, have receptors for the chemical messengers which the brain produces and secretes into the circulatory system to direct the functions of other bodily organs. Nerve cells, conversely, have receptors for certain immune cells. These findings suggest the existence of some sort of communication system which links the brain and the body's natural defences. It has long been known that levels of natural killer (immune) cells are frequently decreased in people suffering from depression or emotional trauma.
Numerous clinical studies reinforce these findings: Terminal breast cancer patients who resisted depression and approached their disease with a fighting spirit or denial lived significantly longer (eighteen months longer on the average) than those who accepted their fates with stoicism, hopelessness, or despair. In 1990, the Journal of Clinical Oncology reported that lymphoma and leukemia patients who underwent psychological interventions for depression lived significantly longer than those who did not. In 1993, the Archives of General Psychiatry reported that California researchers demonstrated that group psychotherapy was associated with increased survival among patients suffering from malignant melanoma.
Depression has been associated with an increased risk of developing other chronic degenerative diseases. At the Stanford University School of Medicine, a study found that arthritis patients who underwent psychological intervention for depression reported less pain and suffered less joint swelling than did patients who did not receive any intervention.
A significant body of scientific evidence suggests that emotional stress and depression may be a significant risk factor for myocardial ischemia, 351, 692, 714, 718, 737, 768, 770, 771, 772, 773 and myocardial infarction. 688, 689, 690, 706, 707, 711, 713 A clinical study published by the Centers for Disease Control (CDC) found that patients who demonstrated persistent feelings of despair or hopelessness had a significantly increased risk of developing and dying from heart disease. 1110 A study conducted at Johns Hopkins School of Medicine found that individuals who have suffered from major bouts of depression may be four times more likely to suffer a myocardial infaction as compared to individuals of similar ages who are not depressed. The study, published in the December 1996 issue of the journal Circulation, was based upon interviews with about 2,000 Baltimore men and women who had no prior history of heart disease before suffering a first heart attack. In a clinical study published in the Journal of Human Stress, van Doornen and Orlebeke 228 found that elevated cholesterol levels were directly related to the degree of depression, hostility and emotional instability, while they were inversely correlated with motivation and happiness. Because the association of cholesterol elevations with an increased risk of heart disease is well established, this may be the mechanism responsible for increased CAD risk among depressed patients.
Symptoms of Depression:
Diagnostic criteria for clinical depression includes symptoms which have been manifested daily for at least two weeks. These symptoms include apathy, fatigue, mood alterations, insomnia, increased sleep, loss of appetite, significant weight loss or gain, psychomotor agitation (trembling), loss of interest in normally pleasurable activities, decreased sex drive, dry mouth, nausea, constipation, diarrhea, and feelings of worthlessness or suicidal thoughts.
beneficial nutritients for anxiety, stress, depression
References for footnotes above