Taking Charge of Your Health

Hi, naturopathic doctor, Talia Marcheggiani,
here. I’m a mental health expert and I’m at Bloor
West Wellness Clinic and today we’re going to talk about the Stress-Depression Connection. Most of us are stressed in North America. There’s a major stress epidemic. We know that anywhere from 70-90% of doctors’
visits are directly or indirectly attributed to stress and the symptoms that it causes
in the body. Most people are stressed, I think the estimate
is 70% to 90% of North American women are experiencing some kind of chronic stress. Many are unaware of it and very few are doing
anything about it or actively managing their stress through methods of self-care, relaxation
techniques, and other therapies to lower the cortisol, or the stress hormones, that are
producing that chronic stress in the body. So, physiologically, when we get stressed,
so, let’s say, you know, you’re in the paleolithic times, you’re walking through the forest and
you encounter a giant bear running towards you. Our bodies would immediately start secreting
epinephrine, or adrenaline, which is the first stress hormone. This is released from the adrenal glands,
these pyramid-shaped endocrine or hormone glands, located on top of both of our kidneys. Epinephrine, or adrenaline, many of us have
felt the effects of before, this makes our heart race, we start sweating, we start to,
you know, you might feel like you have to go to the washroom, you might notice digestive
effects. What will happen is, our blood vessels will
dilate, our pupils will dilate, so that we can’t see fine detail but we can see movement
much more easily so we can see the subtle movements of the bear lunging towards us and
our body is primed for fight, flight or freezing so that we can get away from this immediate
stressor, this threat to our safety and survival. And really incredible things can happen when
we’re in this hyper-arousal state, this sympathetic nervous system state. A friend of mine was walking in Greece and
she fell off a side walk, the side walk just ended, and in the fall, she fell off like
cliff, and one of her arms broke so, she managed, in this superhuman ability, that all of a
sudden she had, through the adrenaline that was coursing through her body to deal with
this stress and surprise, she with the hand that wasn’t broken, grabbed the edge of the
sidewalk and pulled herself to safety. And this was a woman, my friend, that can’t
even do one pull-up she can’t do pushups, she doesn’t have the arm strength to, in a
calm and not hyper-aroused state, perform that kind of physical act. So, epinephrine and the stress response is
amazingly powerful. This stress response can save our lives if
called into action for the right reasons and at the right time. However what’s going on in North America now,
is that, especially in this modern society that we live in, with technology and all of
the stressors that we’re encountering on a day-to-day basis and the pressures we put
on ourselves, we’re in the hyper-arousal state far more often than normal. Back when we were chased by bears and we had
to respond physiologically to that stressor, we would have just, as soon as we reached
safety or finished fighting the bear, or froze, played dead, so the bear would walk away,
we would have returned back to a state of relaxation. I mean, our hearts would have continued to
pound as we kind of got over that stressor, but eventually we would have returned to our
rest and digest state, our parasympathetic state. Back in those days we used to work an estimated
15 hours a week hunting, gathering food, um, in our paleolithic time, in our hunter-gatherer
times, which is what our genes have evolved to succeed in—our genes haven’t evolved
to catch up with the rapid change in the environment that we’ve created for ourselves and so we’re
not used to working 40 to 80-hour work weeks and racing home, through traffic, to pick
up the kids and do after school activities and finish up late assignments, getting to
get after 12 pm and getting up at 6 am to do a workout so we can lose weight and all
of the things that are filling our lives and causing us stress. The issue with many of the women that I work
with, many of the people that I work with, is that we don’t really notice that we’re
under stress, like a lot of people will say that they don’t feel stressed and then the
signs and symptoms that they’re bodies are exhibiting point me in a direction of some
kind of stress response. So, I described what adrenaline/epinephrine
do. But our body doesn’t have a very big reserve
of adrenaline and epinephrine, so when we’re in that fight or flight response for prolonged
periods of time, the adrenal glands, those pyramid-shaped glands on top of the kidneys,
they start to secrete another hormone, called cortisol. Cortisol has some similar effects, but it’s
better for prolonged periods of stress. Cortisol kind of makes us feel alert, it gives
us this grounded energy so we can be effective when we have these daily things thrown at
us. So, when we wake up in the morning, we feel
kind of groggy and then we start to feel alert, maybe we have a quick workout or cold shower
or we eat something, we start to feel like we’re becoming alive, we’re greeting the day. That’s cortisol starting to build up in our
bodies and prepare us for the things that we have to do, for the mental tasks, or the
physical tasks, or the juggling of all the tasks that we have coming up for us in that
day. Cortisol is a good thing. We want to have cortisol because without it,
we can’t perform, we can’t be who we need to be. And we can’t bring ourselves into the world
and do the things that we’re supposed to do that day. The problem is, of course, and I’ve already
mentioned this, is when stress is prolonged and when stress is taking over more than 50%
of our day and our bodies are in that fight or flight state for more time than they’re
in the rest and digest state. Some of the effects of being in this state
and, as I mentioned, a fair amount of us are this state most of the time, or have to be. Some of the effects are high blood pressure,
high cholesterol, heart diseases, even some cancers, suppressed immunity, things like
skin issues, hormonal imbalances, such as infertility, or PCOS or endometriosis, changes
in eyesight, changes in hearing, hair loss, acne, impotence, and various other symptoms. And, of course, depression and mental illness. One of the effects of cortisol is that it
can lower serotonin, which is the feel-good, the happy neurotransmitters that our brain
secretes and dopamine, another neurotransmitter that promotes feelings of well-bring and happy
mood and also helps with that motivation and reward cycle. Cortisol also controls inflammation and, when
we have too much of it, it suppresses inflammation, but once we start to become deficient in cortisol,
inflammation can increase and when our body’s relying on cortisol all the time, the balance
of cortisol can get thrown off and we can have highs and lows of cortisol in the body. We know that there is an implication in inflammation
and mood, so cortisol is often at the root of excess inflammation or inflammatory symptoms. There’s also a condition that’s not really
recognized in conventional medicine, but naturopathic doctors recognize, as well as functional doctors. So functional doctors and naturopathic doctors,
we don’t really work with diseases that you come in with, I mean we work with those too,
but where we really excel is when we’re looking at the patterns and the symptoms and the blood
work showing disease processes before they actually become diseases. And I think depression and most mental health
conditions fall in that area because we know that there’s no blood tests for things like
depression. Direct blood tests, I mean. There’s no real diagnostic criteria beyond
the subjective criteria that’s in the DSM V. So, when somebody’s depressed, we have to
rely on a variety of symptoms and then I can order some blood tests to rule out why someone
might be feeling that, but it’s not a disease like diabetes where you run lab tests and
you can infer from those lab tests directly what’s going on in the person’s blood and
in their body and in their cells. And, of course, the result or the solution
for depression is much different than diabetes, especially type I diabetes where it’s an insulin
deficiency, you inject insulin and the disease is managed. With things like depression, we have to reason
backwards and try and understand what might have led to those symptoms or what’s going
on in the person’s body that’s causing this imbalance that’s causing the symptoms to arise. So, back to adrenal fatigue. So, when patients come in, and they’re experiencing
prolonged stress that begin with something called the resistance phase. So this is when you’re feeling like life is
busy you have a lot on your plate, but it almost, you almost thrive in this situation. It feels kind of good. You feel like you’re in control, you feel
motivated and you feel like you’re getting things done. You might be tired at the end of the day,
you might not be sleeping as well as you could. And you’re definitely not feeling zen. You’re not feeling relaxed and like a Buddhist
monk most of the time. You’re feeling that there’s pressure on you,
but you’re coping. Things are ok. This is called the Resistance Phase. And this means that your body is producing
enough cortisol to deal with the daily tasks at hand. After months to years of this, however, if
this prolonged and we’re not taking enough breaks to allow our bodies to replenish, we
can experience something called Adrenal Fatigue. This is when our body’s not able to produce
the cortisol needed to cover those daily tasks. So remember how I said that cortisol kind
of makes us feel alert and alive and ready to deal with the day ahead of us. In Adrenal Fatigue we’re not able to activate
that stress response when we need it because we’ve had it turned on all the time. It’s almost like the gas tank’s empty and
we’re kind of sputtering to get it going again. We’re trying to get our car to run on the
fumes that are leftover. And, we might call this Burnout, this is another
word for it, is burnout. And so, in adrenal fatigue, and this is a
really common situation that often leads to depression and also often has symptoms that
actually mirror or overlap with depression. In adrenal fatigue, first of all, the main
symptom is just feeling tired, fatigued. There are sleep disturbances. We feel weak, we feel unmotivated, and one
of the key symptoms is that we’re not relieved by exercise. So a lot of my patients will tell me, “I want
to exercise, I know I should exercise but I just don’t have the energy to exercise.” And I’ll ask them, “do you feel like you are
able to push yourself to do some exercise, like go for a brisk 30-minute walk or even,
you know, a quick jog. How do you feel afterwards?” And if they tell me they feel like it depletes
them more, this is often a sign that they’re in that burnout phase, they’re in adrenal
fatigue. Because when you’re in a resistance phase,
exercise can kind of boost your cortisol a little bit, so if you’re still able to make
it, it feels pretty good because it kind of revives you and it perks you back up. But if you’re in an adrenal fatigue situation,
you just don’t have the cortisol reserves to get through that exercise, to get through
that workout and to feel good afterwards. So that’s one of the symptoms. How cortisol is supposed to work in a healthy
person that has adrenal glands that aren’t depleted, is when you wake up in the morning,
your cortisol begins and it’s high. And that’s why you test blood and salivary
cortisol in the morning as soon as you get up. So that means you wake up and you feel like
you’ve slept pretty well and you’re ready to start the day, you feel alert. You’re not groggy, you don’t wish that you
could just stay in bed for the rest of the day. Throughout the day your cortisol will gradually
decline. It might have a few dips and usually perks
up with eating or exercise. So if you have a protein-rich, or carbohydrate-rich
meal, your cortisol can come back up and that’s around meal-times you’ll feel a little bit
more alert. And your cortisol will decline until bedtime
when you feel tired and you feel ready to go to sleep and it will stay low throughout
the night so you won’t be waking up at night. You’ll feel rested and if you have one of
those sleep trackers or a Fitbit, it will show you that you have restful sleep and that
you spend a lot of your time in REM sleep or deep wave sleep. And then the cycle starts again, you wake
up, your cortisol starts to peak and gets higher again. When our cortisol cycle is off. When we’re in adrenal fatigue or even the
end stages of stress resistance, which proceeds that burnout adrenal fatigue stage and often
proceeds depression. The resistance phase is more associated with
anxiety, burnout is more associated with depression. When we’re in that burnout phase, we’re not
able to get the cortisol up in the morning so you wake up feeling exhausted. You will often even have a crash, you might
kind of get going and ready to go or you might just be used to having that level of energy,
on a scale of 1 to 10, you might be anywhere from a 3 to a 7. Around 10 am, though, you’ll notice a dip
in your energy, so a lot of people will have this kind of energy crash around 10 am and
then they get a second wind, they can kind of go. A very typical thing that happens is around
3-4 pm, 2-4pm, after lunch, there’s a massive energy crash and we’re still at work, most
of the time, those of us that work 9-5 and so you’re at work and you’re just feeling
exhausted. And then people kind of get a second wind
and another thing that happens, which is not great, is that you get a second wind right
before bedtime. When you’re supposed to be going to sleep,
you feel this kind of “tired and wired”, like you’re not able to, you know, wind yourself
down to get a restful night’s sleep. You feel like you need to be up and on your
electronics and doing some work, catching up on some things that you need to get done. And eventually you might go to bed and usually
this happens close to midnight or after midnight, and then most people will have a cortisol
spike in the middle of the night between 2 and 4 am where you wake up and are unable
to fall back asleep. And thus the cycle begins again where you
had a spike in the middle of the night, your sleep’s been broken, you’re tired again in
the next morning. So how do we get out of this cycle? Because, you know, depression has low mood,
depression has low motivation, depression has changes in weight and metabolism and appetite
and these feelings of sadness and adrenal fatigue and burnout have a lot of those same
symptoms. There’s not motivation, you’re gaining weight
in the abdomen, you’re immune system is thrown off, you’re feeling just this general malaise
and muscle pain and exhaustion and sadness and low mood and low self-worth and all of
these things that we see in depression. So how do we solve this? So the first thing we do is, if possible,
we try and manage stress, to establish self care routines and this is a process that we
need to work towards, it doesn’t happen in one visit, in a day it takes a few months
to a few years to rebuild and reestablish. We make sure that we’re living a balanced
life and we’re managing our cortisol and we also might prescribe supplements and herbs
to stimulate cortisol production and to help our bodies manage stress and to help our adrenal
glands work more optimally. And this often has a dramatic shift in mood
after a few months. I have personal experience with this myself
and it’s amazing. In a few months you look back to where you
were and you notice big shifts. It’s also necessary to make sure that blood
sugar is not spiking throughout the day because cortisol and blood sugar are tightly interconnected. If our blood sugar drops, our body needs to
create cortisol to bring it back up and likewise, if our blood sugar is high, this is a stress
on the body and it can affect the cortisol balance. If our blood sugar is nice and steady and
we’re eating enough fats and proteins to keep our neurotransmitters and our hormones productive
and in production in the body, we notice a more even mood and energy level and this is
really important so I go over nutrition and how to plan meals, especially in the morning
with a protein and fat-rich breakfast. And, finally, things like bodywork and things
like, if not psychotherapy, then things to help with the life stressors that are going
on, directly addressing those things. Even helping with the body stress response,
the body’s perceived response because a lot of the time we have stress stored in our thoughts
and emotions in the head, which is what addressed usually with many forms of psychotherapy. But oftentimes we also store stress in the
body and so I find that acupuncture can be really affective and there’s studies that
show that acupuncture actually outperforms Prozac in some 6-week trials as well as acupuncture
can also help the brain move into that parasympathetic rest and digest state. So, from 4-6 sessions of acupuncture can really
shift us into a more relaxed state and help us with that stress response that we often
be stuck in. So, for more information, visit my website. I’m at, or you can send me an
email at [email protected] I work at Bloor West Wellness in Toronto. And if you want, leave your questions or comments
below and we’ll start the discussion. Thanks, bye! 🙂

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