Depression and anxiety

Outline
Introduction-
Depression
Stress
Emotions
Social Support
Remedies
   Depression
   Stress/ anxiety
   Negative emotions
Conclusion

Is there an association between our mental health and our physical health? A depressed person who just had a myocardial infarction is 4 time more likely to have a second infarction as the non depressed person. ⁽¹⁾ Depression is a greater risk factor in these people than smoking, cholesterol or high blood pressure! Clearly there is a close relationship between our mental health and our physical health. What about stress is it good bad or indifferent? Do emotions effect our well-being? If so how? As we discuss these issues, it will be come clear that these issue are crucial to our total health.

Depression

In studies of patient with coronary artery disease the following conclusions have been made:
1. About 20% will have significant depression ⁽²⁾
2. Without treatment at least ½ of those depressed will remain depressed ⁽³⁾
3. The patient with coronary artery disease and depressed is three times more likely to die of a heart attack than the patient with only coronary artery disease. ⁽⁴⁾
4. Major depression was the best predicator of a major cardiac event within the next 12 months. ⁽⁵⁾

In another study depression doubles the risk of developing Congestive heart failure in elderly women who have never had congestive heart failure.⁽¹⁵⁾

Stress

Stress has been shown to effect the immune system.  Dr. Dwight L. Evans and associates of the University of Florida College of Medicine in Gainsville report a study on the effect of major stress events in HIV-positive asymptomatic men. They found that the progression from the asymptomatic stage of the disease to the symptomatic was more rapid in those with the most major stress events (death of mate, arrest, trouble with boss, chronic financial difficulty, and break-up of a love relationship). The risk of early symptoms doubled for each major stress event experienced during a 6-month period.

Stress can be positive and in many cases makes life meaningful, without which we are in danger of depression. Example of positive stress would include a new job, marriage, school, and a new faith. Life is full of both trauma and excitement.

Many negative stressful event can be avoided by preparation and forethought. Examples might include studying for the test, save some money ahead, driving carefully, prayerfully considering marriage and job choices, etc. Many negative stressful events cannot be avoided and how we react determines our mental and physical well being.

Emotions

Immunoglobulin A is a antibody that protect against common illness such as colds, intestinal flu, urinary tract infections etc. It is found in the mucosal secretions upper respiratory tract, the gastrointestinal system and the urinary tract. It can be measured in the saliva and makes a good research tool for measuring immunity. A higher level of these antibodies in the saliva is associated with decreased incidence of disease.

Positive emotions produced a significant increase in S-IgA levels . Negative emotions are associated with a decrease in the S-IgA levels.⁽⁷⁾ Inhibition of natural killer cell activity and a decrease number of lymphocytes, markers of depressed immune function, are also associated with negative emotions. ⁽⁷⁾ Anxiety, lack of influence over others, isolation, and sadness are some of the negative emotion that effect our health in a negative way.

A interesting study was reported in Journal of Advancement in Medicine, 1995:8(2): 87-105. They compared the effects of compassion and anger on the levels of the immune system marker S-IgA levels. This was done by have the subject watch a video of Mother Teresa's work with the dying in India. The negative emotions were induced by self-recall and videos which arouse feelings of anger and/or frustration. The emotion of Compassion produced a significant increase in S-IgA levels, while Anger did not.  It is clear that the negative emotions (anger, frustration, anxiety, worry, guilt) are destructive to are immune system. It is also clear that the positive emotions (love, compassion, joy, laughter, peace, patience) are health to are immunity and should be cultivated.

Social Support

Social support in the forms of family interactions, church attendants, group memberships, and amount and quality of friendships has a measurable and positive effect on our health. Perceived Social Support Scale (PSSS) is a common method to evaluate social support.⁽⁷⁾ Many studies have found that religious belief and practice have a positive effect on physical and mental health.⁽¹⁰⁾

In Circulation Apr 25, 2000 a study helps clarify the reason that social support decrease illness and early death. They followed 887 patients that had a myocardial infarction. Of these patients 32% were found to have depression. The relationship between depression and cardiac mortality decreased with increasing social support as measured by Perceived Social Support Scale (PSSS).   More social support was associated more improvement in depression than expected.   High levels of social support protected patients from the negative consequences of depression.⁽⁷⁾

In cancer patients peer discussion groups were helpful (decreased morbidity and mortality) for women who lacked support from their partners or physicians but harmful for women who had high levels of support.⁽⁸⁾ This study indicated that superiority of church and family social support as compared to group therapy.

While neither friend nor mother support appeared to predict drug abuse in teenagers, a low level of perceived father support increased the chance of all types of substance use. ⁽⁹⁾

Remedies

   Depression
Suggestions for relieving depression:
1. Restore the thought imbalance
Many have "thought imbalance" by this we mean that emotions have rule over reason.  Restoration of this balance we call rational therapy.  Much of depression originated in thought imbalance. 

An example of thought imbalance is as follows;
My co worker did not acknowledge me when we crossed paths therefore they do not like me and I am not likable. 
The thoughts of this person are emotionally guided arriving at a negative conclusion. These thoughts are not rational and depend on the emotions at the time.

Irrational destructive thinking (IDT) often seem plausible and reasonable to the person, although they may be far fetched. A  counselor may have more success it they can lead the "client" to discover that their destructive thinking is neither reasonable or plausible rather than stating the counselors opinion.

Irrational destructive thinking is a learned behavior and should be dealt with by recognition and then replacement.

Irrational destructive thinking can be difficult to turn off, especially in the presence of emotional arousal.  They are deeply ingrained effort and time they can be recognized, controlled and replaced.

Thought grow with expression or repetition.  Cultivate rational thoughts and rational thinking.  Bring emotions into subjection to reason.  Cultivation positive thoughts to replace negative thoughts.

Irrational thinking require little thought and appear to be spontaneous, but upon reflection they usual have a trigger that may be external or internal.

Fill the thought with truth, rational thinking, thankfulness.  Plan ways to contribute and help others.  Avoid bitterness, revenge, anger and jealousy.   Count your blessings name them one by one.

2. Restore the social imbalance
As stated above social interaction is crucial to health and is one of the main ingredients in combating depression.  Some suggestion : 1. Join a club and/or a  Church. 2. Rebuild your marriage.   3. Do thing as a family. Very few will recover from depression in isolation.

3. Restoring the chemical brain chemical imbalance
Summary of Chemical imbalances of Depression
In depressed people there are decreased levels of neurotransmitters at the junction between the brain circuits (called synapses).  It is unclear which comes first,   depression that causes decreased neurotransmitter or decreased neurotransmitter that causes the depression.   The neurotransmitters are derived from amino acids and include norepinephrine, serotonin and dopamine.  The strength of the brain signal is effected by the amount of neurotransmitter in the junction.  The amount of the metabolites of these neurotransmitters has been shown to be decreased in the spinal fluid of depressed individuals.  Brain studies in the depressed have shown; 1. Norepinephrine depletion in the limbic system (emotional center), 2. Serotonin depletion in the amygdala (another area of emotion) and in the hypthalmus (area of hormonal regulation, appetite, libido, sleep and stress response). The hypothalamus is the area of the brain that regulates the hormones through regulation of our master gland, the pituitary.  Under stress the hypothalamus produces corticotrophin-releasing factor (CRF) which stimulate the pituitary to produce ACTH which cause the adrenal gland to release cortisone.  Many studies have show that CRF to be elevated in the depressed persons spinal fluid.  Chronic early childhood stress (abuse or neglect) and   maternal stress produces life long overactive CRF producing neurons.  These individuals are at increased risk for depression.

Review of available treatment for the Chemical imbalances of Depression
A. Exercise
A recent study from Duke University Medical demonstrated that aerobic exercise is as good as drug therapy for depression. Details.
B. Restoration of health
C. St. Johns Wort St. Johns Wort
In Europe, where herbal remedied are commonly prescribed physician,  St. John's wort outsells synthetic anti-depressants including Prozac and Celexa.  In the United States a position paper on the treatment of depression was recently publish for the America College of Physicians-American Society of Internal Medicine.  In this publication they sight evidence showing St. John's wort comparable to the other antidepressants.  It however is not as well studied and they conclude. "For short-term treatment of mild acute depression, St. John's wort may be considered, but patients should be cautioned that this treatment is not approved by the U.S. Food and Drug Administration and that preparations may vary substantially from those tested in randomized trials." ⁽¹⁶⁾ The dosage of hypericum extract (St. John's wort ) varied in published trials from 300mg per day to 1800 mg per day.⁽¹⁷⁾   The mechanism of St. John's wort is felt to be that it raises the serotonin levels in the brain.
D. 5-HTP (D. 5-HTP (5-hydroxytryptophan)
When depression  is from a deficiency of the CNS neurotransmitter serotonin "5-HTP (5-hydroxytryptophan) has also been found to be as  effective as a prescription antidepressant such as a tricyclic drugs (e.g., Elavil) or a newer agent (Luvox).^{((11,12,13,14))}.  In addition to relieving depression, 5-HTP also has less side effects. L-5HTP is not a therapeutically effective alternative in depressed patients who have not responded to seratonin uptake inhibitors such as Prozac because the mechanism is similar,   i.e. increasing serotonin at the synapses in the brain.⁽¹⁸⁾
E. Prescription Antidepressants

 4. Restore the spiritual imbalance

 Follow the 7 steps to Mental Health
1. Recognize God cares about you.
2. Recognize your need for Restoration.
3. Turn from your destructive mental habits.
4. Trust in God's Power to protect your will.
5. Growth of Character though proper choices which become habits.
6. Observe the Laws of the mind.
7. Rejoice in all things.

  Stress/ anxiety
Suggestions for coping with stress:
1. Determine what it is that is causing you stress or distress.
Identification is the first step in problem solving
2. Determine if you have control over it.
Can you eliminating it, shorten your exposure or reduce it intensity
3. Determine how you can control your reactions to the uncontrollable stressors.
Are you overreacting, Put the situation in perspective.
Are you expecting the impossible?
Are you expecting to please everyone?
4. Improve your physical reactions to stress
Deep breathing, relaxing your muscles
5. Improve your physical health
Exercise, rest proper diet, water, sun light, avoid coffee, tobacco and alcohol
6. Improve your mental health
Pursue goals which are meaningful to you. Develop hobbies and interest. Help others.
7. Improve your social support
Build supportive friendships. Join a group or Church.