Functional psychiatry: A new approach to mood disorders

It’s not the event, but how we respond which equals stress

Stress is an unavoidable part of modern-day life, yet the effects of stress and how we react during challenging times varies dramatically between individuals. One person may experience a seemingly large amount of stress and not only cope, but excel, whilst others may feel adverse effects from what others consider a significantly lighter stress load. While it is understood that the cascade of physiological events that occur with stress is a primitive physiological response to protect us against a threat, science is beginning to explain why certain people may demonstrate a high resilience to stress, or in contrast, how stress can drive alterations in brain structure and function resulting in common psychopathologies such as anxiety, depression and substance abuse.

Dynamic lifestyle changes

In this rapidly evolving 21st Century, the stress response we know is no longer triggered by the same stressors as our primal ancestors faced.  Instead of needing to flee from or fight a physical threat on a relatively infrequent basis, today we are managing dynamic lifestyles which involve demanding jobs, complex relationships and the constant rationalisation of graphic insults from breaking news and social media.  This ever-changing lifestyle may, in part, explain the dramatic increase in the rate of depression and consequent prescription of mood stabilising pharmaceuticals (psychotropics) seen in recent years in Australia and New Zealand.  Recent data suggests over 25% of Australian adults report high levels of anxiety and/or depression1.  Further, Australia has the second highest rate in the world of antidepressant prescriptions per capita (behind Iceland) and is increasing by around 25% per year2.

An insane approach to treat insanity

There is an old saying that “the definition of insanity is repeating the same thing but expecting a different result”. It could be argued that the use of conventional psychotropics is an example of this in action.  With such a high rate of prescription, it would be logical to assume these pharmaceuticals must be providing lifesaving effects to sufferers of stress and mood disorders.  However, consistent data from scientific reviews show the standard pharmaceutical approach of targeting one or two neurotransmitters fails to provide meaningful clinical efficacy3.   In an area where it is demanded that evidence-based medicine is practised, the evidence for psychotropics is less than overwhelming suggesting a new approach should be considered.  (www.kellybroganmd.com)

It is important to understand the origins of modern pharmacological psychiatry to get a sense of how a powerful belief in our current treatment approach developed from humble and contentious beginnings. It began with a serendipitous discovery in 1952 whereby patients treated for tuberculosis with the drug iproniazid became euphoric and “inappropriately happy”4.  It was found that this medication not only possessed anti-tubercular actions, it also acted as a monoamine oxidase inhibitor, increasing neuronal levels of serotonin.  From here, the monoamine theory of depression was born.  Soon after, clinicians were prescribing these types of pharmaceuticals for depression and anxiety and the model developed a stronghold in psychiatry.  Unfortunately, subsequent research failed to demonstrate the existence of a frank monoamine neurotransmitter deficiency in mood disorders and argued against the simplicity of this model.  Despite this, it appears that allopathic medicine still continues with ‘brain chemical imbalance’ model of explaining and treating mood disorders.

A Holistic approach

Looking beyond the monoamine hypothesis, numerous other lines of research into brain physiology have identified consistent patterns that better explain not only depression, but all stress-related pathologies – including insomnia and addictions. By moving forward and adopting these findings, natural medicine practitioners can expect better clinical outcomes.

neuronsThe integrated model recognises that in affective disorders a much larger network of psychosocial influences, neuronal events and whole body physiological factors re at play. All of these influences result in the reshaping of our brains.  This means we can reinforce positive influences and shape the brain in a way that promotes resilience or we can do the opposite, solidifying negative neural patterns which increase our vulnerability to stress.  Emotional status, therefore, is thought to largely be a net balance between stress-induced neurotoxic cell death and protective neuroplasticity.

 

Cortisol – a key culprit

Elevated levels of cortisol arising from stress concentrates its action on the hippocampus, an area of the brain not only critical for memory but also emotional context. The binding of cortisol to receptors within this brain region causes damage, resulting in neurotoxic stress 5,6,7.  In other words, elevated cortisol can result in a reduction in size of the hippocampus and also prefrontal cortex, the area of the brain responsible for stable emotions and executive function.  With a loss of neurons in areas of the brain responsible for both emotional context and rationale thinking, this can create a state of excessive worry and sadness.

Studies confirm these mechanisms in brains of individuals suffering from both depression and/or anxiety where there is measurable reduction of volume in the hippocampus and prefrontal cortex8.  In contrast, an area of the brain involved in the fear response, the amygdala, increases in volume in anxious patients. This can create excessive worry which is worsened by the lack of rational thinking from a shrinking prefrontal cortex9.

The resilient brain

resilient brainNeuronal health was once thought to follow a linear path to an inevitable demise caused by atrophy and cell death. However, research has found several areas of the brain can grow and regenerate at all stages of life, a process of neurogenesis.  Stress and stimulation drives neurogenesis and this plasticity can be maladaptive or beneficial.  For example, in anxiety there is a maladaptive neurogenesis in the amygdala, encouraging growth in this area of the grain that generates fear10.

In contrast, neurogenesis of the hippocampus and prefrontal cortex can not only atrophy during times of stress, but alternatively, they can increase in volume allowing us to thrive during times of hardship. Brain derived neurotrophic factor (BDNF), renowned for its role in memory, learning and preventing cognitive decline, is also a key protective agent against stress with low levels seen in depression, anxiety and obsessive compulsive disorder12.  Interventions for mood disorders should, therefore, include agents that promote BDNF and beneficial plasticity can assist those struggling with normal daily life events to be able to rise to the challenges and thrive.  If we couple BDNF boosting treatments with ingredients that mitigate neurotoxicity, then the net effect will be a protection against stress and promotion of resilience.

Breaking stereotypes

Similar to the dated views that suggest depression is simply the result of a brain chemical imbalance, nutritional interventions for affective e disorders are often stereotyped by antiquated mechanisms. Science is also discovering complex actions to explain the benefits of nutrients commonly prescribed for stress, giving confidence that these ‘old school’ nutrients are more than adequate to manage 21st Century stress presentations.  [Your qualified Naturopath will be able to prescribe quality supplements].

Whole body psychiatry

The net balance between neuroprotection versus neurotoxicity is not limited to the local environment within the brain. Systemic drivers can also determine if you ‘sink or swim’ under heightened stress.  Our ability to shoulder a burden appears to be largely influenced by mitochondrial function17.  We need sufficient energy supply in order to perform adaptive plasticity under emotional stress and physiological excitotoxicity (eg excessive cortisol)18.   Unfortunately, patients suffering from stress and mood disorders have been found to have both brain and systemic mitochondrial impairments19.  Consequently, these people do not have the neuronal energy reserves to develop positive plasticity and they may have a lower stress threshold pushing them into depression.  Evidence of faulty mitochondria being a cause rather than a consequence of mood disorders has demonstrated antidepressant effects in clinical trials with therapies that boost mitochondrial function20.  Instead of using pharmaceuticals to rev up mitochondrial function, natural medicine has a treasure trove of mitochondrial nutrients which can work splendidly for depression and assist energy production to help raise a person’s stress threshold22.

Inflammation prevents neuroplasticity

On the neurotoxic side of the equation, the universal driver of chronic disease, inflammation, adds to the burden. During systemic inflammation, white blood cells have easy access through the blood-brain-barrier driving neuro-inflammation.  The pro-inflammatory cytokines released upon immune activation can also trigger nerve shrinkage and volume reduction24.  Similar to studies on mitochondrial nutrients, anti-inflammatories have also proven to be more than useful anti-depressants in the treatment of depression and anxiety.

Reduce the bad, increase the good

Undoubtedly, the constant insult of stressors associated with our modern lifestyle can drive a neurotoxic stress response and potentially result in depression and anxiety33.  However, this does not have to be an inevitable outcome.  Our brains change their structure based on inputs derived from the balance of neurotopic factors versus neurotoxic factors, and it is this that determines an individual’s response to stress.  If a person under high amounts of stress has adequate social and biological resources, these can protect them from developing stress-related disorders.  On the other hand, if another person is under mild stress and lacks social and biological support, and additionally is exposed to other biological neurotoxic inputs, such as inflammation, this person can develop psychopathology.

brainhealth

Your natural medicine practitioner may be able to identify and minimise the neurotoxic drivers by reducing inflammation and providing effective natural remedies to help support healthy neurogenesis and neuronal energy production. If you would like assistance, either in supporting or preventing mood disorders, call True Medicine on 07 5530 1863.

 

 

 

References:

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Article courtesy: Nathan Rose BHSc (Nat) Technical Education Manager, Metagenics/Healthworld