Mental health problems are very common, with the Black Dog Institute reporting that 20% of Australians aged 16-85 experiencing a mental illness in any year.  The most common mental illnesses are:

  • depression
  • anxiety
  • substance use disorders

Substance misuse is complicated and can be both cause and effect of mental health issues.  For example, it might be that someone is ‘self-medicating’ for anxiety with alcohol, helping to numb the anxiety of being in social situations, or someone with depression using drugs to numb their emotional pain.

Of the 20% of people who experience a mental health illness in one year, 11% will have two or more disorders and 8.5% will have one disorder.  How many is 20%? Over 3 million people, which is staggering.  Almost half of all Australians will have a mental health illness at some point in their lifetime and mental illnesses are the third leading cause of disability burden, accounting for an estimated 27% of the total years lost due to disability.  (Burden of disease refers to the total impact of a disease measured by financial cost, mortality, morbidity and other indicators, and it is often expressed as number of years of life lost due to ill-health, disability or early death.)

It is imperative to seek assessment and support from a qualified mental health professional.  My role in supporting people with mental health illnesses is to work as part of a health team, not as the primary mental health professional. Some of the ways in which I can help are:

  • exploring stress and ways to build resilience
  • boosting your physical well-being and vitality (which makes it much easier to be able to address any mental health issues)
  • providing nutritional advice and supplementation for general health and specifically to support the body’s ability to make neurotransmitters
  • provide dietary, nutritional and herbal medicine strategies to reduce inflammation and enhance gut health
  • recommend appropriate herbal medicine to manage the symptoms and the effects of mental health conditions
  • provide a compassionate, sensible approach in working with you

Stress

What is stress?

Perhaps surprisingly, stress can be a bit tricky to define accurately.  If you look to physical science stress refers to the pressure or load applied to something, such as how much force you can apply to a sheet of metal. And importantly, it is used to measure how much force, or stress, can you apply to it before it breaks! When you then look at what it means in humans, you can see the similarity!

Endocrinologist Hans Seyle was one of the first people to focus on stress, and how our bodies responded to it, describing stress as “the non-specific response of the body to any demand for change”.  He determined that some stress could be productive and positive, but that prolonged and/or intense stress led to illness.  Seyle’s theory of stress included a predictable pattern of responses to stressors that he called the General Adaptation Syndrome (GAS).  The first stage is the alarm stage, which Walter Cannon described as the flight or fight reaction.  Stage 2 is the resistance stage, where the body attempts to resist or adapt to the stressor. Stage 3 is known as the exhaustion stage, where energy is depleted.  Whilst this model is now a little out-dated, I has been helpful in discovering some of the hormones and neurological processes experienced in stressful circumstances; for example, adrenalin causing a rapid heart rate, high blood pressure and dilated pupils.  Research in the 90s discovered that women have elevated levels of the ‘love hormone’ oxytocin, and this led to the description of a female stress response of “tend and befriend”.

Theories on stress have continued to develop over the years and now the commonly accepted interpretation of stress is that provided by psychologist Richard Lazarus, which is that stress is a condition or feeling experienced when a person perceives that “demands exceed the personal and social resources the individual is able to mobilize”.  That is, we feel the need to respond in some way but don’t believe that we can, or that we can do well enough.

In many ways I think that the key word in Lazarus’s definition is ‘perceive’; stress isn’t an objective experience, but rather it is one we perceive.  For example, two people can be standing near a large tree and because it is objective knowledge, they both know it is a tree; it is not about whether or not they perceive it to be a tree.  On the other hand, if there was a strong wind blowing and the trees branches were moving and creaking in the wind, one person may perceive that to be beautiful while the other person may perceive it to be frightening, because it is a subjective experience.  It is because stress must be perceived that two people can experience the same thing so totally differently.  All of our life’s experiences, including both conscious and unconscious thoughts, in childhood and adulthood, become the filter through which we perceive or interpret our world.

Knowing that perception plays a significant part in our experience of stress helps up have some sense of control in times when we might otherwise feel out-of-control.  Perceptions can, and should be challenged; a simple example of doing this is where you ask a colleague “Am I reading this situation right?  Is the boss treating me differently to other staff?”  This checking of your perception is invaluable – you might be right and get validation or you might be way off in your reading of the situation and checking with a colleague might help prevent further stress and acting in a way that you might regret.

Knowing that we have opportunities to change how we respond to stressors is important because experiencing stress is part of life, and evolutionary scientists might argue that the stress response is part of the reason that we have evolved and still exist at all.  A manageable amount of stress can be motivating, too much stress can cause physical and mental ill-health and no stress means you might lose interest and be at risk of rusting out!

Causes of stress

Doing a ‘stress audit’ helps identify what it really is that is effecting your health and well-being.  Being clear about the causes enables you to address them.  Common stressors are:

  • ‘routine’ stressors: the daily grind or work, school, family and other daily responsibilities
  • not having any downtime to recover and refresh
  • financial issues: lack of independence, unable to pay bills, needing to work two jobs
  • work issues:including not having a say in how you plan your day, excessive workload, and toxic relationships and workplace environment
  • study issues: including bullying at school, struggling to keep up with study demands
  • health issues:yours or that of someone you care about
  • relationships:conflict, abuse, separation and loss
  • major life changes:especially if there are too many major events at once (even if positive events) or negative life changes such as a death of a loved one
  • traumatic stress: including being in an accident, war, assault, or a natural disaster (e.g. fire or flood) where people may be in danger of being seriously hurt or killed

Symptoms of stress

Not only do we perceive stress differently to each other, but how stress manifests in us also differs.  For example, one person might have a flare of irritable bowel symptoms whereas another becomes very forgetful.  The symptoms of stress can be categorised as physical, emotional, cognitive and behavioural and in all categories symptoms may be short-term or chronic.  It is important to note that these conditions can be caused by other factors as well and that stress is likely to be a trigger or only one part in developing the condition.

Physical  effects

  • headache, jaw pain
  • palpitations
  • chest pains
  • back and neck aches
  • diarrhoea, constipation
  • muscular twitches and cramps
  • insomnia
  • feeling drained at the end of each day
  • indigestion
  • craving for sweet or starchy food
  • acne and skin problems

Chronic or long-term stress causes an imbalance in the communication between the hypothalamus and pituitary glands in the brain and the adrenal glands as well as interfering with normal immune function.  This can lead to a broad range of conditions include:

  • menstrual and fertility issues
  • sexual dysfunction
  • chronic digestive issues
  • asthma
  • cardiovascular disease
  • auto-immune disease
  • diabetes
  • chronic pain syndromes
  • migraines
  • poor immune function, recurrent infections and worsening allergies

Emotional effects

  • anxiety
  • irritability
  • frustration or depression not related to a specific cause.
  • a feeling of hopelessness
  • withdrawal from people
  • aggressiveness
  • unjustified levels of anger
  • depression

Cognitive effects

In the very short term, stress focused on a particular task (for example, completing an assignment) can be positive and help people think creatively.  However, if stress continues or is more in many parts of your life, it can lead to cognitive issues such as:

  • forgetfulness
  • inability to pay attention and absorb information or follow instructions
  • confused thought processes
  • inability to concentrate
  • inability or unwillingness to make decisions
  • poor memory

Behavioural effects

  • being uncharacteristically aggressive
  • withdrawing from people, not keeping in touch
  • drinking more alcohol than usual
  • eating more or less than usual
  • changes in behaviour whilst driving
  • being consistently late for or missing appointments

Resilience

In more recent years the focus has been on understanding the differences in how people perceive and respond to stress, and to be able to describe the characteristics of people who seem to ‘manage stress’ better than others, who seem to be resilient.  This has led to the development of courses, production of books, websites, apps and other resources as well as the establishment of  professionals who specialise in the field of resilience-building.  The word resilience comes from the Latin resili which means the ability to ‘bounce back’ or return to the original form.   Bouncing-back resilience in humans means the ability to respond and adapt to stress and adversity.   The concept of resilience also includes how we can develop and grow because of our experiences of dealing with stress and adversity and this is called ‘post-traumatic growth’.

Resilience is not something that you are born with.  It is not exclusive or unique. It is very common and we demonstrate our resilience in managing daily workplace stress or major events such as bush-fires or floods.  Resilience is an ongoing process using skills and adopting behaviours, thoughts and actions that can be learned and practised by everyone. Being resilient doesn’t mean that ‘bad things don’t happen to you’; it means that you are better able to manage them, more likely to have good health and be able to be more productive and happy at work and at home.

Responding to stress and building resilience

Stress affects us physically, emotionally, cognitively and in our behaviour, so we should consider supporting these areas when building our resilience.  We can’t ‘manage stress’ but we can build our resilience, learn new ways of responding, and enjoy improved health and wellbeing.

Do a stressor audit

What are your stressors, the sources of your stress.  Can you change the circumstance around this, can you get help to problem-solve, do you need new skills, would it help if you got more exercise?

Do a stress symptom audit

How is stress affecting you? Have you been knocking back tubs of ice-cream, screaming at the kids, having panic attacks, do you feel depressed and isolated, are you finding it hard to concentrate and remember important things?

Set goals and priorities

Once you have worked out the biggest issues, then set your priorities.  Work out what must be done, what you can and can’t change, what you can remove from your list altogether.

Get support

Doing the above audits can help work out who might best help you.  It might be time for a medical check, especially if you have any chest pain, palpitations or shortness of breath. A counsellor or psychologist will be able to help with emotional and behavioural symptoms.  Friends and family can also be invaluable supports and just staying connected can help with stress even if they don’t help solve any specific problem.

Establish routines

Rhythms and routines can help ground you, help you organise your time and ensure you build in exercise and fun activities and can be re-assuring.

Get regular exercise

It doesn’t have to be intense, a 30 minute walk can help clear your mind, boost your mood and help with fitness. (Note, if you are having chest pain, palpitations or shortness of breath then check with your doctor before starting an exercise program).

Practice a relaxation technique

Building in an activity that relaxes is essential.  Options include yoga, meditation, mindfulness techniques and tai chi.  You can do these individually or in a class, use a video or podcast or take a course such as the Mindfulness Based Stress Reduction Program.  It may be that for you the most relaxed you are is when you garden or do some other activity you love, so do more of that.

Boost your nutrition

There is much that you can do with nutrition to support you during times of stress.  Coffee may feel like it helping when you have a deadline to meet, but too much coffee can worsen anxiety, digestive symptoms and sleep.  Avoid excess sugar, have loads of vegetables and make sure you have some omega 3 fatty acids from oily fish, flaxseed or walnuts.  When you are stressed you have additional nutritional requirements, especially for B vitamins, magnesium and nutrients that provide the building blocks for neurotransmitters and at this time supplementation may be of benefit.

Consider herbal medicine

Herbal medicine may help reduce feelings of stress, anxiety and depression, support adrenal and brain function and improve energy and sleep.  In addition, herbal medicine may help manage symptoms of stress such as digestive disturbance.

Our greatest weapon against stress is our ability to choose one thought over another. William James, philosopher

Anxiety

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Anxiety and stress or worry can feel the same, but in anxiety, the feelings don’t resolve once the stressful event or trigger has gone.  For people with an anxiety disorder the feelings of anxiety are more frequent or persistent, are not always connected to an obvious trigger, and the anxiety impacts on their quality of life and every-day functioning.   Sometimes anxiety is misunderstood as a minor issue, when in fact it significant anxiety can be profoundly debilitating and distressing and have a major impact on your quality of life.

What is anxiety?

The Australian Psychological Society defines anxiety as “…an uncomfortable feeling of fear or impending disaster and reflects the thoughts and bodily reactions a person has when they are presented with an event or situation that they cannot manage or undertake successfully.”  A person with anxiety is actively assessing their situation, both consciously and sub-consciously, trying to predict whether they will be able to cope and what their options are, and this is exhausting and at times feel tormenting.

Anxiety is the most common mental health condition in Australia and early recognition of the signs and symptoms, and thus treatment and support, improves recovery.  Beyond Blue report that one in four people (one in three women and one in five men) will experience anxiety at some stage in their life.  In a 12-month period, over two million Australians experience anxiety.

Anxiety, depression and substance misuse often co-exist and unfortunately people may only have one condition recognised and treated.  It is important therefore to be assessed by a GP and/or qualified mental health professional so you can receive the most appropriate care.

There are many different kinds of anxiety with the six most common forms being:

  • Generalised anxiety disorder (GAD)
  • Social phobia
  • Specific phobias
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Panic disorder

Causes of anxiety

There is no one cause for anxiety, rather it is a combination of factors including  personality factors, difficult life experiences and your physical health. Some of the factors that increase your risk of developing anxiety are as follows:

  • family history (genetics): this does not mean you definitely will have anxiety, just that it may increase your risk
  • ongoing or intense stress: e.g. financial, health, work, relationship issues
  • brain chemistry: communication between parts of the brain may be altered and the mood regulating neurotransmitters may not function normally
  • pregnancy and childbirth: anxiety during pregnancy and post-natally is thought to be even more common than depression
  • nutrient imbalances: low magnesium and zinc, high copper, difficulty metabolising (methylating) folic acid
  • other medical problems: overactive thyroid, cardiovascular conditions and diabetes
  • trauma: distressing experiences, recently or in the past
  • personality: people who have perfectionist, sensitive and shy personalities, or people with low self-esteem are thought to be at greater risk of developing anxiety
  • substance abuse: taking and withdrawing from some drugs can trigger anxiety and panic

Symptoms of anxiety

Symptoms and severity of symptoms will vary between people and even in the same person depending on their situation, though feeling stressed, worried, and having anxious thoughts are common symptoms. Sometimes you may not recognise the symptoms, or you may notice physical symptoms before emotional or cognitive symptoms.  Common symptoms of anxiety include:

Thinking, or cognitive symptoms

  • Difficulty concentrating
  • obsessive thinking, repetitive thoughts
  • catastrophizing, e.g., thinking ‘everything’s going to go wrong’, ‘I might die’, ‘something terrible is going to happen’, ‘I can’t calm down’

Feeling, or emotional symptoms

  • excessive fear
  • nervousness, panicky
  • worry
  • feeling detached from your body
  • worried you’re going crazy

Physical symptoms

  • restlessness, feeling wound up and edgy
  • racing heart
  • quick breathing
  • trembling or shaking
  • feeling lightheaded or faint
  • numbness or tingling sensations
  • upset stomach, nausea or diarrhoea
  • sweating, hot and cold flushes
  • panic attacks
  • tightening of the chest
  • insomnia
  • exhaustion

behavioural symptoms

  • avoidance of situations that increase your anxiety, which may affect work, study and relationships
  • substance misuse

Note: Some of these symptoms can also be signs and symptoms of other medical conditions so please see your GP to be assessed.

Support

Diagnosis and support from a GP and a mental health professional is the first step.  Beyond Blue has a list of health professionals who are interested, experienced and qualified in working with people with anxiety: https://www.beyondblue.org.au/get-support/who-can-assist

As listed above, I am able to support people experiencing anxiety with lifestyle support, nutrition, herbal medicine and appropriate referral to GPs, counsellors and psychologists.

Examples of strategies and treatments that can be helpful include:

  • provide a compassionate, sensible approach in working with you
  • exploring triggers and ways to build resilience
  • suggest relaxation and meditation techniques
  • boosting your physical well-being and vitality
  • providing nutritional advice and supplementation for general health and mental health
  • provide dietary, nutritional and herbal medicine strategies to reduce inflammation and enhance gut health
  • recommend appropriate herbal medicine to manage the symptoms and the effects of anxiety

Nutrients: magnesium, omega 3 fatty acids, B vitamins, specific amino acids, zinc

Herbal medicine: skullcap, magnolia, passionflower for anxiety, hops and valerian to help sleep and more, depending on your symptoms.

 

See also Eating for joy and Eating for joy – what not to eat.

Depression

Depression affects more than one million Australians each year, with some of those people dying from suicide.  It affects how you feel about yourself, your ability to experience joy, meaning and connection, and makes life more difficult to manage.  One in seven Australians will experience depression in their lifetime and the World Health Organization estimates that depression will be the number one health concern in both the developed and developing nations by 2030.  Depression has the third highest burden of all diseases both in Australia (13.3%) and globally.

What causes depression?

As with anxiety, there is no single cause, and the causes or risks differ between people.  Depression is most likely the result of a combination of events and biological factors, genetics and behavioural risks such as alcoholism.  below are some of the causes or risk factors for depression.

Brain function

It is not simply too little or too much of a neurotransmitter, but more about the relationships between transmitter and how neurons communicate with each.  There is also how your brain responds to substances such as hormones, neurotransmitters and drugs and it is possible there is a genetic link influencing this. Recent research has shown how inflammation (in the brain or other parts of the body) can increase the risk of depression.

Reducing inflammation, practices such a mindfulness to help regulate mood and develop new thought pathways as well as herbs and medications that affect neurotransmitters can all help.

Gut-brain connection

This is a recent area of research and it holds lots of promise, especially in influencing the way we eat and live.  The gut-brain connection involves chemical signals between your gastrointestinal tract and your nervous system and brain.  There are three main ways that the gut might influence the brain.  The first is though the immune system and gut bacteria (microbiota).  Inflammation can be triggered when the balance of bacteria is unhealthy and this then stimulates the nervous system.  In particular, this immune-inflammatory response affects the cells that produce serotonin, the neurotransmitter associated with feelings of well-being and positive moods.  Serotonin is the target of common anti-depressant drugs and it might be surprising to realise that up 90% of serotonin is made and stays in the gut; hence, a healthy gut is an excellent place to start.  The second way the gut affects the brain and nervous system is via the vagus nerve, which is a short-cut between the gut and the emotional centre of the brain.  Gut distension, inflammation, immune function, antibodies and the gut microbiota can affect the vagus nerve.  The third way is the by the impact of the metabolic by-products of some gut bacteria.  The unhelpful bacteria can produce substances that can directly affect the brain due to their production of neuro-active substances (including the neurotransmitters  serotonin, melatonin, histamine, acetylcholine and gamma amino butyric acid (GABA)).  As always, the issue is balance; balance in the bacteria in the gut and balanced neurotransmitter levels and function.

Hormones

Depression is associated with hormonal fluctuations in the ovarian cycle and menopause and this is likely due to the interaction of the reproductive hormones (oestrogen, progesterone, lutenising hormone and prolactin in particular) and neurotransmitters (such as serotonin, dopamine, GABA , endorphins, and melatonin).  These relationships are further complicated by adding cortisol (which is elevated in stress and some depression and appears to lead to lower serotonin levels) and thyroid hormones, with depression being a symptom of low thyroid function.

Life events

A person may be more prone to depression if they have experienced intense and/or prolonged negative life events.  Events that may be involved include physical ill-health, unsupportive or abusive relationships, violence, long-term unemployment, long-term isolation or loneliness, and prolonged work stress.  Sometimes the event that seems to trigger depression may not be that significant in itself, but it is ‘the straw that broke the camel’s’ back, when you have a history of negative experiences.  Other times there may be an acute traumatic event such as the death of a loved one or involvement in an accident.

Family history

If there is a family history of depression it may increase your risk, however you may not necessarily develop depression.  Knowing you may be at risk can help motivate you to develop a healthy lifestyle to prevent depression as well as being able to recognise the symptoms and seek help

Personality

A person who tends to worry a lot, have low self-esteem, are perfectionists, who are self-critical and sensitive to the criticism of others may be more at risk of developing depression.

Medical conditions

This is two-fold: some medical conditions can cause symptoms of depression (e.g. low thyroid function) and others can trigger depression, especially if you have chronic pain or a serious condition that requires long-term care.

Drug and alcohol use

Drug and alcohol use can both trigger and result from depression.  Many people with depression also have a substance use disorder.

Main types of depression

There are a number of different types of depression and accurate diagnosis is essential for treatment.  According to the Black Dog Institute, the major types of depression in Australia are:

  1. major depressive disorder
  2. major depressive disorder (with melancholia)
  3. psychotic depression
  4. persistent depressive disorder (or dysthymic disorder)
  5. perinatal depression (also called antenatal and postnatal depression)

Other types of depression include Bipolar disorder, Seasonal Affective Disorder (SAD) and Pre-menstrual dysphoric disorder (PMDD).

Major depressive disorder

Sometimes called major depression, clinical depression, unipolar depression or simply depression, Major depression involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms.  The symptoms are experienced most days and last for at least two weeks and interfere with all areas of a person’s life, including work and social relationships.   Depression can be described as mild, moderate or severe.

Symptoms of depression

Symptoms vary and can be caused by other mental health conditions and/or medical conditions.  Please see your GP and/or mental health professional for assessment.

 Behaviours

  • withdrawing from close family and friends, not going out anymore
  • not getting things done at work/school
  • relying on alcohol and sedatives
  • not doing or enjoying activities that you usually enjoy, including sex

Emotions, feelings

  • persistent sadness, feeling miserable
  • anxious
  • “empty” mood, feeling numb
  • feeling overwhelmed, guilty
  • worthlessness, helplessness
  • irritable, angry
  • hopelessness, pessimism
  • frustrated, disappointed
  • lacking in confidence, low self-esteem

Cognitive, thoughts

  • difficulty concentrating, remembering, or making decisions
  • thoughts of suicide
  • thoughts like ‘I’m a failure’, ‘It’s my fault’ ‘Nothing good ever happens to me’, ‘I’m worthless’, ‘People would be better off without me’ and ‘Life’s not worth living.’

Physical

  • decreased energy, fatigue, feeling physically and mentally “slowed down”
  • insomnia, early-morning awakening, or oversleeping
  • loss of appetite, weight loss, overeating and weight gain
  • feel sick and run down
  • headaches and muscle pains
  • churning gut, and digestion problems

Treating depression

Depression has many causes and therefore it makes sense to address depression with more than one approach for treatment.  It is worth repeating here that it is important to be assessed by your GP and/or mental health professional and to seek professional advice before supplementing with nutrients, phytochemicals or taking herbal medicine.

Diet

Research led by Professor Felicia Jacka at Deakin University and published in the British Medical Journal is ground-breaking in providing evidence for the role of diet in treating depression.  Their study was the first randomised controlled trial to directly test whether improving diet quality can actually treat clinical depression.  The results showed that adults with major depressive disorder who adopted the prescribed Mediterranean-style diet for 3 months had lowered levels of depression, with one-third no longer having a diagnosis of depression.

The diet focused on increasing the consumption of:

  • vegetables
  • fruits
  • wholegrains
  • legumes
  • fish and lean red meats
  • olive oil and nuts

The diet also focused on reducing the consumption of:

  • sweets
  • refined cereals
  • fried food
  • fast-food
  • processed meats
  • sugary drinks

In addition to benefits for depression, this style of diet is not expensive, does not cut out major food groups, is varied and delicious, and is known to reduce illness and death from other conditions such as cardiovascular disease and cancer.

See also Eating for joy and Eating for joy – what not to eat.

Supplementation that may assist addresses nutrient balance, inflammation, immune function, and the provision of the ingredients for the body to make neurotransmitters.  Some supplements that may help include:

  • omega 3 fatty acids
  • folate, vitamin B6 and B12
  • vitamin D
  • S-adenosyl methionine (SAMe)
  • zinc
  • N-acetylcysteine (NAC)
  • green tea
  • prebiotics and probiotics

Herbal medicine can support normal neurotransmitter function, energy production and mood.  Herbs that may be helpful include:

  • St John’s wort
  • saffron
  • lemon balm
  • passionflower
  • rhodiola
  • turmeric
  • lavender

Note: there are contraindications to some herbs and nutrients, as well as potential interactions with medications, so please seek professional advice from a herbalist, nutritionist or naturopath and avoid self-prescribing.

 

Lifestyle

Regular exercise is effective and does not need to be vigorous or take all your time. Recent research by the Black Dog Foundation suggests that as little as 60 minutes per week can prevent 12% of depression.  Exercising outdoors means you can also get some vitamin D from the sun and fresh air.

Forest bathing, or Shinrin-yoku was a practice developed in Japan during the 1980s and is done to promote both mental and physical health.  The concept is that by being in nature, and walking in a relaxed and beautiful environment, you will feel clam and less depressed.

Meditation, mindfulness practices and yoga are also helpful and may be provided specifically as part of a treatment for depression.

Psychological treatments include cognitive behaviour therapy, counselling, psychotherapy and mindfulness-based cognitive therapy.

24 hour support

In addition to online programs and apps, the following provide 24 hour support