Managing our stress is absolutely critical to managing our illness. In fact, for many of us it may be more useful for us to think of ourselves as having a stress disorder that manifests as a mood disorder. A series of ground-breaking studies explain why:
The First Study
At a symposium at the 2002 American Psychiatric Association annual meeting, Charles Nemeroff MD, PhD of Emory University recounted his famous 2000 experiment, where he and lead author Christine Hein PhD and colleagues put 49 women in high-stress situations, including math tests and speaking in public. Blood samples and heart readings showed that the women with a history of childhood abuse exhibited increased pituitary and autonomic responses to stress compared with the controls. This was especially true for the women with current depression and anxiety.
"Is the biology of depression the biology of early trauma?" Dr Nemeroff asked his audience.
In response to stress, the hypothalamus in the brain secretes the hormone CRF, which results in the pituitary gland releasing another hormone, ACTH (the abused and depressed women in the Hein/Nemeroff study exhibited a six-fold greater ACTH increase over the controls), which activates the adrenal glands that turn loose the stress hormone cortisol. This neuroendocrine feedback loop is referred to as the HPA (hypothalamic-pituitary-adrenal) axis.
Women abused in childhood, Dr Nemeroff explained, end up with a sensitized brain system, where CRF receptors are to be found in abundance. Depressed patients have high concentrations of CRF in their cerebrospinal fluid.
As the Surgeon General in his 1999 Report on Mental Health observed:
"The compelling impact of past parental neglect, physical and sexual abuse, and other forms of maltreatment on both adult emotional well-being and brain function is now firmly established for depression."
The Brain Under Siege
At around the same time as the Heim/Nemeroff study, two Centers for Disease Control surveys looked at the effects of armed conflict on groups of Albanians and Serbs.