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Stress

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

Everyone experiences stress from time to time. Stress disorders, however, are different. These occur as a result of profound trauma, such as encountering or witnessing a death, or experiencing serious injury. People with stress disorders have intense fear, helplessness, or horror. Acute stress disorder occurs soon after the traumatic event and lasts for a month or less. Post-traumatic stress disorder (PTSD) may begin within a few days of an event or may have delayed onset -- sometimes as long as 30 - 40 years -- and continues for more than 3 months.

Signs and Symptoms

A stress disorder is often accompanied by the following signs and symptoms:

• Flashbacks, dreams, and intrusive thoughts
• Avoidance of anything that causes you to remember the trauma
• Inability to recall aspects of the traumatic event
• Detachment, a decrease in emotional responsiveness
• A sense that one's future will be cut short
• Impulsiveness, risk-taking
• Hopelessness
• Overreactions, such as increased arousal and startled response
• Problems functioning normally in work and social settings
• Fatigue
• Weight gain or weight loss

What Causes It?

Stress conditions are caused by the combination of a traumatic event and a strong reaction to it. Such traumas include war, rape, inappropriate sexual experience, illness, bereavement, or natural disaster.

Who's Most At Risk?

People with the following conditions or characteristics are at a higher-than-average risk for developing a stress disorder:

• Women are at greater risk than men
• Older people and children
• People with the following personality traits: neurotic, extroverted, poor self-confidence, past history of psychiatric problems
• Genetic predisposition
• Guilt or shame
• Lack of social support or financial security
• Early separation from parents, childhood neglect
• Alcoholic parents
• Poverty

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with stress disorder, you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

Your provider will do a physical examination, noting if you appear pale, tired, or disoriented. Diagnostic procedures may include a psychiatric exam and psychological testing, hypnosis in cases of amnesia, and an electroencephalogram (EEG) to rule out brain damage or diagnose sleep disorder. Imaging techniques can also rule out brain damage.

Treatment Options

Prevention

Crisis intervention can help prevent post-traumatic stress disorder from developing.

Treatment Plan

While symptoms associated with acute stress usually automatically decrease with time, long-term stress requires a longer and more complex treatment plan. Crisis intervention may provide support, acceptance, and education. Psychotherapy can help people master their fears and overcome avoidance behaviors. Recent research supports the management of a hormone called cortisol, which is released from the adrenal glands when people are under long-term stress.

Drug Therapies

Your health care provider may prescribe the following medications for symptom relief (although none has been approved by the Food and Drug Administration for this use):

• Benzodiazepines -- drugs used as minor tranquilizers and hypnotics
• Antidepressants to reduce anxiety and impulsiveness
• Sedating antidepressants to relieve insomnia

Complementary and Alternative Therapies

A comprehensive treatment plan for managing stress may include a range of complementary and alternative therapies. If you are taking prescription medications or have pre-existing medical complications, talk to your health care provider before using complementary and alternative therapies.

Nutrition and Supplements

The following nutritional tips may reduce symptoms:

• Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
• Omega-3 fatty acids, such as fish oil, 1-2 capsules or 1 tablespoonful oil daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg daily, as an antioxidant.
• Probiotic supplement (containing Lactobacillus acidophilus) , 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your acidophilus products.
• Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• L-theanine, 200 mg one to three times daily, for nervous system and immune support.
• Melatonin, 2 - 6 mg at bedtime, for immune support and sleep.

Herbs

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures or liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with your favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls per cup water, steeped for 10 - 15 minutes (roots need longer).

The following herbal remedies may provide relief from symptoms:

• Kava kava ( Piper methysticum ) standardized extract, 100 - 250 mg one to three times a day as needed, for symptoms of stress and anxiety. Use only under the supervision of your health care provider if you have pre-existing liver problems, drink alcohol, or take prescription and non-prescription medications.
• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anti-stress, and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Relora, 250 mg one to three times a day, for stress and related adrenal problems.
• Bacopa ( Bacopa monniera ) standardized extract, 50 - 100 mg three times a day, for symptoms of stress and anxiety.

Catnip ( Nepeta cataria ), Chamomile ( Matricaria chamomilla ), and Lemon Balm ( Melissa officinalis ) are herbs commonly used to help manage stress in tea form. Combine all three herbs, and make calming teas to sip throughout the day.

Acupuncture

Few clinical trials have examined the effect of acupuncture on stress. One small study found that acupuncture helped reduce blood pressure levels in people under mental stress. Another study found that auricular (ear) acupuncture successfully reduced anxiety in some individuals. Because stress can affect a variety of meridians, treatment is based on an individual assessment. Qualified acupuncturists may also recommend lifestyle and dietary counseling and herbal treatment.

Chiropractic

No well-designed studies have evaluated the effect of chiropractic on individuals with stress, but chiropractors report that spinal manipulation may reduce stress in some people. Spinal manipulation may have a relaxing effect on the body. There is no evidence, however, that spinal manipulation has any greater impact on stress than that potential effects of other physical relaxation techniques, including massage.

Homeopathy

An experienced homeopath can prescribe a regimen for treating stress disorder that is designed especially for you. The following are some of the most common acute remedies:

• Aconite for panic with heart palpitations, shortness of breath
• Arsenicum for anxiety with restlessness
• Phosphorous for free-floating anxiety and foreboding

Acute dose is three to five pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.

Prognosis/Possible Complications

People with stress disorder are at greater risk of developing other mood or anxiety disorders, or experiencing substance abuse. They are predisposed to conditions such as heart disease, insomnia, and gastrointestinal illness. Suicide is more common among people with a stress disorder.

Following Up

Patients are treated on an outpatient basis until symptoms have subsided. In cases where there is a concern about self-abuse or suicide, the patient will be referred for treatment on an inpatient basis.

Supporting Research

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Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci. 2002;70(22):2581-97.

Birdsall TC. The biological effects and clinical uses of the pineal hormone melatonin. Alt Med Rev. 1996; 1(2):94-102.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998: 422, 425, 431, 462.

Braunwald E, ed. Heart Disease: A Text Book of Cardiovascular Medicine. 5th ed. Philadelphia, Pa: W.B. Saunders; 1997.

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• Review Date: 8/13/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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