Introduction:

Everyone has stress from time to time. Stress can come from good things and bad things in your life. Your body and mind react to these things with a heightened state of readiness -- the “fight or flight” response. This reaction causes your brain to make hormones -- including adrenaline and cortisol.

Adrenaline gives you more energy by increasing your heart rate and blood pressure. Cortisol increases the amount of glucose in your blood and tamps down body functions that might be harmful in a fight-or-flight situation, such as digestion and reproduction. It also affects your immune system. This can help you perform well on a test or at a sporting event; but it can also distract you, keep you up at night, and make you lose your appetite.

Your body and mind' s response to a stressful event is designed to end when the event is over. But many of the things that cause stress -- such as work, family, and relationships -- go on for a long time, raising the risk that your stress response could become chronic. Stress becomes chronic when your body doesn' t shut off its stress response, so you are always in a heightened state of readiness. This can lead to mental and physical health problems.

Stress disorders are severe reactions to stress and can happen as a result of trauma, such as witnessing a death, or experiencing serious injury. People with stress disorders feel intense fear, helplessness, or horror. Acute stress disorder happens 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 happen later -- sometimes as long as 30 - 40 years after an event -- and lasts for more than 3 months.

Although stress disorders are more uncommon, many people in the U.S. suffer from stress. A 2007 poll by the American Psychological Association found that one-third of Americans report experiencing extreme levels of stress. About one in five said they have high levels of stress 15 or more days per month.

Signs and Symptoms:

Stress can cause many symptoms, both physical and mental:

• Headache
• High blood pressure
• Rapid heartbeat
• Chest pain
• Upset stomach
• Insomnia
• Tight muscles or muscle aches
• Teeth grinding
• Depression
• Weight loss or gain
• Mood swings
• Inability to concentrate
• Anger
• Withdrawal from friends and family
• Worrying

Someone with a stress disorder may have the following signs and symptoms:

• Flashbacks, dreams, and intrusive thoughts
• Avoiding anything that causes you to remember the trauma
• Not being able to remember parts of the traumatic event
• Detachment, a decrease in emotional responsiveness
• A sense that your 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?:

Short-term stress can come from normal, everyday activities, such as a job interview, a first date, your wedding, buying a house, or taking a test. Chronic stress can be triggered by problems at work, difficult relationships, worrying about money, or dealing with an ongoing illness. Traumas such as war, rape, inappropriate sexual experience, illness, bereavement, or natural disaster may lead to severe stress disorders, such as PTSD.

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 stress interferes with your daily life, talk to your doctor about it. If you have symptoms associated with stress disorder, you should see your doctor right away. Your doctor can make a diagnosis and help guide you in determining treatment that may work best for you.

Your health care provider will do a physical examination, noting if you appear pale, tired, or disoriented. Diagnostic procedures may include a psychiatric exam and psychological testing, and an electroencephalogram to rule out brain damage or diagnose sleep disorder.

Treatment Options:

Prevention

Using relaxation techniques and maintaining a positive attitude can help you manage stress and prevent it from becoming chronic. Sometimes simply remembering to take deep breaths can help you cope with stressful situations. If you are dealing with ongoing stressful situations, it is important to take care of your health by eating well, exercising, and getting enough sleep. In the case of stress disorders, crisis intervention can help prevent post-traumatic stress disorder from developing.

Treatment Plan

While symptoms of acute stress usually 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 negative behaviors, and a type of therapy called cognitive behavioral therapy can help you reframe your negative thoughts about stressful situations. Research supports the management of the hormone cortisol, which is released from the adrenal glands when people are under long-term stress. Numerous studies show that regular exercise helps your body and your mind cope with 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 (FDA) for this use:

• Benzodiazepines -- a group of drugs used to help reduce anxiety that have sedating effects. They take effect quickly, but they can be habit forming and are usually prescribed for short-term use. They may cause drowsiness, constipation, or nausea. Do not take these drugs if you have narrow-angle glaucoma, a psychosis, or are pregnant. Benzodiazepines include
  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
• Buspirone (BuSpar) -- an anti-anxiety drug that does not appear to cause drowsiness or dependence. However, you must take it for 2 weeks before feeling any effect. Side effects can include insomnia, nervousness, light-headedness, upset stomach, nausea, diarrhea, and headaches.
• Antidepressants -- a group of drugs that act on neurotransmitters (brain chemicals) that may be involved in the stress response. Antidepressants sometimes used to treat anxiety and stress include :
  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Venlafaxine (Effexor)

Complementary and Alternative Therapies

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

Nutrition and Supplements

Although there is no diet to relieve stress, eating healthy meals keeps your body well nourished and strong. Avoid caffeine, alcohol, and nicotine. Eat more fresh vegetables, whole grains, and fruits. Eat small meals often that contain protein, complex carbohydrates, and healthy fats to avoid high and low blood sugar.

These tips can help you maintain a proper diet and stay healthy:

• 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 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.
• Eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

The following nutrients may help specifically with stress, although there is not a lot of scientific evidence:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium. In two studies, people who took a multivitamin were better able to cope with stressful situations than those who took placebo.
• Vitamin C, 500 - 3,000 mg daily, as an antioxidant. In one study, large doses of vitamin C (3,000 mg per day in a slow-release formula) reduced physical and mental responses to stress. Lower dose if diarrhea develops.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, can help with digestion and gastrointestinal health. You should refrigerate your acidophilus products.
• L-theanine, 200 mg one to three times daily, for nervous system and immune support. A few studies show that theanine, a constituent in black tea, helped reduce the physical reaction to stress.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, 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:

• Ginseng (Panax ginseng,Panax quinquefolius), 100 - 200mg per day of standardized extract containing 4 - 7% ginsenosides. Ginseng is often called an “adaptogen,” a substance that helps the body deal with stress and strengthens the immune system. Some animal studies suggest that ginseng can help the body cope with physical stress, but most of the studies have not been well designed. More research is needed. People who have diabetes or take blood-thinning medicine should talk to their doctor before taking ginseng. Pregnant women should not take ginseng. Ginseng should not be used long-term without your doctor' s supervision.
• Eleutherococcus or Siberean ginseng (Eleutherococcus senticosus), 300 - 400 mg of extract per day. Like true ginseng, eleutherococcus is often called an “adaptogen.” However, good scientific studies are lacking, so it isn' t known whether eleutherococcus can truly help with stress. Pregnant women or people with liver or kidney disease should not take eleutherococcus without a doctor' s supervision Eleutherococcus should not be used long-term without your doctor' s supervision.
• Bacopa (Bacopa monniera) standardized extract, 50 - 100 mg three times a day, for symptoms of stress and anxiety. A few studies suggest that a proprietary Ayurvedic mixture called Mentat containing bacopa and other ingredients may help reduce symptoms of stress, but the studies were not well designed. More research is needed.
• 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.
• Valerian (Valeriana officinalis, 150 mg 2 - 3 times per day) is an herbal treatment for insomnia, and is sometimes used to treat anxiety and stress as well, although evidence is mixed. Some studies show that valerian does help reduce anxiety, but one study found that valerian was no better at reducing social anxiety than placebo. Valerian is often combined with lemon balm (Melissa officinalis) or with St. John's wort (Hypericum perforatum) for treating mild-to-moderate anxiety. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines; barbiturates, narcotics; antidepressants; and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. St. John's wort can affect other drugs you may be taking, including antidepressants, birth control, or other medications. You should avoid St. John's wort while pregnant or nursing. Talk to your doctor before using St. John's wort with any other medications.
• Kava kava (Piper methysticum, 100 - 200 mg 2 - 4 times a day) is sometimes suggested for mild to moderate anxiety, but the FDA has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. Talk to your doctor before taking kava, and don' t take it for more than a few days.
• Catnip (Nepeta cataria), chamomile (Matricaria chamomilla), and lemon balm (Melissa officinalis) are herbs that are often made into teas and used to help manage stress. Combine all three herbs, and make calming teas to sip when needed. Strong doses of chamomile may interact with birth control pills.

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 people. 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 looked at the effect of chiropractic on people 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 other physical relaxation techniques, including massage.

Homeopathy

An experienced homeopath can prescribe a regimen designed especially for you for treating stress disorder. 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 chronic stress or stress disorder are at greater risk of developing other mood or anxiety disorders, or experiencing substance abuse. They are at higher risk of conditions such as heart disease, insomnia, and gastrointestinal illness. Suicide is more common among people with a stress disorder.

Following Up:

With changes in your lifestyle, you can learn to manage chronic stress successfully. People with stress disorders may be treated on an outpatient basis until symptoms get better. In severe cases where there is a concern about self-abuse or suicide, the person may be referred for treatment on an inpatient basis.