Kiwi Men: Stressed & Depressed
This talk was written for men and it was given in the context of several other complimentary talks by my Ancestral Health Society colleagues Jamie Scott, Phil Becker, Andrew Dickson and my co-presenter Felicity Leahy. However, much of what is discussed here is relevant to any human who experiences chronic unremitting stress.
The word “stress” or "busy" just rolls of the tongue these days, and has almost become the new black of NZ society. No one with a pulse is immune and actually, not all stress is even bad for us. But chronic stress takes its toll and the scales can be tipped from coping to struggling seemingly in an instant, but usually this is after a long period of alerts going off, but pushing on anyway.
The fact is that the human stress response simply wasn’t designed to be constantly switched on. Rather, it is a sophisticated emergency response designed to switch on and off for our survival in the face of a threat (think of a lion chasing you on the savannah). This alarm response is stage one of three researched by neuroendocrinologist Dr. Bruce McEwen - 1) alarm, 2) endurance, and 3) exhaustion (see image below).
Stage 1 - Alarm.
In this initial stage, often termed fight/flight/freeze, the body gears up to respond and survive either through taking action, running away, or feigning dead (whichever one is determined at the time to be the best approach to the threat).
In our 21st century environment, we don't so much have lions chasing us and so our threats are generally non-life-threatening but highly insidious. Like constant device notifications, juggling work/family/study, commuting, rushing, deadlines, high expectations of ourselves, perfectionism, avoiding difficult feelings, and working into evenings and weekends. Many humans have their protective alarm going off (e.g., tiredness, anxiety, insomnia, irritability, health issues) without listening to it, which has widespread effects on minds, bodies, relationships, and behaviour. And what do we do when the alarm starts amplifying? Do we stop and check out the source of threat to fix the problem at its root (i.e., rest, recover, repair)? Not quickly enough, instead we do things to override this protective mechanism so we can keep going, or stage two - endurance (AKA "push through").
Stage 2 - Endurance.
This is an evolutionary mismatch of physiology, environment, and behaviour. A symphony of adverse things can occur during this stage, listed on this slide below. The person may have no indication that any of this is occurring though, as they continue to push through using external things to override their body's important messages (coffee, alcohol and drugs, food cravings, working harder, medication reliance). This may be necessary such as when working on a work deadline, completing university study, or supporting a loved one through an illness or trauma.
But what I see with many of my clients, is that the constant stress of the second endurance stage persists beyond that stressor, and becomes their normal lifestyle. Including the amplification of "pushing through" behaviours I group as “excesses” - things they do too much of - and “deficiencies” - things they're omitting to do enough of.
This can be described by the following typical day of many humans. When you’re tired or struggling you’re more likely to reach for caffeine, sugar, junk food, or medications to push through. You’re more likely to be engaging in isolated sedentary screen based activity to meet deadlines and clear emails, and to be going around and around in your head with thoughts of busyness, worry, and stress. Exercise won’t be a priority in your life – you’ll be too busy and too tired. Because of these things, you will struggle to unwind and get off to sleep at night without alcohol or sleeping pills. You won’t have time to eat well – may skip breakfast or mainline coffee, and there won’t be adequate nutrients going in to support the increased stress demands which burn up B vitamins, Zinc, and Magnesium among other necessary foundations for good mood and functioning. Doing things for pleasure or relaxation will be the last thing you think you have time for or you may over-rely on these activities as a way to avoid or numb reality. Other ways to avoid or numb involve automatic mindless activity like gambling, gaming, Netflix, pornography use or relying on sex to reduce tension. You’ll become distant from the people who matter most to you, as you treat them differently when in stress mode, being irritable, snappy, impatient and self rather than other focused. The tendency to isolate and avoid people and retreat can result, as well as a disconnection from true closeness and intimacy with those few deeply meaningful relationships in life.
Humans are wired for connection and science clearly finds that our relationships with close others help offset our stress response, help us manage pain, help us heal faster, and support our health and mental health, therefore a connection deficiency can be a great threat to optimal health and wellbeing.
At some point, humans who have remained in the endurance stage for too long generally shift into the third and final stage - exhaustion. This is commonly diagnosed as depression or may involve what I've previously written about as a "loss of zest". Is it really any wonder that we're experiencing a mental health crisis of epic proportion? And the vicious cycle described by Bruce below means it is difficult to find a way back from this place.
Stage 3 - Exhaustion.
Depression = the end result of unrelenting stress + poor coping strategies?
“The connection between stress and depression is complex and circular. People who are stressed often neglect healthy lifestyle practices. Stress, or being stressed out, leads to behaviors and patterns that in turn can lead to a chronic stress burden and increase the risk of major depression.”
~ Bruce McEwen, PhD, The End of Stress as We Know It.
The types of experiences people have when exhausted/depressed/or zest-less can vary somewhat but generally they'll tick off many of these phenomena listed here:
Deep fatigue
Sleep more/less
Withdraw
Loss of motivation and pleasure
Irritability/low mood - guilt/hopelessness
Higher or lower libido and appetite
Eat more/less (poorer food choices/cravings)
Weight gain/loww
Cognitive changes - memory, focus, attention
Suicidal ideation for some
Depression is the official psychiatric diagnosis purported to be the leading cause of disability worldwide (according to the World Health Organisation). In NZ, it’s constantly reported in the news that we have a mental health crisis. Depression and anxiety are the second leading cause of health loss according to the Ministry of Health. The worst of this situation is the consistently high suicide rate NZ has, especially for our young people, especially for our young men and men in general. We lose approximately 500-600 New Zealanders to suicide each year, and this is a rate of three times more men than women - roughly one man per day! These statistics are simply tragic.
We also have the highest rates of antidepressant use ever in history world-wide, with 1/9 of us Kiwi's being prescribed these types of medication (1/6 women), which, according to Pharmac data I obtained, represents a 65% increase over the past decade and shockingly a 98% increase in prescribing to our children and teenagers.
Modern antidepressants are called selective serotonin reuptake inhibitors (SSRI's). Prozac, the first ever SSRI, hit the shelves in 1987, and with it came a discourse of depression as brain chemical imbalance involving low serotonin levels in the brain. This has become a favoured marketing narrative for depression, supporting the widespread acceptance of SSRI medication as a mainstream treatment.
However, SSRI’s are extreme meds, they have serious effects and they do not address the underlying causes for depression which involves multiple factors, including the result of chronic unremitting stress and altered physiology. Recent meta-analyses that consider all available research indicate that SSRI’s may be not much more effective than that of placebo/belief or sugar pill, especially for mild or moderate depression, and that lifelong outcomes may be worse for those medicated than those not. Tolerance can also occur over long-term use and discontinuation can be disruptive at best and impossible at worst, due to sometimes debilitating withdrawal effects. And in some cases, SSRI use seems to be lifesaving, life-enhancing, or supports someone through a difficult patch short-term.
The problem with the serotonin and antidepressant narrative is that it’s too simplistic, lacks robust support, and is relied on too quickly without considering other options.
A newer understanding of immunity and the body’s stress response supports an integrated inflammatory model of depression known as the Cytokine Theory. In this view, many cases of depression are the end-point of a stress response being constantly switched on which results in altered immune functioning via the gut-brain-axis, poor or habitual stress coping mechanisms, and inadequate diet and lifestyle.
Over time, the body will eventually protect itself from further damage via an exhaustion phase - i.e. effectively stopping the person who has not heeded earlier messages in their tracks, and enforcing a period of rest and repair. There are myriad reasons for this epidemic of depression and depression pills, and so integrative solutions are required if we are ever to lessen it.
This writing is just part one of my talk, which focuses only on describing the three stages of chronic stress leading to exhaustion/depression. But part two will get more into the practical solutions to help someone find the path back from either the endurance or exhaustion stage. This is where things get way more interesting in my opinion.
Please note: this blog is here to share information on a public talk given on Men's Mental Health. The information here is not designed to replace individual medical advice from your health professional - please do not stop or reduce medication without consulting with them first.
