Major life stresses persistently increase cortisone type steroid levels which activate MR in the upper right section of the diagram. Switching on MR is a common denominator in the cause of depression, high blood pressure, and heart disease. The same signaling impacts the brain and the body. What do you think?
The mind body connection is powerful. We can’t quantitate stress, but it’s impact is undeniable. If a person has basically any chronic disease state and they are depressed, if the depression is not addressed the outcomes are negatively impacted. We’ve all seen this over and over, yet a patient’s mental status still frequently may not be addressed (a function of the EMR requiring too many clicks detracting from the time that can be spent with the patient?).
Bill, I had a cardiac patient years ago that drove these points home. He’d had an extensive MI with an intramural thrombosis that had spit out peripheral emboli, mainly to his toes. He was refusing to go to Cardiac Rehab or to Wound Mgt. for his gangrenous toes. He felt it was pointless as he wouldn’t make it much longer. He denied he was depressed but made zero eye contact and his wife said he would blow a gasket over nothing.
Convinced him we need to control these hyperadrenergic outbursts and persuaded him finally things could get better. Started him on fluoxetine, and a few weeks later he was a new man. Had a big smile on his face and bluntly stated “Prozac saved my life”. Was exercising, the necrotic digits were improving, and a few weeks later he attended his grandkid’s graduation. I couldn’t really dispute that the SSRI was a turning point for him.
As a mental health clinician (retired), I am surprised to read about the MR switch, as most information I learned when practicing related to various neurochemicals such as serotonin. SSRIs and SNRIs were huge game-changers when they came on the market. As all major depression is not related to stress, does the MR switch always activate depression? Of course, depression itself can add to stress, as it becomes difficult to concentrate and make decisions, eating and sleeping habits may change and other physical symptoms such as psychomotor retardation may emerge. To some degree, this may depend on comorbid psychiatric conditions, such as post-traumatic stress disorder and borderline personality disorder. I would expect to see more stress-related symptoms in the former than the latter, though not in all cases.
The mind body connection is powerful. We can’t quantitate stress, but it’s impact is undeniable. If a person has basically any chronic disease state and they are depressed, if the depression is not addressed the outcomes are negatively impacted. We’ve all seen this over and over, yet a patient’s mental status still frequently may not be addressed (a function of the EMR requiring too many clicks detracting from the time that can be spent with the patient?).
Bill, I had a cardiac patient years ago that drove these points home. He’d had an extensive MI with an intramural thrombosis that had spit out peripheral emboli, mainly to his toes. He was refusing to go to Cardiac Rehab or to Wound Mgt. for his gangrenous toes. He felt it was pointless as he wouldn’t make it much longer. He denied he was depressed but made zero eye contact and his wife said he would blow a gasket over nothing.
Convinced him we need to control these hyperadrenergic outbursts and persuaded him finally things could get better. Started him on fluoxetine, and a few weeks later he was a new man. Had a big smile on his face and bluntly stated “Prozac saved my life”. Was exercising, the necrotic digits were improving, and a few weeks later he attended his grandkid’s graduation. I couldn’t really dispute that the SSRI was a turning point for him.
Great insight. How is this also connected with stress…increased cortisol…. Increased release of glucose…increased insulin….IR!
As a mental health clinician (retired), I am surprised to read about the MR switch, as most information I learned when practicing related to various neurochemicals such as serotonin. SSRIs and SNRIs were huge game-changers when they came on the market. As all major depression is not related to stress, does the MR switch always activate depression? Of course, depression itself can add to stress, as it becomes difficult to concentrate and make decisions, eating and sleeping habits may change and other physical symptoms such as psychomotor retardation may emerge. To some degree, this may depend on comorbid psychiatric conditions, such as post-traumatic stress disorder and borderline personality disorder. I would expect to see more stress-related symptoms in the former than the latter, though not in all cases.