In 2014 the World Health Organisation stated:
“The average lifetime prevalence of depression has been estimated at 14.6% in high-income countries, 11.1% in low-to middle-income countries. Depression will become the second leading cause of disability-adjusted life years lost by the year 2020.”
This was a shocking prediction back then, but having volunteered as a listener for Samaritans for 3 years I can attest to the large number of people that suffer with depression, anxiety and other related mental health issues, that struggle to receive support for these debilitating conditions. It would seem they were correct in presuming this issue would get worse.
But it is not just the emotional and cognitive that are challenged through un-resolved mental illness, physical health for those suffering is severely compromised too, and sometimes with devastating consequences.
Those that suffer depression, anxiety and other mental health issues are at a significant increased risk of heart disease, and this is the biggest killer on the planet.
In 2014, an American Heart Association statement listed depression as a risk factor for a poor prognosis after a heart attack or unstable angina (chest pain at rest due to reduced blood flow to the heart).
One study found that the risk of death in heart attack survivors with depression was three times that of those without depression.
A 2014 Meta-analysis of 30 studies & 40 independent reports that met the inclusion criteria, were analysed. These covered 893,850 participants between 1993 & 2014.
This meta-analysis of data concluded:
“Depression is independently associated with a significantly increased risk of Coronary Heart Disease and Myocardial Infarction.”
This revelation crystallises how important it is to ensure that sufferers seek help to resolve their mental health issues as soon as they can, to avoid them becoming life-threatening.
One of the reasons that mental illness increases heart disease risk is because it creates a chronic elevation of cortisol.
Cortisol is an important hormone produced by the adrenal glands. It is secreted by the body in response to stress and is one of the hormones involved in the fight-or-flight response.
Cortisol plays an important role in everything from how the body uses glucose (blood sugar), to the regulation of blood pressure and the functioning of a healthy immune system.
Cortisol has many benefits, when administered in small doses periodically when needed by the body. It primes you for physical and emotional challenges, facilitates bursts of energy and can provide surges of immune activity when you're confronted with infectious diseases.
All good here, so what’s the issue?
When you're exposed to continuous or prolonged stress, which results in chronic over-production of cortisol you will start to experience negative side effects.
Chronically elevated levels of cortisol throughout the day will increase blood sugar (which in turn elevates insulin chronically) which will in-turn increase fat storage, elevate blood-pressure, and reduce your ability to fight infections.
Clearly it is a very bad thing to put yourself through chronic stress throughout the day.
If you are wondering what the stressors are that increase cortisol, here are a few.
Additionally, poor sleep, road rage, fear, poor relationships, a job you hate, being stuck in traffic, an argument with your boss....pretty much anything that triggers anger, sadness and emotional distress will elevate your cortisol.
All of these things tell your brain to activate the sympathetic nervous system and trigger the same chemical reactions that would have elicited a fight-or-flight response in days gone-by, in moments of danger. Except these days there is no real danger, just emotional antagonists of modern life.
Ironically, feeling anxious or depressed will increase cortisol, which will make you feel more anxious and depressed.
So when you suffer with depression it actually increases cortisol, creating a vicious cycle.
And instead of this happening periodically, maybe once a week, in our modern, busy lives we experience these things many times each day.
Our bodies are amazing machines, that are equipped with natural self-repair mechanisms that fight cancer, prevent infection, repair wounds, and protect us from infectious agents and foreign bodies.
These natural self-repair mechanisms are, however, deactivated when the body is full of stress hormones. This suppresses the immune response, which increases the risk of developing all sorts of diseases, including arthritis, cancer, and auto-immune disorders.
Ongoing chronic stress means that cortisol, and it’s co-conspirators adrenaline, noradrenaline and insulin are elevated throughout most of the day, wreaking havoc on our bodies and our brain.
Ordinarily cortisol in the blood peaks in the morning and decreases throughout the day.
However, in about half of people that suffer with depression, it peaks earlier and does not level-off or decrease in the same way, exacerbating the issue.
To make matters worse, some of the symptoms of depression, such as low energy and lack of motivation, can make getting regular exercise, eating healthy foods, and sticking to a relaxation protocol very difficult.
The key to resolving this is to break the cycle and shift the body away from this chronic stress response towards a relaxation response.
When this happens your cortisol levels drop and your body’s self-repair mechanisms get back to work.
Here are a few ways you can lower your cortisol levels and start to work towards breaking the cycle of anxiety and depression:
Eat a low-glycemic diet. Sugar, and elevated blood glucose from carbohydrates and heavily processed foods, can increase adrenaline and cortisol. Consume plenty of saturated fats, proteins and greens to help regulate cortisol and insulin.
Engage in regular physical activity. Moderate physical exercise does wonders to relieve stress and lower cortisol levels. High-intensity interval training is also fantastic for managing stress or ones and insulin. Go for a walk, or some sprints.
Practice meditation. Even a few minutes of meditation a day has a cumulative, positive effect on your stress levels. A 15 minute meditation session each morning will help you start the day calm and relaxed.
Get proper rest. Insomnia causes high cortisol for up to 24 hours afterwards. Interruptions to sleep, even if brief, can also increase your levels and disrupt daily hormone patterns. Try to get to bed at the same time every night and wake up at the same time each morning. Try not to eat, drink alcohol or engage in screen-time for a few hours before bedtime, and sleep in a cool room.
Be sociable. Even if you sometimes don’t feel like it, reach out my to others and regularly meet with and call friends and family. Isolation and loneliness increase stress, anxiety, and depression. It’s important to find ways to connect socially with other people to manage your stress.
Laugh. Researchers have found that laughing significantly reduces stress hormone levels. In one study, laughter decreased the cortisol levels of participants by nearly 50%. So the next time you’re feeling anxious, try watching a comedy.
Of course this doesn’t resolve some of the real world issues that may be catalysts for anxiety or depression, such as relationship issues, money worries, bereavement, and a many other life challenges, but these strategies should form part of the bedrock of good mental health.
Addressing mental health challenges often starts just by feeling able to talk about them, and Samaritans is a great place to start if you are finding that difficult to do.
Research for this article can be found here