Stress can be a precursor of mental disorders, the most common being depression and anxiety. Together these make up around 80% of GP's mental health workload.

Mental illness is more common than cancer yet disorders fail to be recognised in 40% of cases by GPs.

Depression

Depression is regarded by some psychiatrists as an out-of-control stress response. Some estimates suggest that 80% of cases are a result of a life event.

Depression undermines a person's quality of life more than many other chronic diseases such as arthritis, diabetes, and back pain.  It is a crushing feeling of not being able to cope, manifesting in many symptoms including loss of interest, feeling useless, lack of motivation, irritability, fatigue, and insomnia.

Depression goes untreated in many cases due to a variety of reasons: not recognising the signs, not consulting a doctor owing to the stigma that still unfortunately surrounds mental illness, belief that if you keep going the symptoms will go away, and treatment of the symptoms rather than the cause.

Details of antidepressants for the treatment of moderate to severe depression are provided in the Depression topic.  Whilst drugs remain the mainstay of treatment, they do not remedy the cause.  Social support and counselling help you understand the source of emotional stress.

Anxiety disorders

Anxiety is a natural emotion known to all.  But many suffer it day in, day out: this is known as Generalised Anxiety Disorder.  This is recognised by worrying habitually, always on edge, and not being able to relax.

Stress and anxiety create a viscous circle.  Anxiety, causes stress, which then makes people more sensitive to stressful events.  This in turn contributes to the risk of developing an anxiety disorder.

There are several related to stress, from generalised anxiety disorder through to obsessive-compulsive disorder and post-traumatic stress disorder.

Obsessive Compulsive Disorder (OCD) is a condition when people have persistent thoughts and feel the need to repeat tasks.  It appears to be linked to both environment and personality, being more common in perfectionists, .  As the condition worsens, it becomes more difficult to lead a normal life due to the increasing number of times that actions have to be repeated.

Panic attacks are bouts of intense, debilitating fear.  They usually last a few minutes, but the dizziness and breathlessness can be so intense that it feels as though you are dying.  Attacks leave people tired or exhausted.  Avoidance of the associated triggers can lead to missing out on opportunities and fun that life has to offer.  Understanding why they happen goes a long way to being able to obtain or provide the support required.

Post traumatic stress disorder (PTSD) - although often debated as to whether it is a disease or not, the occupational and social problems that arise are real.  The symptoms of feeling detached, emotionally numb and reliving the event, yet not being able to talk about it, are experienced a long time after the event that has precipitated the condition.  Acute stress disorder can be a precursor, occurring within months of the trauma.

Not everyone who has suffered a traumatic event will suffer PTSD.  It is dependent on premorbid personality and the context of the trauma.  Those more susceptible to PTSD include anxiety-prone worriers, those with a history of a mental disorder, those in poor physical health or who suffer with lack of sleep and those who have suffered serial trauma such as child abuse.

Early intervention can reduce a lot of the emotional and social toll.  PTSD can be diagnosed through taking a detailed history of the patient, including lifestyle before and after the event.  If their lives have changed dramatically for the worse 6-12 months after the event, then PTSD is possible.

It is considered that PTSD is characterised by a faulty memory, the faulty pathway being laid down after the acute trauma.  Serotonin and noradrenaline are involved in establishing long-term memory, therefore drugs that affect these levels affect PTSD sufferers.  For example, Selective Serotonin Reuptake Inhibitors (SSRIs) decrease intrusive thoughts whereas drugs that increase serotonin levels increase the flashbacks due to the impact on long-term memory.

03/06/2009