Takeaways from Dr. Bergquist’s Live Chat on Stress Management

stress-cil-638Thanks to everyone who attended our live chat, “Managing Your Stress,” Tuesday, Dec. 22, with Sharon Horesh Bergquist, MD, who serves as Emory Healthcare Network primary care physician and associate professor with the Emory University School of Medicine.

Dr. Bergquist fielded some great questions on a range of topics, including:

  • Stress and its relationship to autoimmune disorders
  • Stress effects on aging
  • Anxiety attacks
  • Best stress-relieving activities
  • Managing grief during the holidays
  • Good stress and how to make stress work for you
  • The effects of stress on migraines
  • How your primary care physician can help you manage stress

If you didn’t get a chance to join us, read the full transcript from “Managing Your Stress” here.

Two questions didn’t get answered during the live chat, so we’re sharing them here, along with Dr. Bergquist’s responses:

Question: Are other SSRIs as effective as fluoxetine for treating SAD?

Answer: SAD can stand for social anxiety disorder as well as seasonal affective disorder, so I wasn’t sure which one is being asked here.

For social anxiety disorder, the SSRI paroxetine and the SNRI venlafaxine are effective. Older drugs from a family called MAO inhibitors, such as phenelzine can also be used.

Seasonal affective disorder, a seasonal pattern of recurrent depression in fall or winter months, can affect 1.5% to 9% of people. It is typically treated with antidepressants, light therapy or psychotherapy.

There are actually very few high quality studies looking at the best anti-depressant for seasonal affective disorder, and there is virtually no data comparing SSRIs for treating SAD. The data is limited to studies on fluoxetine compared to placebo (in which fluoxetine shows a non-significant benefit) and fluoxetine compared to light therapy (it is nearly equivalent). Other SSRIs are commonly used in practice for SAD but there is little data to know if they are effective.

A recent review on the topic found bupropion XL to be an effective alternative for preventing recurrences of SAD (but even here it was effective at best in a small percent of people, around 20%).

Question: Due to psychoneuroimmunology, if a person has cancer, does distress increase the risk of cancer recurrence?

Answer: A relationship between stress and cancer progression has long been suspected. Recently, through animal cancer models, we are learning that the molecular link between the two may be through the beta-adrenergic signaling pathway which mediates the sympathetic nervous system induced fight-or-flight response.

Stress, through the beta-adrenergic pathway, may contribute to the progression and metastasis of a cancer . (Immune mediated macrophages can infiltrate some tumors such as breast cancer and, like a switch, induce pro-metastatic genes to be expressed.)

The stress hormones epinephrine and norepinephrine can attach and turn on receptors on tumor cells to control a variety of function involved in progression, such as proliferation, migration and invasion. Yet, little research is available to answer the question about whether distress can increase cancer recurrence.

Dr. Bergquist is an Emory Clinic Primary Care Physician and Assistant Professor of Medicine at Emory University School of Medicine. Her expertise includes healthy aging, heart disease prevention and management, women’s health, diabetes, nutrition and obesity counseling and treatment of mood disorders, such as anxiety and depression. She has appeared in over a hundred health segments, including Good Morning America, Fox New Network, CNN and Fox 5, has served as an editorial consultant for WebMD and wrote the TED Ed Lesson, “How Stress Affects Your Body.”

Below we have also highlighted some questions that were asked during our live chat.

Question: It’s been said that a certain amount of stress is good. How does a person maintain a good level of stress without tipping over into chronic debilitating stress?”

Short-term stress is advantageous—not only can it help us perform our best but even supports resilience at a cellular level. Stress becomes debilitating or “toxic” when it is prolonged or recurrent, such as worrying about a sick child or finances. The interaction between stress hormones and the hormones and immune cells, among others, throughout our bodies are responsible for both the good and adverse effects.

Question: How does stress affect aging?

Stress has been associated with decreasing longevity and shortened telomeres. These are the shoelace tips at the ends of chromosomes that allow DNA to get copied every time a cell divides without damaging the cell’s genetic code. With each cell division , telomeres shorten until a cell eventually dies. Stress accelerates this process.

In one study done on mothers who were either caregivers of healthy children or children who were chronically ill, the women who felt the most perceived stress had telomeres that were shorter on average by the equivalent of a decade of aging compared to mothers that felt the least stressed.
How much does exercise really help with stress?

Exercise is one of the most effective ways to manage stress. Exercise can reduce cortisol, which is otherwise known as the “stress hormone”. Exercise can also improve other neuroendocrine changes that take place from chronic stress, and it can reduce the immune system mediated damaging inflammation that occurs from chronic stress.

Question: Mindfulness- what does this mean and what role does in play in stress management?

Mindfulness is actively focusing on the present, and observing your moment to moment thoughts and emotions without passing judgment on them. It’s the opposite of being mindless. Mindfulness has become a widely used way of reducing stress, helping with concentration and focus, increasing compassion and self-awareness, and controlling emotions.

Question: Can a certain diet affect your stress levels?

Omega 3 fatty acids are vital for proper nerve function. A diet that is high in omega-6 to omega-3 fatty acids can exacerbate the chronic inflammation that can be triggered by chronic stress and can adversely affect brain function. . Refined carbohydrates, such as sugar, can cause a spike and then a drop in your blood sugar level. People can feel irritable when their blood sugar drops. B vitamins, zinc, and magnesium are necessary in sufficient amount to support our brain chemicals. There is also a lot of research linking gut bacterial balance and brain health. Fiber rich foods support a healthy gut while sugar, fat, and processed food can disrupt gut bacterial balance.

To view the entire chat transcript click here.

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