By Michael A. Keys, MD

Dr. Keys is a geriatric psychiatrist, Adjunct Associate Clinical Professor of Psychiatry at the University of Cincinnati College of Medicine, and Director of The Senior Health Program at the Lindner Center of HOPE, Mason, Ohio.

I recently learned first-hand what stress can do to your life.  I’ve been involved in an exciting but stressful project with the opening of a brand new hospital.  Plenty of stress there. We had a meeting one afternoon that was almost a comic book experiment of trying to simulate stress.  Imagine a group of doctors sitting in a conference room when they begin testing the new fire alarm system. The initial blare of the ear-splitting signal certainly startled and got the crowd’s attention.  Most of us reflexively were out of our chairs and ready to head for the door when we hear that it’s just a test.  We all had the flash of adrenalin, a sense of acute attention and startle, and the unconscious move to our feet and out the door.  Gradually, the wave of anxiety fades and we try to get our focus back.  And then it happens again.  And again.  You get the picture.  One could never get use to the screaming alarm or suppress the initial startle, but most of us could suppress the need to run out the door.  But you were left with a sense of anticipation and vigilance that the alarm would sound again.  It became harder to keep to our task and the meeting eventually broke without much getting done.  It’s a nice illustration of what stress researchers might do to understand the impact of stress

One of the most fascinating areas in neuroscience research has been on the general impact of stress, mood, and medical illness. You first have to realize that the brain is hooked up and a chief regulator of all the systems of our body.  Stress is defined as an internal response to a stimulus or pressure that threatens to disrupt our equilibrium.  Our response, often referred to as “fight or flight” involves both profound psychological and physiological responses. From an evolutionary stand point, the system is designed to be used sparingly.  It is the equivalent of a human fire drill, in which we quickly mobilize with our energy to move to action quickly in response to an alarm signaling an immediate threat.  So we are use to practicing a fire drill once or twice a year at school or work.  What if the hideous fire-alarm went off several times day?  Would your response change?  Would you still get up and move?  What would it do to your “nerves” and the rest of your system?

One way to think about depression is that it is the consequence and expressive face of chronic stress. We know overly or chronically stressed animals (and this includes humans) have worn out response systems from overuse.  This results in the outpouring of glucocorticoids, cortisol being the classic example. But too much cortisol is not a good thing.  It has profound effects on the brain with both animal models and imaging studies suggesting that we begin to see actual brain shrinkage in stressed animals as well as in patients who have had recurrent and chronic bouts of depression.  But there are also profound health effects.  We know that stress accelerates aging in general.  It deadens our response to other hormonal systems such as insulin response leading to diabetes.  It weakens bone and muscle. It accelerates the vascular changes associated with heart disease and stroke.  It weakens the immune system leaving a person vulnerable to a wide variety of illnesses including a possible link to some cancers.

Now think of some of the stressors that many of our seniors live with day to day.  What is the impact of a loss of a husband or a wife?  Financial strains? Dealing with a major new health problem?  What about “silent” stressors like the impact of living alone, being socially isolated?  What about the hour to hour stress a care-giver to a spouse with Alzheimer’s disease experiences?  These are the common stressors that seniors deal with each day, every day.  And we believe they take their toll and contribute to depression, overall health, and sense of well being.

So the question is what to do.  One, recognize and take stock of the stress signals and alarms in one’s life.  Stick to a routine, which means get up, shower, get dressed, and have a basic plan to get something accomplished ever day, no matter how small or trivial.  Expand your social network.  If there is a lack of family and friends, going to the neighborhood senior center or being more involved with your church may be good places to start.  For those in care giving situations, expand the care network as best you can.  Incorporate routinely family members, friends, and professionals to help structure the care week.  Regular exercise.  Physical exercise is one of the best stress-reducers and antidepressants that we know. Eat right.  Think of Alcohol or smoking as red flags of stress and try to eliminate.  Incorporate each day activities that you find rewarding, enjoyable, and meaningful.  That may be as simple as taking a walk in the park.  And finally, if you are recognizing signs and symptoms, especially a sense of being overwhelmed and helpless, it may be a good idea to speak with your doctor or a mental health provider.