Where Mental Health and Women's Health Collide
According to the National Center for Health Statistics (NCHS) and the US Census Bureau, more than 42% of Americans have reported symptoms of anxiety or depression in 2020. This is an increase from 11% the previous year.
What’s changed? We can, of course, look at the global pandemic as a major proponent of stress-related mental illness. The experiences of job loss, housing instability, and food insecurity continue to threaten proper physical nourishment, an underappreciated but essential foundation of healthy mental function and mood. Don’t underestimate these stressors.
According to the Office on Women’s Health of the U.S. Department of Health & Human Services, “more than 1 in 5 women in the United States experienced a mental health condition in the past year, such as depression or anxiety.”
Turns out, sex chromosomes, genes, and biology play a role in creating these symptom disparities. Some conditions, like depression or anxiety, affect more women, and often in different ways, than men. Scientists recognize sex differences in mental illness are a complex interplay between genetic, hormonal, immunological, and psychosocial factors. More research is still needed to understand how sex and gender-based differences affect disease patterns, symptoms, and treatment outcomes.
Imbalance: The Roots of Illness
A functional medicine framework teaches us that at the root of any illness is a fundamental imbalance or system dysfunction. Mental illness could be a possible sign that something else is out of balance. While the psychopathology of mental health conditions is multidimensional and extremely complex, let’s narrow in on just one relevant root to an imbalance in a year of unprecedented stress.
Meet the HPA axis or hypothalamo-pituitary-adrenal axis.
We know – it’s a mouthful, but simply put, this is a network of organs (hypothalamus, pituitary gland, adrenal glands), hormones, and signaling molecules that manage our response to stress. Dysregulation of this system has been linked to neuropsychiatric diseases and mood disorders like major depression, bipolar disorder, and anxiety.
This system functions best in balance. The sympathetic nervous system talks to the HPA axis to control our body’s stress response. Stress tells our adrenal glands to secrete hormones that increase blood pressure and blood sugar. Think: fight or flight mode. When stress subsides, our parasympathetic nervous system kicks in to decrease stress hormone production, reduce blood pressure, heart rate etc. Think: rest and digest.
This system gets wonky under conditions of chronic stress. The exposure that causes overactivation of these mechanisms, i.e. chronic stress, traumatic experiences, or ineffective coping, can trigger harmful systemic effects.
Unfortunately, the HPA axis exhibits strikingly sex-biased activity. Translation: HPA axis function is more easily disrupted in females. Women are at twice the risk of developing a disease or mental illness as a consequence of unchecked stress that overstimulates - and eventually dysregulates - HPA axis function.
Symptoms could be related to either too much or too little cortisol production - depends on how long the stressor persists. Typically, the body responds to stress by overproducing cortisol. This is followed eventually by low cortisol production in the setting of burnout.
Too much cortisol may present with diminished immune function, less restful sleep, hormone imbalances, anxiety, depression, panic attacks, irritable bowel syndrome, poorly controlled blood sugar, high blood pressure, and more.
Symptoms of too little cortisol may include seasonal affective disorder, fatigue, burnout, or brain fog.
If you’re feeling off-kilter, you should speak with your doctor about your cortisol pattern and hormonal status.
While there’s no antidepressant to date marketed to “fix” HPA axis dysfunction, rebalancing the system is possible with lifestyle interventions like improving sleep, reducing daily stressors, and focusing on a balanced diet.
Simple lifestyle interventions are powerful adjuvant therapies in mental illness. Food and nutrition are a particularly important piece of the mental health puzzle, as the information in our food plays direct and indirect roles in every body system: energy levels, mood, hormonal balance, and even response to stress.
Some suggestions to help keep a well-balanced diet:
- Limit ultra-processed foods & refined carbohydrates. A diet consisting of too many refined carbohydrates and sugars may exaggerate the stress response. These types of foods increase blood sugar which can elevate cortisol (stress hormone). And when blood sugar drops, mood fades, and energy wanes making you tired and irritable.
- Reach for nutrient-dense, high-fiber carbohydrates. Fruits, vegetables, whole grains, and legumes are healthful carbohydrate sources that may help dampen the stress response and reduce cortisol. Try this Savory Lentil Pecan Trail Mix as a healthy snack. Research also suggests the gut microbiome can also influence HPA axis activity. A healthy gut requires plenty of pre-biotic fibers found naturally in plant-based foods. And don’t forget the fermented foods! Try homemade Kimchi.
- Watch your stimulants and depressants. Many of us reach for coffee or energy drinks for a mid-day energy boost or a glass of wine to unwind from a stressful day. Rethink reflexive habits. Common stimulants, like caffeine, may exacerbate symptoms of anxiety and impair restful sleep. Common depressants, like alcohol, could lead to mental and physical health problems. Consume both in moderation.
- Avoid restrictive dieting. Depriving the body of total energy (calories) or major food groups (i.e. carbohydrates) may add insult to injury in the setting of stress and HPA axis dysfunction. Restrained eating may itself be an added stressor!
- Choose healthy fat & protein. These macronutrients not only play important roles in neurotransmitter and steroid hormone genesis, but are closely tied with healthy blood sugar management – remember, this is commonly out of whack when you’re stressed.
For more information, read this article on how to Boost Your Mood with the Power of Food!
This year brought unprecedented stress to so many people, especially women. It’s possible that the recent rise in prevalence of mental illnesses like anxiety and depression are a direct correlation to the chronic stress we’re under.
Females appear to be particularly susceptible to the impact of stress via HPA axis dysfunction and are high risk for developing mental illnesses like depression or anxiety as a result of their sex and hormone differences.
Ladies, pay attention to your mental health.
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