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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Larry Hoover on November 27, 2002, at 12:46:00
Here's a review article about what we know(?) about stress, and the HPA-axis. This is complicated stuff, eh?
J Psychosom Res 2002 Oct;53(4):865-71
Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress.Tsigos C, Chrousos GP.
Hellenic National Diabetes Center, Athens, Greece.
The stress system coordinates the adaptive responses of the organism to stressors of any kind.(1). The main components of the stress system are the corticotropin-releasing hormone (CRH) and locus ceruleus-norepinephrine (LC/NE)-autonomic systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. The CRH and LC/NE systems stimulate arousal and attention, as well as the mesocorticolimbic dopaminergic system, which is involved in anticipatory and reward phenomena, and the hypothalamic beta-endorphin system, which suppresses pain sensation and, hence, increases analgesia. CRH inhibits appetite and activates thermogenesis via the catecholaminergic system. Also, reciprocal interactions exist between the amygdala and the hippocampus and the stress system, which stimulates these elements and is regulated by them. CRH plays an important role in inhibiting GnRH secretion during stress, while, via somatostatin, it also inhibits GH, TRH and TSH secretion, suppressing, thus, the reproductive, growth and thyroid functions. Interestingly, all three of these functions receive and depend on positive catecholaminergic input. The end-hormones of the hypothalamic-pituitary-adrenal (HPA) axis, glucocorticoids, on the other hand, have multiple roles. They simultaneously inhibit the CRH, LC/NE and beta-endorphin systems and stimulate the mesocorticolimbic dopaminergic system and the CRH peptidergic central nucleus of the amygdala. In addition, they directly inhibit pituitary gonadotropin, GH and TSH secretion, render the target tissues of sex steroids and growth factors resistant to these substances and suppress the 5' deiodinase, which converts the relatively inactive tetraiodothyronine (T(4)) to triiodothyronine (T(3)), contributing further to the suppression of reproductive, growth and thyroid functions. They also have direct as well as insulin-mediated effects on adipose tissue, ultimately promoting visceral adiposity, insulin resistance, dyslipidemia and hypertension (metabolic syndrome X) and direct effects on the bone, causing "low turnover" osteoporosis. Central CRH, via glucocorticoids and catecholamines, inhibits the inflammatory reaction, while directly secreted by peripheral nerves CRH stimulates local inflammation (immune CRH). CRH antagonists may be useful in human pathologic states, such as melancholic depression and chronic anxiety, associated with chronic hyperactivity of the stress system, along with predictable behavioral, neuroendocrine, metabolic and immune changes, based on the interrelations outlined above. Conversely, potentiators of CRH secretion/action may be useful to treat atypical depression, postpartum depression and the fibromyalgia/chronic fatigue syndromes, all characterized by low HPA axis and LC/NE activity, fatigue, depressive symptomatology, hyperalgesia and increased immune/inflammatory responses to stimuli.
Posted by Joel Maxuel on November 27, 2002, at 16:42:22
In reply to Stress does what?, posted by Larry Hoover on November 27, 2002, at 12:46:00
Stress gives you hives.
--
Joel Maxuel
ShamelessPlug(http://www.maxuel.ca);
Posted by Squiggles on November 27, 2002, at 17:12:09
In reply to Re: Stress does what?, posted by Joel Maxuel on November 27, 2002, at 16:42:22
Hi Joel,
I took a look at your pics (gaaad talk about
snail pace) - worth it though; definitely looks
like a relative's place in Nova Scotia, but alas
i think it is not, and simply another example
of retro 60s living; made me very nostalgic for
a similar place if spent my youth at.So, it looks like a good place to follow your
psychiatrist's directions.Cheers,
Squiggles
Posted by bluedog on November 27, 2002, at 21:18:35
In reply to Stress does what?, posted by Larry Hoover on November 27, 2002, at 12:46:00
> Here's a review article about what we know(?) about stress, and the HPA-axis. This is complicated stuff, eh?
>
LarryYour post has put into words exactly what I have been thinking for years but didn't quite know how to express it ( :) )
Stress comes in many different forms
1. Dietary stress (too much pizza, beer and coca-cola)
2. Financial stress (damned mortgage and credit card debts)
3. Psychological stress part 1( worrying on Sunday night that I have to go to work in the morning)
4. Psychological stress part 2 (waking up and realising that it's a work day)
5. Physical stress part 1 (getting out of bed)
6. Physical stress part 2 (twisting my ankle running to the bus because I'm late for work)
7. Work stress part 1 (my boss not impressed by me coming in late)
9. Physical stress part 3 (discs in my lower back wearing out due to endless hours spent slumped in the couch watching the beautiful people on television living exotic and fulfilled lives)
8. Work stress part 2 ( the injustice of having to work for a living when all those beautiful people on the television are having fun in the sun).At least I know what's happening to me as a result of my (past) lifestyle.
On a more serious note I very strongly believe that stress is the root of (mostly)all evil when it comes to my current condition. I note that your post blames stress as the cause of many conditions including some types of depression and chronic fatigue and I can explain the role that stress has played in my depression and chronic fatigue.
I have greater difficulty seeing the causal relationship between stress and my social anxiety. Do you have any thoughts on this question? I am very interested to hear your views.
Thanks Larry
bluedog
Posted by Larry Hoover on November 27, 2002, at 22:51:51
In reply to Re: Stress does what? » Larry Hoover, posted by bluedog on November 27, 2002, at 21:18:35
> On a more serious note I very strongly believe that stress is the root of (mostly)all evil when it comes to my current condition. I note that your post blames stress as the cause of many conditions including some types of depression and chronic fatigue and I can explain the role that stress has played in my depression and chronic fatigue.
>
> I have greater difficulty seeing the causal relationship between stress and my social anxiety. Do you have any thoughts on this question? I am very interested to hear your views.
>
> Thanks Larry
> bluedogSocial anxiety is probably more likely to develop in someone whose HPA axis is entering a phase of serious dysregulation. Hormone levels not only reach extreme levels, they also oscillate between extremes....too low can follow too high, and vice versa.
This sets the stage for the possibility of an unfortunate coincidence between some social event and an uncomfortable oscillation in hormones. The amygdala unconsciously processes the coincident experiences, and a conditioned response develops. Later social interactions bring back the experiential 'memory' of earlier discomfort. This arises without a conscious thought, and the discomfort is quite real. Just like Pavlov's dogs drooling at the sound of the bell. The bell isn't food, but the dog cannot control its salivation.
One of my professors used to tell this tale about himself. He took part in some of the preliminary work in aversive training for alcoholics. The drug now known as Antabuse was under investigation for its ability to make people violently ill if so much as the smell of alcohol was encountered. Before testing it on alcoholics convicted of drunk driving causing death, my professor (then a university student) was given the experimental drug, and offered a drink. Without thinking, he asked for a scotch (his favourite drink, and one he could seldom afford as a student). He was incapacited by retching and vomiting, for over an hour. When he told me the story, some forty years later, he still could not go near scotch. He regrets to this day not choosing wine. His amygdala won't let him have scotch, as violently vomiting is often associated with poisoning. It's wired into us, this capacity for aversion.
I'm applying something I was just looking into, in another context, but it seems to make sense to me to apply it to social anxiety, too. What do you think?
Lar
Posted by bluedog on November 28, 2002, at 3:34:56
In reply to Re: Stress does what? » bluedog, posted by Larry Hoover on November 27, 2002, at 22:51:51
>
> I'm applying something I was just looking into, in another context, but it seems to make sense to me to apply it to social anxiety, too. What do you think?
>
> LarWhat you say seems to make sense Larry. However I will get back to you with a more detailed response in due course. I am trying to process this information and come to some sort of conclusions of my own.
The thing is I happen to be a hell of a lot more knowledgeable about my depression and chronic fatigue than I am about my social anxiety. The reason for this is that I need to get my depression and chronic fatigue under control before I can start looking at the social anxiety side of things.
There is also a further problem as it seems to me that there is a lot more research available and more is known about the causes of and the neurological processes in depression than in social anxiety.
I think the "Pavlov's Dogs" theory has some merit to it but my gut feeling is that a nutrition and supplement approach will be less effective in social anxiety than in depression or chronic fatigue. In other words depression is more likely to be caused by chronic stress and chronic nutritional deficiencies that lead to an imbalance that can be corrected by a nutrition and supplement approach whereas under the Pavlov's Dogs model that you propose, the problem is much more one of hardwiring of the neural pathways in the brain.
These are my initial views, though I saw my psychiatrist today and he believes that social anxiety sufferers have certain "imbalances" and deficiencies in the brain, particularly in the GABA processes that supplementation may help to balance to some degree.
If your at all interested the following link to a forum on social anxiety published in the Journal of Clinical Psychiatry to me really demonstrates how little is known about social anxiety even by the experts.
see http://www.psychiatrist.com/supplenet/59s17/59s17toc.htm
bluedog
Posted by Larry Hoover on November 28, 2002, at 8:02:09
In reply to Re: Stress does what? Social Anxiety!! » Larry Hoover, posted by bluedog on November 28, 2002, at 3:34:56
> >
> > I'm applying something I was just looking into, in another context, but it seems to make sense to me to apply it to social anxiety, too. What do you think?
> >
> > Lar
>
> What you say seems to make sense Larry. However I will get back to you with a more detailed response in due course. I am trying to process this information and come to some sort of conclusions of my own.
>
> The thing is I happen to be a hell of a lot more knowledgeable about my depression and chronic fatigue than I am about my social anxiety. The reason for this is that I need to get my depression and chronic fatigue under control before I can start looking at the social anxiety side of things.Well, sorry to add more weight to your brain, but you might want to read this:
Med Hypotheses 2002 Nov;59(6):727-35
Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients.Gupta A.
Robinson College, University of Cambridge, CB3 9AN, Cambridge, UK
Here, a novel hypothesis for chronic fatigue syndrome (CFS) is proposed. CFS may be a neurophysiological disorder focussing on the amygdala. During a 'traumatic' neurological event often involving acute psychological stress combined with a viral infection or other chemical or physiological stressor, a conditioned network or 'cell assembly' may be created in the amygdala. The unconscious amygdala may become conditioned to be chronically sensitised to negative symptoms arising from the body. Negative signals from the viscera or physiological, chemical and dietary stressors, become conditioned stimuli and the conditioned response is a chronic sympathetic outpouring from the amygdala via various brain pathways including the hypothalamus.This cell assembly then produces the CFS vicious circle, where an unconscious negative reaction to symptoms causes immune reactivation/dysfunction, chronic sympathetic stimulation, leading to sympathetic dysfunction, mental and physical exhaustion, and a host of other distressing symptoms and secondary complications. And these are exactly the symptoms that the amygdala and associated limbic structures are trained to monitor and respond to, perpetuating a vicious circle. Recovery from CFS may involve projections from the medial prefrontal cortex to the amygdala, to control the amygdala's expressions.I shall firstly discuss predisposing, precipitating, and perpetuating factors involved in the possible etiology of chronic fatigue syndrome (CFS), followed by the patient's experience of the illness. Finally, I shall look at a suggested explanation for the symptoms of CFS.
Posted by Joel Maxuel on November 28, 2002, at 20:27:28
In reply to Re: Stress does what? » Joel Maxuel, posted by Squiggles on November 27, 2002, at 17:12:09
> I took a look at your pics (gaaad talk about
> snail pace) - worth it though; definitely looks
> like a relative's place in Nova Scotia, but alas
> i think it is not, and simply another example
> of retro 60s living; made me very nostalgic for
> a similar place if spent my youth at.
>
> So, it looks like a good place to follow your
> psychiatrist's directions.Akolee, I spent a few months in the city, but yeah, cozy NS.
Thanks for looking at my site.
--
Joel Maxuel
ShamelessPlug(http://www.maxuel.ca);
This is the end of the thread.
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