The Chemistry of Stress

Understanding the chemistry of stress begins with an appreciation of molecules in our bodies called neurotransmitters.  Dubbed “molecules of emotion” by the scientist who first discovered their existence, Dr. Candace Pert, these are produced throughout our bodies, most notably in the brain and along the gastrointestinal tract.  One of the neurotransmitters, serotonin, seems to have been installed in us to lessen our physical response to stress.

The so-called ‘stress response’ gets triggered when the adrenals, a pair of walnut sized glands atop the kidneys, receive distress messages from the brain.  The adrenals release adrenalin (ephineprine) and cortisol, two hormones that in turn initiate the well-known ‘fight or flight’ response.  The ‘fight or flight’ symptoms are familiar: rapid heart rate, muscle contraction, cold hands and feet, racing thoughts. As uncomfortable as these symptoms may sound, in the right situation they are useful.  For example, escaping a street mugging, or (if you are a deer in the woods) the sound of a hunter’s footsteps.  The stress response was designed to be an ‘on-and-off’ event.  Originally, it was not designed to deal with chronic stress.

However, as we developed as humans, chronic stress did enter our lives.  One can envision prehistoric man hunting for days in the wilds and biologically in need of a system to keep a cool head.  Enter serotonin.  This useful neurotransmitter seems to act as a buffer against stress, allowing us to perform in challenging or even threatening surroundings.  Consider Agent James Bond as the prototypic individual with plenty of serotonin to spare.  Despite flying bullets and exploding cars, Mr. Bond never breaks into a sweat or fails to perform sexually.

The situation developed differently for women.  Probably because she was back at the cave, doing some gardening and taking care of the kids, instead of hunting with her mate, prehistoric women never needed to develop serotonin levels equal of men.  Indeed, measurements of spinal fluid serotonin confirm that women have only 25% that of men.  And this is a problem.

Low levels of serotonin are unfortunate considering the difficulties confronting women in contemporary times.  During the past fifty years, the day-to-day stresses faced by women vastly exceeds that of men. As many women in their forties will report, coping skills are stretched thinly. Contemporary women are wage earners, and unlike their spouses, are responsible for home, family, and aging parents (both hers and his). In addition, around the world, women exist in societies that condone gender injustice to the extent they often fail to recognize what’s happening around them. Underpaid, overworked, victims of fraud, rape and other violent crime, sexual inequality has become so institutionalized, that most women don’t even get irritated that they feel nervous about riding public transportation, going to a movie, or having a beer in a bar without male ‘companionship.’

These, and dozens of other daily injustices, contribute in no small way to the ongoing stress issues women experience. And the symptoms that follow.

It has been estimated that some 40% of the population is susceptible to a whole menu of what are termed ‘serotonin related disorders (SRD).’ Understand however, that being susceptible to an SRD is not the same as actually having one. This is because in order for an SRD to manifest itself, something stressful in one’s life usually occurs beforehand. For example, the first SRD described in medical literature was clinical depression. But virtually everyone who has sought treatment for depression will relate a stressful triggering event (divorce, losing a job, death of a loved one). In other words, they were biochemically unprepared to deal with the stress.  And the treatment, as you may be anticipating, is a ‘something’ to raise levels of serotonin. Enter Prozac (or Paxil, Zoloft, Celexa and others).  These simply raise levels of serotonin within the brain. If you don’t have a SRD, these medications simply don’t do much of anything.

Susceptibility to the serotonin related disorders run through families, especially among the women, like fault lines running through California. When family trees are explored, multiple generations may suffer from depression, fibromyalgia, alcoholism, panic attacks. Symptoms can certainly begin in childhood and the complaints of the little girl who has “tummy aches” on Monday morning before school should not be ignored. These SRDs, both emotional and physical, account for the reason that women are by far the main users of the American health care system.

The emotional SRDs include: depression, generalized anxiety disorder (GAD), panic disorder, and obsessive-compulsive disorder (OCD). Since alcohol and tobacco dependence, as well as overeating, are all unhealthy stress ‘coping mechanisms,’ these three are often included in the SRDs. As serotonin is needed for the development of brain cells, patients with an SRD often report “feeling more intelligent” within two months of starting medication.

The physical manifestations of serotonin related disorders are really not diseases but rather exaggerations of the “fight and flight” response. For example, the widespread muscle pain of fibromyalgia is triggered by the constant outpouring of adrenalin on the muscles (“I always carried my stress in my neck” is heard by every doctor who treats fibro). But part of the stress response includes racing thoughts, triggered by cortisol which, on a long term basis, actually blocks short term memory (“fibro fog”). The adrenalin released during a stress was originally designed to evacuate the intestines (“It scared the s—t out of me”) which may be useful if you are a deer trying to escape being shot but not so helpful if you are about to have a job interview or a final exam.

The physical SRDs now include fibromyalgia, chronic fatigue (from adrenal exhaustion), irritable bowel syndrome, sleep disorders, migraine headaches, and temporomandibular joint dysfunction. With each of these, as well as the emotional SRDs, there is a general female predominance, and, importantly, no “positive” diagnostic tests. There are no positive tests because (and this is very important to remember) there is no disease present. These conditions are all exaggerated responses to the fight and flight phenomenon.

Although it’s comforting to know that no actual disease is present, ironically, this lack of illness is not particularly helpful to the woman whose life is made miserable by her fibromyalgia, learns that her tests are fine and is told “there’s nothing wrong with you.” And, since her doctor feels compelled to do “something,” she’ll likely leave the encounter with that “something” being a prescription to suppress her symptoms or calm her down.

Holistic medicine comes in handy right at this point. Holistic medicine is not alternative medicine (although practitioners will frequently recommend alternative therapies) but rather a philosophy of healing that addresses the whole person. One of the axioms of holistic medicine is that most symptoms are not signs of a disease somewhere, but rather a message from your body that it requires some action of your part. Pay attention to the message, so says holistic medicine, and the symptom will, more often than not, simply disappear. A smoker’s cough is an excellent example of the phenomenon, being your body’s irritation at being compelled to inhale the smoke of burning leaves. Taking a cough drop clearly misses the point of the message. Ignoring the body’s symptoms (messages) is similar to taking your telephone off the hook when someone is trying to call and tell you your house is on fire.

That said, the exaggerated stress responses of the SRDs can be viewed as messages. If your migraines are triggered by missed meals, eat regularly. If you’ve intestines churn because you overextend yourself, learn the art of saying “No.” Consider how complicated you are. Your fibromyalgia may require medication to control pain (a source of stress in itself) but you may also need a few months of Prozac or St. John’s wort to shore up your serotonin levels, herbs to deal with your PMS (yet another stressor) as well as some counseling sessions to teach you coping skills.

It’s very useful to remember that by and large, we are an extraordinarily healthy society. Good nutrition and sanitation have virtually eliminated illnesses that wiped us out a century ago. Before you reach your Medicare years, your likelihood of developing a serious illness is, thank God, quite small. Symptoms, on the other hand, beset us constantly and throughout our lives, and keep the waiting rooms of doctors full. But most of these symptoms are messages, and when you listen carefully to the content of the message, underlying will be the request for you to consider stress and its effect on your life.