‘Environmental factors can make a huge difference’

METRO DETROIT — Conditions such as stress and anxiety can often be easy to ignore or write off as minor problems. However, this April, which is Stress Awareness Month, medical experts want to remind people that caring for their mental health can be as important as caring for their physical health.

Dr. Jeffrey Guina is the program director of the psychiatry residency training program at Corewell Health. He said that while some people have higher risk factors for stress than others, it is a condition that can affect anyone.

“Whenever I think about risk factors for anything, I step back and think about things biologically, socially and psychologically. It is both nature and nurture at play. Some risk factors include genetics. We’ve identified certain genes which are associated with higher risks of stress or higher risks of anxiety disorders or depressive disorders. A lot of these affect serotonin dysfunction, which can affect emotional regulation. Other genes affect cortisol, which is our body’s primary stress chemical,” Guina explained. “If someone has a family history of conditions like PTSD or depression or anxiety, they may be at higher risk of developing disorders themselves. … Environmental factors can make a huge difference. Personal history like child abuse or neglect or trauma from combat can cause a lot of recurrent stress and anxiety in people’s lives.”

Dr. Asha Shajahan, the medical director of community health for Corewell Grosse Pointe, said that stress can have numerous effects on both the human mind and the human body.

“When you get stressed out, people get that fight-or-flight response,” she said. “Your body is fully alert, but different parts of the body are affected by this. Muscles tense up, for instance. This can, when this stress is frequent, can cause headaches or muscle aches, because it happens so often. You also can get rapid heart rate or rapid breathing issues. This can induce panic attacks or cause blood pressure to increase. That in turn can lead to heart attacks or strokes.”

Shajahan went on to say that the effects can be wide ranging in ways most people don’t think of.

“It can affect the brain-gut health,” she said. “The bacteria that grows normally are affected, so people can get stomach aches, bloating, diarrhea and so forth. The increase of certain hormones and the reduction of others can cause problems including obesity, diabetes or harm your immune system.”

“Not getting enough sleep is another big risk factor,” Guina added. “(Not) getting enough rest, with no TV or radio or phone exuding light, can make our sleep less deep, restful and restorative. Nutrition and exercise are both important factors when dealing with anxiety and stress. Exercise releases endorphins and ensures you get good nutritious meals and makes sure we get all of the right building blocks of serotonin, like B12 and protein; then our body can’t make enough of it to help us regulate emotions and our sleep.”

Guina said that among the worst factors that can come into play can be using or overusing a substance to try to artificially control stress and anxiety.

“Substance abuse is often a vicious cycle,” he said. “People use substances when they are stressed, which abates it in the short term, but as they develop it as a habit, it can cause dysfunction in their lives, which increases stress in the long term. As Michigan has recently legalized marijuana, people think it reduces stress, but in my experience, it does the opposite. Most studies show it worsens anxiety in the long term, and irritability is one of the chief symptoms of its withdrawal.”

Both Guina and Shajahan said one of the most important things for people living with stress and anxiety to do is find healthy relaxing activities.

“The biggest thing is finding something to help you relax,” Shajahan said. “That tenseness or gut problems needs to be addressed. Regular exercise and proper sleep are the two big things people should be doing. Finding things you enjoy doing, whether it’s going out in nature or spending time with family, also is important. You need those things that help you relax.”

“Avoiding those negative things like drugs and alcohol. Seeking support and social activity can help. Friends, family, clergy or psychological professionals can all be part of a good support network,” Guina added. “Formal treatments can be important in a lot of cases, which can include medication. There are dozens of medications which can help with stress and anxiety. Medication is rarely a magic bullet to eliminate a condition like anxiety, but it can be a key component.”

Both experts don’t want people to panic about conditions such as stress, since there are treatments, medications and lifestyle changes that can help. However, Guina pointed out that ignoring such issues can have dire consequences.

“Life is difficult. You may think you’ll deal with it later, but there’s a good chance that more stress is around the corner. Unresolved stress or trauma can only pile up with the new. This can mean not keeping up with school or work. You can be irritable or on edge, and it can affect friendships, family relationships or romantic relationships. It can also become internalized and cause social issues and people isolating themselves. We saw a lot of that during the pandemic as people isolated by necessity and had job insecurity. Sites like gyms and places of worship were closed, but liquor stores and marijuana dispensaries were still open, so a lot of people developed poor coping mechanisms,” he said. “Don’t forget that self-harm or suicide can be extreme results from (stress and anxiety). It’s not something that everyone will have to deal with, but for some people, that can be the end of this road if these issues go untreated.”