A 2020 Trilogy for Mental Health: Burnout, to Begin with
As COVID wears on, as election season turns into an election saga, the seasons change and the holidays go from one to the other (and each one seeming more complicated than the last), I think now is a fine time to talk about mental health. There’s just a lot of yuck going around, more than our usual fair share, and it has an impact. In both my herbal practice and in the lives of my medical patients, depression, burnout and anxiety continue to overshadow any other complains or concerns. For that reason, I want to offer some thoughts, ideas, protocols and maybe a little hope for the American humans out there struggling to keep their heads above water right now.
I am a categories person. While not everything in this world fits into a neat little box, I do find that breaking things up into smaller pieces can sometimes be helpful, especially when it comes to the plants, topics in medicine or the hidden depths of our minds and hearts. So I want to talk about three major categories of mental health concerns, all of which are becoming more and more common as we try to survive the rest of 2020 and head into the long Winter ahead. We will do these in different posts, because I want to be sure to give each designation its due.
Let’s dive in. Let’s talk about burnout.
I want to start here because in a lot of ways, I think “burnt out” is a concept that truly captures how a lot of us are feeling right now. Parents are burnt out. Teachers are burnt out. Healthcare workers are burnt out. Voters are burnt out. We have all just become a cesspool of chronic stress and fatigue, even more than we were already. One stressful day leads to another, and we just can’t seem to get a foothold.
Before discussing what to do about it, let’s take a look at why we react the way we do to stressful situations. In the old days, before YouTube and the Tea Party, the biggest stressors humans had in their lives were starvation and becoming dinner for a mountain lion. That was basically it. In order to lessen the chances of those situations happening, our bodies evolved very, very specific responses to environmental stressors that targeted 1) not starving and 2) not getting eaten.
That was basically it.
Here’s a more specific look at what those body responses looked like. When presented with an environmental stressor, the following would occur:
*blood pressure and heart rate go up, to pump blood to the legs to run away from big cats
*hyperventilation occurs, to increase oxygen availability to the aforementioned legs
*Pupils dilate, to see better to run away from or fight the big cat
*Sweating, because the metabolic rate increases and to keep the body cool as temperature rises
All of this happens, with the express goal of not getting murdered by a puma.
And we haven’t even gotten to cortisol yet.
Cortisol is a funky little hormone who’s job it is to do two things: first, while the nervous system is doing all the above stuff really fast, cortisol is “turning down” the rest of the body to focus energy on survival. Second, it helped primitive humans not starve. Remember that the threat of starvation is also a stress state! Cortisol really good at keeping us fat when this stress state is activated
Cortisol turns off the immune system, turns off digestion and turns off our libido. Who needs all that when your fighting for your life? Just an energy waste. It also sends messages to the bones to put calcium into the blood, since our hearts and muscles need calcium to maximize performance. And, of course, there’s whole keeping us fat thing. Cortisol interacts with hormones like insulin, leptin, thyroid hormone and glucagon to delicately manage your metabolic rate, sometimes raising it (like during fight/flight) but sometimes lowering it (like when your body thinks it starving).
So that was all well and good in the times of primitive humans. But in our modern world, our stressors look very different. They come in the form of social media, work deadlines, pandemics, irritating drivers and families. These issues come up, especially this year, multiple times a day. Unfortunately, our bodies are still quite primitive: they only know how to react as if we are all being chased by panthers. For that reason, our nervous systems and hormones are overreacting dailyand without a break.
Our stress response is meant to be a short-term state of being. It’s not meant to go on and on seemingly without end, day in and day out, sometimes for years. The body’s resources go dry after a while. This is burnout – complete denigration of energy stores. Burnout can also include:
-GI upset, constipation
-lack of appetite
-physical and mental exhaustion
-high blood pressure
-weight changes up or down
-sick all the time, weak constitution
These changes occur because our bodies repair, restore and replenish during “rest or digest”. When we get stuck in flight or fight, we completely miss our opportunity to do all our routine upkeep. Add immune system suppression, GI slow down, insomnia and metabolic overdrive, well its no wonder that the body eventually just crashes.
We see here that chronic stress is not the same as anxiety. We will discuss anxiety in the next post, but true chronic stress is a state of burnout. It becomes all encompassing. It is not “mental worry” or obsessive thinking – it occurs when a person is so completely overwhelmed by their environment that their ability to perform normally and maintain health disappear.
Ok. So what to do we do about it.
I want to offer up a protocol for recovery including herbal support, and then I want to spend a little time talking about the responsible use of adaptogens. The protocol below is a starting place for recovery – I will also be posting this under “Other Writings” for ease of use and quick findings.
Chronic Stress and Fatigue:
A Recovery Protocol
Lauren Eadline, FNP-C
Some pearls to remember:
*Burnout is a cold and dry condition – decreased function with atrophy and physiological depression
*Whenever someone is in crisis, their body is in survival mode – they are not going to be able to make huge positive changes all at once. Be patient and compassionate.
*Initial herbal therapies must be geared towards supportingdeeper recovery, not as a substitution for that recovery
*Our interventions are geared towards encouraging the return of homeostatic function and rebalancing the nervous system
1. What can be done to remove the stressors?
-This may be limited by the circumstances
-Can the relationship, job, toxic environment be left?
-What support systems can be utilized/created otherwise
-Psychotherapy, support groups, tribe, etc.
-Folks with burnout need sleep as the first fundamental intervention
-Sleep allows the liver and adrenal glands to rebuild energy stores and focus on tissue repair
-Sleep is a major obstacle for those facing chronic stress:
Hypnotics: herbs that promote sleep
1. Valerian root
4. Kava Kava
6. California Poppy
3. Vitamin Supplementation: goal is to promote tissue repair and replenish energy stores
4. Dietary Intervention
-Goal is to promote healthy return of parasympathetic dominance and replenish energy stores
-Proper gut function also mandatory for serotonin production
-Folks with burnout do not digest well – bringing back healthy digestion takes time
-Stress disrupts the microbiota – consider supplementing with probiotic foods/capsules
-Chronic cortisol depletion leaves the body prone to inflammation caused by food:
-Anti-inflammatory food choices/diets
-Rule out food intolerances
-Increase protein to help rebuild energy stores and repair damaged tissue
-Warming, easy to digest foods that are high in protein?
-Consider soups/stews as first line
-Tea can be helpful for some and impossible for others
Warming Aromatics – cold bitters not always appropriate for this population of peeps
3. Mint family
4. Ginger (with care)
5. Herbs for Constitutional Support: What is the picture of a person struggling with burnout?
Dry – atrophied tissue
Oily, moistening, nutritive herbs to put life and nourishment back into worn out tissues. Many moistening herbs are also cold, so use with care:
b. Mullein Root
c. St. John’s Wort
d. Milky Oats
Cold – depressed function
Gently warming herbs to bring tissues back to proper function and revive the vital force
a. Kava Kava (relaxant)
b. Ginger (with care)
c. St. John’s Wort
6. Herbs to Promote Relaxation and Calm: Nervines
-Verbena – white and blue
7. Once Energy Stores are Replenished….
-Maintaining healthy pattens – sleep, food, supportive environment
-Reintroduction of mild exercise with caution regarding oxidative stress
-Consider clarifying herbs like Holy Basil (Tulsi)
In future posts on anxiety and depression we are going to talk more about some of the groups of herbs I mentioned above, including nervines, aromatics and the mint family. In this post, however, the herb family of focus is adaptogens.
Adaptogens are a tricky thing. They are one of the most popular categories of herbs in commerce today, whether sold as supplements, tincture or the latest additive to your energy drink. Their claim to fame is, well, just that: an energy boost.
And adaptogens do that really well. Really, really well.
And on the surface, this looks like the perfect treatment for folks in burnout. Because folks in burnout sure are exhausted.
But with the exception of tulsi, ashwaganda, and the “immune modulating” plants such as astragalus and codonopsis, adaptogens can easily throw the body into a further state of energy debt because they increase energy output and make you feel a whole lot better but do not actually increase energy stores. So you and your adrenal glands feel like you’re 16 again, but you’re not, and since you’re still not sleeping and still not spending a great deal of time in “rest and digest”, your body is not actually healing. All you’ve done is “adapted” to the stressor. That being said, there are times during burnout when the use of adapotgens is a really good idea, and when used for short periods of time, can be life-saving.
To me, adaptogens are “herbs for strength and courage”. When someone is in an environment, relationship, workplace or other situation that is, as we discussed them, causing a state of endless stress, there are times when adaptogens can help modify the effects of those environmental triggers. Short-term use of adaptogenic herbs can help us to do one or all of the following:
-get the hell out of a terrible situation
-be more resistant to the bad effects of a bad situation
-be more receptive to (or have the energy implement) foundational interventions
-after energy stores have been replenished, they can help guard against future stressors
Worthy goals indeed! My favorite folks for adaptogens are the ones who need to find the courage to quit a job that’s killing them, or need to hang in there during a crisis just a little longer, or are finding themselves bogged down by their own fears on their journey towards reaching their dreams.
In other words, use adaptogens for short periods of time when someone just needs to freakin’ rally.
Like all of us do, until that New Year’s Eve ball drops, signaling the end of this crazy year.
Remember when giving adaptogens that they do not take the place of sleep, nutrition, or counseling. They should be given alongside these interventions. When there is neuro-endocrine damage as a result of chronic stress, adaptogens can also be used short-term once a person has recovered from energy debt to restore the endocrine system back to good working order.
Some commonly used adaptogens including Siberian ginseng, American ginseng (lots of other uses here besides adaptogenic), rhodiola and Schisandra.
For further reading about adaptogens, I highly recommend the following sources:
Paul Bergner: https://traditionalroots.org/files/2015/05/Bergner-Dark-Side-Adaptogens.pdf
Lisa Fazio: https://therootcircle.com/blog/2018/4/28/adaptogens-and-the-many-ways-we-dance-with-life
For a fabulous, in-depth review of the Endocrine system including a great Materia Medica on adaptogenic herbs at the conclusion, check out Evolutionary Herbalism’s lengthy but worth-it manifesto: https://www.evolutionaryherbalism.com/wp-content/uploads/2016/11/The-Endocrine-System.pdf
Thanks for stopping by everyone! Be sure to check back in over the next few weeks as we discuss protocols for anxiety and depression. Be safe and stay well :)