Chapter 159
Promoting Mental Health — 7
The brain-gut microbiome axis is likely playing a bigger role than anticipated for our response to stress. From combined analysis of multiomics of fecal samples (DNA, RNA, metabolomics) and brain MRIs in over one hundred participants, certain bacterial species and their metabolites were correlated with resilience to stress or vulnerability to depression and anxiety symptoms. Whether pre- or probiotics can promote resilience to stress needs to be assessed, but, if confirmed, this will further highlight the gut microbiome’s impact on our mental health.
Given what we have learned about the GLP-1 family of drugs for obesity, we have to wonder what influence they may have on mental health. All the data reviewed by regulatory agencies thus far do not support this drug class leading in any way to depression or suicide. On the other hand, this family of drugs’ ability to suppress systemic and brain inflammation, a well-recognized feature of depression, along with improvement in self-image after substantial weight loss, may ultimately prove to be important for reducing depression and anxiety.
Obviously, we need drugs that can do that. The mental health toll of the COVID pandemic and climate change have taken the burden of stress, anxiety, and depression to new heights. A global survey for eco-anxiety found that 60 percent of people are extremely or very worried about climate change. There’s no shortage of speculation about secondary ill-effects increasing vulnerability to diseases. For example, does anxiety or depression increase the risk of cancer? While this has been generally accepted as true, an important analysis of all the data available across eighteen cohorts, involving more than three hundred thousand participants, indicated it’s not the case, apart from lung and smoking-related cancers. But it’s not so clear-cut. Although chronic stress activates the immune system, it appears to do so in a way that disrupts the ability of our immune cells to fight cancer and may impede cancer treatments. “Good stress” is adaptive and helps build resilience, ability to cope, and neuroplasticity. In contrast, “bad stress” is maladaptive, which is a way of saying that it has a negative biologic consequence. Chronic bad stress is a trigger for mood and anxiety disorders, which increases vulnerability for diabetes and cardiovascular disease. In a study of more than 211,000 people in Sweden with over twenty years of follow-up, nearly 8 percent developed depression, anxiety, and stress-related disorders. These individuals had significantly higher blood glucose levels and triglycerides as well as lower HDL values, raising the possibility that metabolic dysregulation is associated with risk across the spectrum of these mental health conditions. But how do we know if our response to stress is healthy (“good”) or bad? Maybe there is a new technological answer.
FROM DIGITAL TRACKING TO CHATBOTS
Depression, anxiety, and stress-related disorders have traditionally been diagnosed and monitored subjectively, through self-report and interviews. Wearable sensor technology has been making significant inroads to provide objective metrics such as activity and sleep patterns, frequency and duration of phone and text interactions, light exposure, heart rate and heart rate variability, galvanic skin response (electrodermal activity), smartphone facial expression mood capture, emotions via voice tone and inflection, and sweat biomarkers.