by Dr. Evelyn Le, ND

Happy Summer! We hope everyone is enjoying the sunshine. This article is hopefully quite relevant to you, as the topic is the healthy management of stress.  In this article, I will recap what we can do to help with moods, stress, and burnout, especially post-pandemic after lengthy wintertime, and we will also dive into how to maintain healthy stress levels throughout the year. 

I want to start by asking you to consider a couple of questions.  Have you ever felt down, and no matter what you do, you still have difficulty getting your mind up, especially in the winter or after a challenging life event? When traveling, have you ever felt anxious before getting on an airplane, especially during and after the pandemic?  Have you ever taken different medications and supplements for mood and brain health but felt stuck within your cognitive circle?  If you are answering “yes” to some or all of these, then it may be time to book a visit and discuss your stress.

Everyone has different triggers and responses to stress, which, if untreated, can lead to chronic mood disorders.  Mood disorders can be acute or chronic and affect an individual’s emotional, psychological, and social well-being and behavior. These conditions include depression, anxiety, and others. According to the Kaiser Family Foundation, mental health conditions have been exacerbated during the COVID-19 pandemic. Many adults in the U.S. reported symptoms of anxiety and depression, with approximately four in ten adults reporting these symptoms in early 2021, before declining to about three in ten adults as the pandemic continued. From February 1 to 13, 2023, 32.6% of adults in Washington reported symptoms of anxiety and depressive disorder, compared to 32.3% of adults in the U.S. (Drake & Panchal, 2021).

I remember feeling so gloomy in the first winter in Washington after many years of immersing myself in the hot and humid weather of Texas. I realized what it meant to have a seasonal depressive disorder (SAD). Roughly 6-8% of Washington State’s total population is impacted by SAD. 

Research shows that depression is common in individuals with vitamin D deficiency (Khan et al., 2022). Except during the summer, the skin makes little vitamin D from the sun at latitudes above 37 degrees north, including the Pacific Northwest, or below 37 degrees south of the equator. People living in these areas are at greater risk for vitamin D deficiency (Harvard Health Publishing, 2008). Vitamin D helps your body absorb calcium, helping you build strong bones and stave off osteoporosis. It is also essential for your immune system and muscles (NIH, 2019). Too much Vitamin D can lead to toxicity presenting with bone pain and kidney problems, so please ask your doctor to test for Vitamin D at least once or twice per year for target dosing. Vitamin D is fat-soluble, so it is better to take it with foods high in healthy fat content. 

The pandemic has added a new stressor to families, communities, schools, workers, businesses, and all other sectors of life that correlates with all-time high burnout and stress (Abramson, 2022). The body is not built for prolonged stress and slowly breaks down the body. I am reminded of the book “Why Zebras Don’t Get Ulcers” by Robert M. Sapolsky. He speaks at one point about how adaptability and resilience can only go so far when dealing with stress and that prolonged or multilayered stress keeps us in a perpetual fight/flight/freeze mentality detrimental to the ability to cope and respond in a healthy and restorative manner. Chronic stress can lead to adrenal insufficiency, thus making you tired throughout the day. The adrenal gland secretes cortisol to regulate blood pressure. Still, during stress, adrenals release excessive cortisol that, over time, becomes overtaxed and can no longer produce the cortisol necessary for optimal body function (Endocrine Society, 2022).

Recently, I traveled to Massachusetts to see my best friend in April. It was the utmost anxiety moment I had not experienced in a long time. The flight was supposed to take off at 11:36 pm. The gate was supposed to close at 11:24 pm. I got to the Sea-Tac airport 1.5 hours early. It was a rainy night that delayed such heavy traffic. The signs of anxiety started to show. My heart pounded when I saw an extremely long line outside the TSA, like a snake folded five times into itself.

I thought I was the only crazy person taking a red-eye flight on Thursday night, but I was not alone. I ran so fast to the train connecting to the gate with my clammy hands holding onto my dear backpack, and I was out of breath. “I probably missed the flight,” I thought. I saw another passenger run up next to me, and we started to race to the gate and encourage each other hysterically. I felt a little comfort that, at least, I was not alone. The clock ticked 11:45 pm when we arrived at the gate.

Thankfully, there were people still lining up. All that hard work was not in vain. Looking back, the weather, long traffic, and long waiting TSA line were out of my control. My physiology was distorted with a fast heart rate, shallow breathing, and dysregulated thermal. You might have experienced different stories with similar themes in your own life. Next time when we see each other in the clinic, I look forward to hearing your stories about anxiety too.  

Here are some useful tips for moods regulation: 

  • Sleep at least 7 hours per night for healthy adults and more than 9 hours for young adults. Sleep accelerates physical recovery from common inflammation, stimulates muscle repair, and helps restock cellular energy through glucose and glycogen (Watson et al., 2015). This book will blow your mind “Why we sleep” by Mathew Walker, Ph.D. 
  • Nutrients such as omega-3 (cold fish, avocado, ground flax seeds, chia seeds, etc.), B vitamins (red meat), antioxidants (leafy greens, berries, fruits, and vegetables), amino acids (peas, chickpeas, lentils, soybeans, peanuts) and serotonin (salmon, nuts, eggs, pineapple, banana) are best captured in natural food sources. 
  • Social engagement with friends, family, and social support groups in a safe and positive environment helps us regulate our nervous system through affective experience, emotional expression, facial gestures, vocal communication, and social behaviors. Check out Dr. Stephen Porges’ Polyvagal theory (Porges, 2009).
  • Battle against stigma. Our society strongly stigmatizes mood disorders, gender groups, political groups, and many more ideologies that make individuals feel discriminated against at work, school, community, and family. Talk to someone, get support, and get help. 
  • A Lightbox mimics outdoor light that can expose 10,000 lux of light with little UV light. You can use it within the first hour of waking up for about 20 to 30 minutes, about 16 to 24 inches from your face. However, follow the manufacturer’s instructions about distance with eyes open but not looking directly at the light (Mayo Clinic Staff, 2020).
  • Talk therapy and counseling are great tools where you can safely share your stories, and together with the guidance of a trusting therapist, you can move forward and shift your framework to a new perspective. Please don’t hesitate to reach out to any provider in our clinic. We can help you find the right resources. 
  • Cognitive behavioral therapy and biofeedback. Biofeedback is a non-invasive treatment technique with a bio-monitoring system and sensors to measure and provide feedback information that enables an individual to learn how to change physiological activity (such as respiration, heart rate variability, blood flow, and blood pressure) (Schoenberg & David, 2014). In the clinic, I couple biofeedback with breathwork and meditation to help patients calm down their fight-or-flight nervous system. 

The bottom line is that there is no quick fix for our stress and anxiety, but there are a number of proactive solutions that you can explore.  If you want more personalized advice, please do give a call and book a visit to discuss.  I’ll leave a few additional resources here for you to look into as well.