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Stress has taken over: How canI turn my mind off?

Asked by Cindy, Montana

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Somehow I have managed to let stress take over my life. I have several issues to deal with -- a lot of people, financial problems, health problems, family issues, etc. -- but over time I have been worrying and stressing over them constantly. I can't seem to turn my mind off. It feels like I am surrounded by hundreds of little stress monsters, and they constantly fire little stress arrows into my brain. I know that sounds weird, but it's almost like they are competing to be the No. 1 stressor. Sometimes this goes on late into the night, preventing sleep. I guess it would be called "racing thoughts." How can I turn my mind off?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

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Dear Cindy,

If you came to my office with exactly these complaints, I'd empathize with your situation, but before much time had passed, I'd start asking you about other symptoms of major depression. Why? Because studies show that one of the most sensitive questions for detecting depression in someone is simply to ask him or her if they've been feeling very stressed out over the last couple of weeks. Most people who are feeling hugely stressed out are actually depressed. And if the stressed-out feeling has been going on for more than a few weeks, it's time to think about treatment.

Notice what I have done. I have shifted attention away from the external world, where you feel that your problems exist, toward the internal world of your brain and body, where changes in physical functioning have made your world seem unmanageable. It is this feeling of unmanageability that is a hallmark of depression.

Your well-said observation that "it's almost like your problems are competing to be the No. 1 stressor" is also a very classic mental marker for depression. When we are not depressed, we see our challenges as discreet entities that can be tackled one by one. When depression sets in, our problems seem to melt into each other until we are faced with one hellish soup of difficulty.

Please recognize that by shifting my focus from your problems to your internal state I am not making light of your problems, but only suggesting that getting you into fighting shape is the best way to handle what you have to deal with.

Let's consider an analogy. Suppose someone was given the task of running nonstop from point A to point B. The challenge is that point B is atop a mountain, and point A is in the valley. One approach to making things easier would be to dynamite away the mountain a bit at a time until point B had been brought down to the level of point A. This would be analogous to resolving all of one's real world problems.

But wouldn't you agree that rather than spending years dynamiting away the mountain, a better tack might be for someone to begin to exercise until he or she is in good enough shape to run up the mountain? In this analogy, beginning to exercise is equivalent to building internal resilience to be able to cope with the problems as they are. And the best way to build resilience when one is depressed is to get rid of the depression. When depression departs, one's problems look amazingly more manageable.

We toss the word "depression" around a lot, as if we all know what it feels like to be depressed. But in fact, depression has a number of emotional faces. Sometimes it feels like the kind of sadness that makes you cry. More often it feels like a type of dull dread of the world. Often it mostly manifests as a feeling that one is really unworthy to be taking up space on the planet. And very frequently it presents itself as a feeling of overwhelming stress, a feeling that one's problems are beyond dealing with. The fact that this last feeling is so common in depression explains why being "stressed out" is such a good marker for major depression.

There is an explanation for why depression so often manifests itself as feeling stressed out. If you look at the bodies and brains of depressed people, often they look as if they are being perpetually chased by a tiger. That is, their stress systems are on constant hyperdrive. This constant stress hyperdrive continually signals the brain that the world is dangerous, and after a while, the brain completely believes it. This is why it is so hard to get a grip on the kind of racing thoughts you mention.

So in terms of practical advice, rather than trying to tackle all your difficult problems at once, I'd recommend seeing your doctor so that he or she can evaluate whether you indeed have developed a depression.

Your doctor will ask about whether you've been feeling down or blue, whether you've lost interest in things you usually enjoy, whether you feel guilty or especially down on yourself, whether your sleep and appetite are disturbed, whether you feel exhausted most of the time, whether you are having trouble concentrating and whether things have gotten bad enough that you've thought some about ending your life.

If most of these symptoms sound familiar, it is likely that you are depressed and would benefit from either psychotherapeutic or medicinal treatment.

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