Targeted Exposure to Stress Can Improve Depressive Symptoms

Introducing time-limited adaptive stressors through therapies such as psychedelics and whole body hyperthermia (WBH) has demonstrated a profound effect on patient well-being, but efforts to sidestep stress often overshadow these approaches in today's society, Psych Congress 2020 cochair Charles Raison, MD, said at the virtual conference.

Rather than mimic evolutionary history that rewarded species-typical stress that promoted survival, today's humans are lured to conveniences that make life easier but can worsen rather than enhance emotional health, said Dr. Raison, the Mary Sue and Mike Shannon Distinguished Chair for Healthy Minds, Children & Families at the University of Wisconsin-Madison.

“If we don't find ways to re-expose ourself to these types of adaptive stressors, we see what we're beginning to see, which is a rise in depression, especially in young people,” he said. This results in part from important social connection being replaced by more distant communication online among youth, he said.

Offering a comparison relevant to COVID-19 and other infectious diseases, Dr. Raison explained that while vaccines act by stressing existing immune mechanisms safely, antibiotics import new mechanisms into the host and can produce high rates of adverse events, with overuse diminishing their effectiveness over time. Similarly in depression treatment, while antidepressants remain necessary for patients at higher levels of severity, “we have been overly heavy on the side of these treatments that you have to take continuously, and that are much better at treating the disorder than preventing the disorder,” Dr. Raison said.

WBH and psychedelics are among treatments that appear to work more like vaccines and less like antibiotics, Dr. Raison explained in his session. Numerous cultures have seen the wellness benefits of relatively brief but intense exposure to heat, through sweat lodges, saunas, hot yoga and the like.

These benefits have been backed by clinical research: A study published in 2016 in JAMA Psychiatry showed that patients receiving WBH experienced significantly greater declines in depressive symptoms at 6 weeks than patients who received a sham heat treatment, he said.

Seminal research on psychedelics (specifically, psilocybin) at Johns Hopkins and New York universities has found that administration of 1 or 2 doses leads to long-term improvements in depression and anxiety, Dr. Raison said. During facilitated sessions in which patients are administered psilocybin, research subjects often will confront difficult feelings that they had formerly pushed aside, but this short-term struggle can produce long-term benefit.

Research on use of psychedelics in nonclinical settings has revealed that “the more difficult the experience was, the better [users] felt afterwards,” Dr. Raison said. He added, “There's a feeling that their lives have a meaning that wasn't necessarily apparent to them before.”

Active ways to introduce adaptive stressors, such as through patient fasting or exercise, also generate antidepressant effects, Dr. Raison said. But these interventions can be challenging to implement and sustain in individuals who are struggling.

“We need to add treatments that behave more like vaccines to our current treatments that behave more like antibiotics,” Dr. Raison concluded, adding there is good evidence that antidepressant use over time in some patients leads to drug resistance similar to what is seen with antibiotics.

—Gary Enos

Reference

“Evolution, Adaptive Stress and the Future of Depression.” Presented at Psych Congress 2020: Virtual; September 13, 2020.