In an earlier post, I introduced a broader concept of chronic stress causation than often recognized in medicine. We also learned about the three likely culprits of chronic stress, which cause symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain.

In this post, I want to provide you with a paradigm or road map for three categories of non-prescriptive treatments that support the stress response and reduce or resolve symptoms for nearly everyone who implements them.

1. Lifestyle Therapies for Chronic Stress

Patients with burned-out brain syndrome are typically complex cases, and it is often difficult to know where to begin. Over the last twenty years, I’ve seen better responses when recommending lifestyle and habit changes first.

Exercise

Exercise produces increases in dopamine, norepinephrine and serotonin, which all have direct effects on energy, mood, concentration and sleep. This powerful lifestyle therapy also directly releases endorphins for pain control and brain-derived neurotrophic factor (BDNF), which stimulates growth of new neurons. Few therapies can provide better resilience against stress and anxiety than 30 minutes of exercise three or more times per week.

Sleep

During sleep, the brain performs critical functions in preparation for the next day, including cleaning itself of toxins (autophagy), consolidating memories, growing and repairing neurons with BDNF, and restocking neurotransmitters. Key habits to maximize these sleep functions include getting 30 to 60 minutes of outdoor light each day, blocking blue spectrum light from the eyes at least two hours before bedtime, and avoiding late-night eating.

Fasting

Fasting for at least 14 hours during each 24-hour period improves autophagy, fat metabolism, cellular detoxification and neural tissue growth through increased BDNF release. Teaching patients to eat all food and liquid (other than water) within the same ten-hour window each day can accomplish this.

2. Mind-Body Therapies

Cognitive behavioral therapy (CBT) is a traditional approach to understanding thought patterns and implementing behavior modification, and it has demonstrated effectiveness for pain control, anxiety and depression. While it is a tried-and-true non-prescriptive therapy for these conditions, access to trained and skilled therapists is limited in many areas of the United States.

Mindfulness-based interventions (MBI), which include mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have been shown to be as effective as CBT. These involve learning a non-judgmental approach to thought monitoring and redirecting thoughts to the present. There is a rapidly growing body of evidence that this is a powerful therapy to support the HPA axis and can be implemented independent of worldview or religious beliefs.¹

3. Nutritional Supplements

When evaluating and treating patients struggling with burned-out brain symptoms, many will want to jump right to nutritional supplements, particularly nootropics, but that is often only partially effective, especially in more complex and symptomatic patients.

In all cases, lifestyle habits that include exercise, sleep and time-restricted eating (fasting) are great places to start and some of the best-tolerated therapies. Teaching your patients mindfulness-based interventions then gives them the tools to deal with episodes of high stress and disabling symptoms. Once these approaches have been implemented, the nutritional approaches become far more effective when needed.

I recommend the following supplement options for chronic stress treatment:

• GABA: A primary inhibitory neurotransmitter that produces a calming effect and reduces anxiety, stress, fear and pain
• Magnesium: Releases GABA and is used up quickly during high stress, making most people moderately to severely deficient
• Bacopa extract: Demonstrated effectiveness in improving cognition and memory as well as reducing symptoms of anxiety and depression
• L-theanine: Easily crosses the blood-brain barrier to increase both dopamine and serotonin, which reduces anxiety and improves focus and learning
• Huperzine A: A reversible anticholinesterase inhibitor shown to increase focus, memory and retention
• Kava rhizome extract: Reduces neuroexcitability through a reversible blockade of sodium and calcium ion channels, which reduces anxiety without impairing cognitive functions (as benzodiazepines do)
• Valerian root extract: Can lower cortisol but primarily increases GABA and serotonin as well as activates adenosine receptors and has shown effectiveness for headaches, heart palpitations, anxiety and insomnia related to high levels of stress
• Phosphatidylserine: Plays a key role in neuronal energy production and communication in the brain to improve cognitive function, enhance neurotransmitter formation, and prevent excess excretion of cortisol during a stressful event

The Bottom Line

Should none of these non-prescriptive approaches produce the desired results, it will be necessary to consider functional testing for underlying causative factors, such as HPA axis dysfunction, biotoxins or nutritional deficits. Please refer to my previous post for evaluation approaches.

Christopher Mote, DO, DC, IFMCP earned his doctorate in osteopathy from the Chicago College of Osteopathic Medicine at Midwestern University. He earned his doctorate in chiropractic and Bachelor of Science in human biology from the National University of Health Sciences (NUHS) in Lombard, Illinois, and he is certified in functional diagnostic medicine. With a focus on addressing the root cause of health concerns, Dr. Mote specializes in the diagnosis and treatment of chronic health disorders.

References

1. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008