Neutralize Doctor Stress Naturally
Patricia Gerbarg, M.D., is an assistant clinical professor of psychiatry at New York Medical College. Richard P. Brown, M.D., is an associate clinical professor of psychiatry at Columbia Presbyterian College of Physicians and Surgeons. They are the editors, along with Philip R. Muskin, M.D., M.P.A., of Complementary and Integrative Treatments in Psychiatric Practice from APA Publishing. APA members may purchase the book at a discount. Muskin is a professor of psychiatry at Columbia University Medical Center, APA secretary, and editor of PsychoPharm.
From the first day of medical school until the last day of professional practice, physicians work under intense stress. The high rates of burnout, depression, suicide, and diseases of aging that affect medical students and physicians also impact the care given to patients. Efforts to improve doctors’ health have highlighted lifestyle, diet, exercise, and rest, but many find that financial and career pressures preclude time for regular exercise, healthy meals, or a good night’s sleep, particularly during training. The same stressors and lack of time erode relationships and take a toll on physician families.
Natural treatments requiring very little time can support health under stressful conditions. Safe, accessible, and inexpensive, the following evidence-based complementary and integrative approaches reduce adverse effects of stress on the mind and body.
Best Picks for Busy Docs
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Herbs: Adaptogenic herbs contain bioactive compounds that help organisms adapt to multiple stressors. Among this elite class of phytomedicines, Rhodiola rosea best supports a physician’s needs for physical and mental energy, endurance, alertness, and focus. For example, R. rosea markedly reduced errors over 12 hours of repeated stressful cognitive testing in a study of Russian college students. Unlike synthetic stimulants, R. rosea causes neither addiction nor withdrawal. By improving cellular production of high-energy molecules, this herb sustains functioning over time and fuels cellular repair systems, thus counteracting adverse effects of damage from free radicals, toxins, chemotherapy, and radiation exposure.
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Nutrients: S-adenosylmethionine (SAMe) is a natural metabolite that donates methyl groups for DNA methylation and for production of crucial molecules (for example, neurotransmitters, phospholipids, and amino acids). A literature review by members of the APA Council on Research and the APA Caucus on Complementary and Integrative Medicine in Psychiatry confirmed previous findings of efficacy for depression, lack of common side effects (weight gain and sexual dysfunction), and growing evidence of cognitive improvement in age-related decline and dementia when combined with other nutrients. Anecdotally, in clinical practice, we found the 1-4 butanedisulfonate SAMe formula to be the most effective.
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Mind-Body Medicine: Mind-body practices—yoga, qigong, tai chi—are ideal activities for physical and emotional health, but who has the time? Below are some ways to quickly nourish the mind, body, and spirit without losing time from work or study.
When you feel sluggish or unfocused, a few minutes of shaking and vigorous tapping, especially with upbeat music, can wake up the mind and body.
Breathing slowly and gently through the nose with eyes closed for a few minutes, particularly coherent breathing at four to six breaths a minute with equal time for inhalation and exhalation, reduces acute stress, worry, frustration, anger, and rumination. Practicing coherent breathing for 20 minutes five days a week balances and strengthens the stress response system, lowers blood pressure, and may reduce inflammation. Breath-pacing tracks or apps can be downloaded. In addition to eyes-closed practice, coherent breathing can be done inconspicuously with eyes open while waiting, walking, writing, or riding a bus or train. We recommend coherent breathing to relieve anxiety before, during, and after exams because it induces a state of calmness with enhanced mental focus and cognitive functioning.
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Technology: Despite feeling exhausted, doctors often find it difficult to quiet their minds enough to sleep. Mild cranial electrotherapy stimulators (CES), no bigger than a smartphone, help reduce anxiety and insomnia. CES can be combined with coherent breathing for even better effects.
Stay Smart Naturally After Age 50
Maintaining cognitive and memory performance is crucial for patient care as well as for keeping up with the onslaught of new information and new technologies. Most physicians become aware of gradual age-related declines in memory and cognitive function before the age of 60. Cerebrovascular disease, dementia, and other conditions that accelerate brain aging may threaten a physician’s fitness to practice. In addition to the well-known preventatives—vitamins, omega-3 fatty acids, polyphenols, healthy diet, and exercise—certain herbs and nootropics (brain enhancers) can improve and prolong optimal functioning.
Best results can be achieved by strategic combinations of nutrients; adaptogens, such as R. rosea, Schizandra chinensis, Eleutherococcous senticosus (Acanthopanax), Panax ginseng, Withania somnifera (Ashwaganda); and other herbs, including Ginkgo biloba, Lepidium meyenii (Maca), and Bacopa monniera.
Reduced perfusion due to cerebral vascular disease after age 60 is a common MRI finding. Insufficient blood flow contributes to neuronal senescence and a decline in performance, particularly under stress. Picamilon, a cerebrovascular dilator synthesized from gamma-aminobutyric acid and niacin (B6), can improve alertness, mood, and cognitive function.
Centrophenoxine, an ester of dimethyl-aminoethanol and p-chlorophenoxyacetic acid, protects cell membranes from oxidative damage. In aging rats (16 and 24 months old) it significantly increased multiple unit activity in hippocampal CA3 while decreasing lipofuscin concentration and lipid peroxidation. Low in side effects, centrophenoxine complements the benefits of other cognitive enhancers and may provide neuroprotection as the brain ages.
Stress Resilience Naturally
Complementary and integrative medicine (CAIM) can promote physician health, stress resilience, and professional performance. These approaches are particularly suited to the needs of physicians because they tend to be low in side effects and, therefore, unlikely to interfere with professional duties. Also, they do not require prescriptions. Physicians who incorporate CAIM into self-care and patient care may access APA courses, publications, and the APA CAIM Caucus for evidence-based information and treatment guidelines. ■
Author disclosure: Gerbarg and Brown receive no financial remuneration from any companies that manufacture or market herbs, nutrients, nootropics, or brain stimulators. They teach mind-body courses that include coherent breathing. Brown holds a patent with Humanetics for the use of 7-keto DHEA for PTSD.
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Psychiatrics News
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Published online: 3 August 2018
Published in print: July 21, 2018 – August 3, 2018
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