Dealing with stress

As the senior clinician at the Center for Affective, Stress, and Sleep Disorders (ZASS) in Basel, Dr Johannes Beck treats patients suffering from conditions such as stress and professional burnout. Sleep plays an important role as an indicator and a means of delivering treatment. As the psychiatrist explains, “Sleep disorders are among the most common symptoms of depressive disorders. Poor sleep precedes a depressive episode, and it is not unusual for sleep disorders to persist even after the depression has receded.” Most people suffering from depression report having trouble getting to sleep at night, problems sleeping through and waking up early in the morning. However, atypical forms of depression may be associated with an increased need for sleep.

“Not all depression is the same”

Although the “disorder” may manifest itself in a similar range of symptoms, its biological causes and progression vary. “Not all depression is the same,” Beck says. “We try to offer each patient a targeted form of treatment. Its progress is monitored and, where necessary, it is altered and adapted as soon as possible if it is not proving effective.” The aims are to reduce the length of time the patient is ill and to restore their quality of life more quickly. Research findings show that recording of brain waves during sleep (sleep EEG) can yield valuable markers for progression, response to treatment, and risk of relapse among patients suffering from depression.

Another strategy looks at the so-called stress axis. As a product of evolution, this hormonally controlled system is fundamentally “a good thing”, according to Beck. In a pressurized situation, cortisol is secreted by the adrenal cortex, leading to heightened responsiveness – “fight or flight”. Sugar is released, while energy-consuming processes such as inflammations are scaled back and postponed. This is pure stress – ideal for dealing with the sort of life-threatening situations we faced in the past, such as running into a sabertoothed tiger, but harmful when it becomes chronic, due to pressure of deadlines and volume of work, and the alarm system remains permanently switched on. The consequences range from difficulty concentrating, anxiety, and poor sleep through to depression and accompanying physical illnesses such as high blood pressure. It is a vicious circle.

The primary aim is to measure progression and to draw conclusions with regard to treatment. Depression is accompanied by a rise in cortisol levels, while typically sleep EEGs show a change in frequency of eye movements during the so-called REM phases. Together with the Max Planck Institute of Psychiatry, the Center is working on sleep EEGs to identify typical indicators. With the help of extensive hormonal tests, it is also becoming possible to make predictions about treatment outcomes at an early stage.

Students as fitness consultants

Beck is excited by evidence that there is a simple treatment that can be clearly shown to have a positive impact on stress: sport, which brings down stress levels. After regular endurance training, people’s mood improves, their brain recovers, and they sleep more deeply. It is not necessary to run a marathon— half an hour’s exercise three times a week can make a significant impact. Beck is delighted to report that twelve weeks of endurance sport can also help to remedy the cognitive deficits that are still measurably present after burnout or depression, even when people are no longer exhausted and are back in a good frame of mind.