ABSTRACT
We release hormones such as adrenaline and cortisol in response to stress-a smart evolutionary adaptation that triggers rapid physiologic changes such as increased heart rate and blood pressure, and redirects blood ow to your muscles so that you may ght or ee. For more than 50 years, scientists have agreed that psychosocial stressors are the most potent activators of the stress feedback loop, known as the hypothalamic-pituitary-adrenal (HPA) axis.1 However, the alarm can backre:
Introduction .................................................................................................................................... 171 Normal Regulation of HPA Function ............................................................................................. 172 Allostatic Load ............................................................................................................................... 173 Pregnenolone Steal ......................................................................................................................... 173 HPA Dysregulation in Mood Disorders ......................................................................................... 173 General Adaptation Syndrome ....................................................................................................... 174 Evaluation of HPA ......................................................................................................................... 174
Gathering the Patient’s Story .................................................................................................... 174 Laboratory Investigation ........................................................................................................... 175
Summary of HPA Dysregulation in Mental Health ....................................................................... 177 Other Conditions Linked to HPA Dysregulation ........................................................................... 178
Lifestyle Interventions .............................................................................................................. 178 Dietary ....................................................................................................................................... 178 Carbohydrate Timing ................................................................................................................ 179 Alcohol ...................................................................................................................................... 179 Exercise ..................................................................................................................................... 179 Meditation ................................................................................................................................. 180 Religion and Spirituality ........................................................................................................... 180 Sleep .......................................................................................................................................... 180 Yoga........................................................................................................................................... 181 Supplements .............................................................................................................................. 181 Dehydroepiandrosterone ........................................................................................................... 181 Ketoconazole ............................................................................................................................. 181 Melatonin .................................................................................................................................. 182 Phosphatidylserine (or Phosphorylated Serine) ........................................................................ 182 S-Adenosyl Methionine (SAMe) .............................................................................................. 182
Conclusion ..................................................................................................................................... 182 Acknowledgments .......................................................................................................................... 183 References...................................................................................................................................... 183
The HPA is more vulnerable than once realized under the threat of chronic psychosocial stress, which may cause HPA dysregulation and thereby signicantly compromise mood and health.2 Untangling what we know about the HPA and its positive and negative levers is key to skillful and integrative care of people suffering with mood disorders.
