Former Surgeon General Vivek Murthy, M.D., recently sat down to talk with National Institutes of Health Director, Francis Collins, M.D., Ph.D., to talk about the public health consequences of stress in America—how stress is affecting us and what we can do about it.

Ongoing stress can hurt our mental and physical in a variety of ways. Approaches such as regular exercise, social connections and contemplative practices can help.

It’s important to remember when talking about stress that not all stress is bad, Murthy noted. Limited stress over a short period of time can help us perform better, in a sports competition or on an academic test, for example. Short-term stress is adaptive and can assist with healing and with performance, Murthy noted. He suggested an analogy of lifting weight in a gym. If you lift for brief periods with rest in between, you can build up your muscles. But if you were to hold weight for hours and hours, it may do damage to you. Chronic stress, over the long-term, can increase Inflammation in the body and Increase our risk of cardiovascular disease, cancer, anxiety, depression and other illnesses.

Murthy relayed a story of speaking before hundreds of college students and asking, “How many had experienced an almost unbearable amount of stress in the past month?” About 95 percent of the hands went up. He then asked how many felt they had tools for dealing with that stress in a healthy way, and less than 5 percent of the hands went up. That experience, Murthy noted, helped him to realize the lack of attention being paid to addressing stress and emotional well-being. “We’re missing a major contributor to our health and how our country functions,” he concluded.

One potential contributor to stress for many people is increasingly fast-paced workplaces. “The idea of being overextended has become the norm,” Murthy said. Health concerns for ourselves or for family members can also be a tremendous source of stress. Chronic lack of sleep, which can take a tremendous toll, can be both a contributor to and a consequence of stress. Sleep allows our brains to regenerate and form memories and bodies to heal.

One most powerful antidotes to stress, Murthy noted, is social connection. For example, facing a challenging health condition can be much less stressful when faced with the support and compassion of family, friends and others facing similar challenges.

Many of us are connected to many people on social media. But is our social media connection really helpful? Researchers have found that it can be helpful, but can also contribute to negative feelings. As Murthy explained, when you use social media as a weigh station It can be helpful in improving your connection and diminishing stress, but it can be problematic when used as a destination. For example, if you’re going on a trip and go on Facebook to look up friends to meet up with, it helps reduce loneliness and increase connection. However, if you’re feeling lonely on a Friday night and go on Facebook to see what friends are doing, it may end up feeling like everybody else is having a great time and you’re not.

Murthy discussed contemplative practices, such as meditation, as another important tool to help address stress and enhance our emotional well-being. Murthy also stressed the importance of exercise in reducing stress and promoting overall health and well-being.

Murthy called on health care providers to be more sensitive to the illness stress causes. He urged everyone to think about how to incorporate ways to reduce stress into all aspects of our everyday lives—in the workplace, at home, at school, in recreation and leisure activities.

What Are Bipolar Disorders?

Bipolar disorders are brain disorders that cause changes in a person’s mood, energy and ability to function. Bipolar disorder is a category that includes three different conditions — bipolar I, bipolar II and cyclothymic disorder.

People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well. Bipolar disorders can be treated, and people with these illnesses can lead full and productive lives.

Bipolar I Disorder

Symptoms of Bipolar I Disorder
Bipolar I disorder can cause dramatic mood swings. During a manic episode, people with bipolar I disorder may feel high and on top of the world, or uncomfortably irritable and “revved up.“ During a depressive episode they may feel sad and hopeless. There are often periods of normal moods in between these episodes. Bipolar I disorder is diagnosed when a person has a manic episode.

Manic Episode

Hypomanic Episode

Major Depressive Episode

Risk Factors

Treatment and Management

Bipolar II Disorder

Bipolar II disorder involves a person having at least one major depressive episode and at least one hypomanic episode (see above). People return to usual function between episodes. People with bipolar II often first seek treatment because of depressive symptoms, which can be severe.

People with bipolar II often have other co-occurring mental illnesses such as an anxiety disorder or substance use disorder.

Treatment

Treatments for bipolar II are similar to those for bipolar I — medication and psychotherapy. Medications most commonly used are mood stabilizers and antidepressants, depending on the specific symptoms. If depression symptoms are severe and medication is not working, ECT (see above) may be used. Each person is different and each treatment is individualized.

Cyclothymic Disorder

Cyclothymic disorder is a milder form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly. People with cyclothymia experience emotional ups and downs, but with less severe symptoms than bipolar I or II.

Cyclothymic disorder symptoms include the following:

• For at least two years, many periods of hypomanic and depressive symptoms (see above), but the symptoms do not meet the criteria for hypomanic or depressive episode.
• During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months.

Treatment

Treatment for cyclothymic disorder can involve medication and talk therapy. For many people, talk therapy can help with the stresses of ongoing high and low moods. People with cyclothymia may start and stop treatment over time.

Physician Review By:

Ranna Parekh, M.D., M.P.H.
January 2017