The Role of Stress in Migraine Headache, Serotonin Dysfunction, and the Initiation of Depression by Victor O. Vidal, BS. MA. H(ASCP) - - author of the book: Overcoming the Invisible Crime

Introduction

The manifestation of the excruciating emotional pain of depression can be debilitating for some people. Because of the ugly social stigma attached to depression, people always never want to admit to the illness. Society doesn't always embrace open discussion of the issue except in a professional setting inside the hidden closet of a psychotherapist. The truth is, by the age of 35 years, many people particularly women have experienced and suffered from transient or reactive depression due to a personal life crisis. Women suffer more depression not only because of life crisis but also due to biochemical changes throughout their life cycles -- the events which have been ignored for years till now. Years ago, mentioning emotional changes in women due to menopause could initiate very explosive reactions from some women. Today we gracefully accept Kira (a form of St. John's wort -- the herb from Hypericum Perforatum) for emotional balance in such women -- thank goodness! Some patients however suffer from continuous depression not due to transient or reactive depression, nor mild biochemical changes; but due to permanent alteration in brain chemistry condemning them to life long suffering of severe depression. These patients must be on medication for life. Permanent alteration of neuro-chemistry and receptor changes due to drug administration may in part be responsible for some drug addicts inability to completely recover from drug addiction despite treatment, and they eventually die of overdose.

The smileless face of depression is very ugly, displaying the mask of silent insanity! It's like a face-mask worn by a mysterious being. Behind this mask is a very troubled person, totally detached from the environment, and imprisoned behind the walls of severe depression -- an excruciating emotional pain. In most cases, medications have yanked a depressed patient from the fangs of death. At other times, it may be too late as a troubled mind succumbs to self induced death in relentless pursuit of relief from an agonizing emotional pain. Prior to Dr. Jack Kevorkian's popularity, many will disagree with suicide as a correct choice of treatment for severe depression and physical pain. Unfortunately, some have chosen this route to end their suffering. At a point and time when depression becomes a crippling disease, psychiatrists have resorted to electro-convulsive shock therapy.

Ten to 12 million Americans suffer from depression with females being affected twice as males. Fifteen percent of the hospitalized patients for depression will commit suicide. Fortunately, 80 to 90% of depressed patients can successfully be treated. Adding to the number of depressed patients, is the new group of suffers from reactive-depression due either to burn-out by job stress, personal life crisis or family tragedy. Personal problems have always initiated depression at one point in life and can usually be handled. However with increase in job-related stress today, personal life crisis becomes harder to handle. For the most part, the job stress is not transient, it becomes prolonged, leading to persistent anxiety and eventually depression. Unfortunately, with increase job stress and intense pressure to produce more work with less staffing, reactive job depression is going to be the number one job related illness for a long time. Employers can reduce stress by evaluating the stress points of their employees. They should determine at what point and time are they pushing their employees too far? Smart employers will immediately start working on this issue because burned-out employees do not perform well, and can sometimes be very dangerous when their emotions boil over! Work place violence has increased in the past couple of years; it's going to get worse!

Ironically, money is supposed to bring happiness after relentless pursuit of success. But, by the time such goal is attained, a person's brain is fried like pancake or torn into many pieces. Subsequently, depression becomes a life long battle despite the availability of money, as happiness becomes very elusive. Perhaps, it is time we evaluated our values, and whether these material things will guarantee happiness. This article will evaluate the role of stress in inducing biochemical imbalance leading to the excruciating pain of migraine headache, the chemical brain lesion resulting to depression, (the "miserable stranger within") and the danger of sensory deprivation.

Stress as the Cause of Migraine Headache

In America 16 to 18 million people suffer from the excruciating pain of migraine headache. This horrible discomfort can be caused by many factors including vascular abnormalities leading to spontaneous cerebral vasospasm or brain tumors. However many of the migraine headaches are stress induced more than other causes.

Based of the biochemistry of the central nervous system as of today, the hypothesis of serotonin being the culprit in the generation of migraine headache and depression has been postulated for years. By understanding how the brain functions, we can then predict the type of medication for the relief of the clinical discomfort of migraine. Although factors leading to the migraine are not well delineated in neurology, however the headache may be caused by events preceding the onset. The events leading to a migraine are not necessarily obvious to a suffering patient because people worry about the onset and subsequent events. In many cases of stress induced migraine, the patient's brain has been subjected to enormous amount of adrenergic drive due to norepinephrine pouring down like crazy over the brain. At this stress stage, the individual is driven by the stress of performance, frustration, need to accomplish goals during the final deadline, and many other stressful events of life. During this time, some older people or executives proned to coronary heart disease may develop a myocardial infarction or stroke -- blowing up the blood vessels because of hypertension. At the stress stage, the body needs more oxygen and this is the reason for the shortness of breathe experienced over emotional exertion. Physical exertion will initiate the same problem causing some older people to drop dead from myocardial infarction while shovelling snow.

The stress stage is followed by the brain recovery stage -- the brain goes into a protective phase to preclude the increase in adrenergic drive from blowing up the brain's vascular system. Recovery stage leads to vascular vasodilation causing blood vessels to get larger and consequently putting irritation on the trigeminal nerve of the brain. This irritation is experienced as the migraine headache. The reason for an early morning headache after a night's sleep is due to stress -- like a day after an alcohol binge -- called the hangover. The migraine headache is the norepinephrine hangover as a result of prior adrenergic over-drive. Interestingly, this is how the brain protects itself from adrenergic over-stimulation after the assault by catecholamines a day before. Findings by Capman L.F., Arch of Neurology 3:223, 1960 reported large amount of catecholamine metabolites in the urine of patients suffering from migraine headache. These findings support the hypothesis that the patient's brain might have been subjected to increase in adrenergic drive of catecholamines prior to the onset of migraine. Although people experience vascular vasodilation, the trigger mechanism is not known. Perhaps this mechanism is similar to the way baro-receptors function in the heart -- firing as soon as they notice a transient increase in blood pressure to bring about normotension. The Varatrum alkaloids (previously used to treat hypertension) trick the heart this way to reduce blood pressure.

Sumatriptan helps to relieve the symptoms of migraine because of its selective serotonergic agonist effect on the serotonin receptors (serotonin subtype 5-HT-1d). The effect causes a vasoconstriction leading to the relief of the migraine symptoms. According to the Briefing Report by the Society of Neuroscience, Feb. 1998, it is believed that sumatriptan targets both the trigeminal nerve and the blood vessels that serve the head and other parts of the body including the heart. Rizatriptan (Maxalt) is the new anti-migraine drug acting at the same receptors and same actions as sumatriptan. Maxalt is said to be more effective in smaller doses than Sumatriptan. 

Physicians treating migraine must exercise caution! As a vasoconstrictor, sumatriptan can raise blood pressure, it is therefore very crucial that the medication is given at the correct phase- brain recovery phase, when the brain is no longer under the assault of the adrenergic drive. Measuring the patient's blood pressure prior to the administration of the medication can be helpful, otherwise the headache may be intensified. Increase adrenergic drive is the leading cause of most stress induced hypertension and headache during the stress phase. Therefore, it is very important to treat the increase in blood pressure first by a beta blocker to remove the assault of norepinephrine. Afterwards, sumatriptan can be administered for the relief of migraine headache - if it is ever needed after the blood pressure goes down. Although sumatriptan induces mild increase in blood pressure, the danger of hypertensive encephalopathy in malignant hypertension can not be underestimated. This danger should be considered before prescribing Imitrex - a vasoconstrictor to treat a headache that is assumed to be due to migraine without measuring the patient's blood pressure. In most cases, Imitrex is contraindicated in uncontrolled hypertension or in patients with ischemic heart disease.

Neuro-chemistry of Stress and Depression

The human body is designed to protect itself from the emergence of danger or impending disaster. When such situation ensues, the body is prepared for "flight or fight" by chemical transmitters particularly norepinephrine -- the systemic stress hormone. Increase in blood pressure, tremors, fear, anxiety, sweating, increase in heart rate and myocardial contractility, (defecation and urination in children) are mostly the actions of norepinephrine to prepare an individual for his or her fate in impending danger. From the physiological point of view, most of these responses are supposed to protect an individual in danger by pushing blood to vital and essential organs -- sparing the non-essential ones. Similarly in the central nervous system, the brain reacts to stress or anxiety by an out-pour of neurotransmitters. In a case of prolonged anxiety caused by persistent stress, there is a gradual depletion of some essential neurotransmitters in the brain. At a point and time, the neural cells stop firing adequately, the state of balanced mood or affect (emotion) is altered, (especially when the person is at rest) and the individual starts to experience depression.

Understanding how the nerve cells communicate will elucidate how excessive stress eventually leads to depression. Nerve cells communicate each other by firing -- sending electrical impulse from one cell to another. The process of cell-firing is mediated by neurotransmitters in the central nervous system. Neuro-transmitter actions of serotonin and norepinephrine have been implicated in depression. It is important to emphasize that the altered mood did not result directly from the depletion of the neurotransmitters as much as the result of inadequate firing of those cells in the brain. Therefore, any process that can cause the cells to fire adequately including increase availability of the neurotransmitters will be helpful in treating the illness of depression. Consequently, not everybody going through mild depression needs medication. Regular counseling or psychotherapy may suffice for some patients, and the neural cells start firing again.

Most of the drugs used for depression have been known to increase both the actions of serotonin and norephinephrine in the central nervous system by potentiating the firing of the neural cells. Clearly, when a person is exposed to too much stress, chemical communications in the brain start to fail -- leading to aches and pains, depression and anxiety, loss of appetite, irritability, and sometimes desire to want to die or want to kill somebody.

People who remained hyperactive either physically or mentally rarely get depressed compared to low key-quiet people. But, the adrenergic drive of hyperactive people can be dangerous when they become hypertensive due to a prolonged periods of catecholamine intoxication or adrenergic over-drive. Highly hyperactive women losing the protection of estrogen after menopause are more proned to hypertension and coronary heart disease. When an already hyperactive person is subjected to persistent stress over time, catastrophic behavior may result! Even under normal conditions, working with an adrenergic over-driven person can be a trying experience since such highly charged people are oblivious to the emotional torture endured by their co-workers.

Mechanism of Serotonin and Neuroleptics in Depression

Serotonin dysfunction more than any other neurotransmitters has been implicated in the pathogenesis of depression. Serotonin is synthesized in the brain and stored in vesicles. Upon nerve impulse, it is released into synaptic cleft, and later reacts with post-synaptic receptors. The nerve impulse is terminated by serotonin diffusion, metabolism, or re-uptake. Depression is treated by pharmacology agents acting on serotonin. Tricyclic antidepressants primarily blocks the re-uptake of norepinephrine and serotonin. Tertiary amines like imipramine and amitriptyline are more selective in inhibiting serotonin than norepinephrine (catecholamines) compared to the secondary amines such as desipramine.

Other drugs that mimic the action of serotonin (serotoninmimetic) and those that block its storage have been used successfully for the treatment of depression and other illnesses. For example, the second generation of antidepressants like Prozac, Zoloft and Paxil selectively block serotonin uptake. Prozac has been approved for the treatment of obsessive-compulsive behavior. Moreover, tricyclic antidepressants are also used for the treatment of enuresis and chronic pain.

Serotonin Receptors and Suicide

A high rate of suicide attempts have been observed in patients with lower levels of serotonin in their brains. After death, there is a high number of serotonin receptors in suicidal patients who succeeded in the self therapy of killing themselves. The phenomenon of increase receptors in these patients is similar to what is observed in polycythemia secondary to decrease in tissue oxygenation of smokers or people with long term obstructive lung disease. Although the cellular pathology observed after a patient's death can give clues about the pathogenesis of the disease processes, but these changes can't always give conclusive evidence about the pathophysiology leading to cellular abnormalties observed. However in this case, we can deduce that compensatory cellular amplification secondary to decrease serotonin activities in the brain of severely depressed patients, is responsible for increase serotonin receptors observed in suicidal patients at autopsy.

The Complexity of the Brain's Serotonin Receptors

According to Kennett, G.A., the Assistant Director of Neuro-behavioural Research of SmithKline Beecham Pharmaceuticals in Canada, serotonin is not only implicated in depression, but also in anxiety, schizophrenia, eating disorder, obsessive compulsive disorder, migraine, and panic attacks. The serotonin receptors are divided into many subtypes from 5-HT1 -A to F, 5-HT2-A to C, 5-HT3 to 5-HT7, and many more will be discovered in the future as we understand more about the neuro-physiology and anatomy of the system. The functions of some of the receptors have been defined unlike others. The 5-HT1 series for example, are widely distributed in the central nervous system especially in hippocampus, septum and amygdala -- areas associated with mood control. The 5-HT1B subtypes are concentrated in the basal ganglia, striatum, and frontal cortex. The 5-HT1D receptor agonist like sumatriptan targets the fifth cranial nerve -- the trigeminal. The drug causes vasoconstriction of the surrounding the blood vessels -- consequently helping to reduce the migraine headache. The 5-HT2C receptors are largely distributed in the choroid plexus and lower distribution in cerebral cortex, hippocampus, striatum, and substantia nigra. Due to high a concentration in choroid plexus, it is suggested that the receptors may be responsible for the regulation of spinal fluid production. The 5-HT2C receptors have been identified as the target of action of methylsergide - the non-selective 5-HT2C receptor antagonist used for migraine prophylactic effects. Activation of these receptors also induce hypophagia, penile erections, oral dyskinesias and hyperthermia in rats. It's been observed in laboratory animals that mutant rats lacking 5-HT2C receptors suffer spontaneous convulsions, obesity through increase food intake, and cognitive impairment. Large amounts of serotonin are secreted by carcinoid tumors distributed throughout the gastrointestinal tract by the enterochromaffin cells located throughout the gut.

Synergistic Actions of Norepinephrine and Serotonin in Mood Control

Since we are beginning to better understand the complexity of human brain chemistry, it is important to expatiate on the plausible neuro-chemistry causes of depression. There is a hypothesis that serotonin and norepinephrine may be working together in a synergistic way to maintain a state of "balanced emotion." When there is dis-equilibrium of these neurotransmitters depending on what part of the brain or the transmitter in question, a neuro-pathology may manifest itself. For example, if excessive adrenergic activation dominates a particular part of the brain -- panic attack or obsessive compulsive behavior may result. It seems as if when serotonin decreases in function, norepinephrine action dominates the brain function and very aggressive behavior comes alive in some people. The hyperactive emotional illness incurred such as panic attack can be treated with beta blockers (blocking the action of norepinephrine) in combination with drugs that will potentiate the action of serotonin. The manifested disease in neuro-chemistry dysfunction is therefore dependent not only on what part of the brain is affected, but also what neurotransmitter is decreased or increased. Therefore, depressed patients have been successfully treated with norepinephrine re-uptake inhibitors to increase adrenergic drive. Some people manage their depression well by regular exercise. Others use non-conventional ways such as "yelling" to force innocent people to share their emotional pain. These patients derive pleasure from ventilation of anger on others, especially those working under them. Both exercise and "yelling power" produce increase in norepinephrine leading to the adrenergic-high for the individual person. Deriving adrenergic-high at others' expense is not only a horrible way to treat depression, it can expose an already hypertensive aggressor to the risk of sudden myocardial infarction or stroke. Some miserable supervisors manage their depression this way. The best thing to do with such an obnoxious manager is to offer a nice cup of coffee with a smile to help increase the individual's adrenegic drive. Early morning coffee can be very crucial to start a day for some people before they start attacking innocent co-workers.

However, it may be very premature to conclude that an emotional balance is maintained primarily by the synergistic actions of both norepinephrine and serotonin alone. Although the study by Brian Knutson et al from The American Journal of Psychiatry, March, 1998, confirms that central serotonergic function improves positive affective experience and increase affiliative behavior with the administration of a Selective Serotonin Re-uptake Inhibitor to normal patients. But, it does not provide the entire explanation of the biochemistry of brain events during stress. There are more neurotransmitters involved in human emotions than we understand, including the intrinsic systems serving as compensatory mechanisms in dealing with stress. Perhaps, the vasodilation activity in migraine patients is one of the compensatory mechanisms induced by the brain in response to stress, similar to cardiomegaly in a failing heart or the firing of baro receptors of the heart during a transient increase in blood pressure. Oblivious to science, is the complexity of different activities taking place in the human brain during stress, and prior to the manifestation of depression. The same stress which eventually leads to depression has been known to cause malfunction of the immune system and predisposing the patient to neoplastic changes. Other stress related illnesses include hypertension, sleeplessness, loss of appetite, over eating, paranoia, irritable bowel syndrome, bleeding gastric ulcer and many more. Therefore, rich people live longer because they remain happier longer than poor people for most of their lives.

Treatment of Stress

Sadly, depression creeps into the human mind without notice. If stress can be immediately handled effectively, the painful road to reactive depression can be avoided. People who don't react to every problem in life as a pressuring-disaster tend to do better than people who regularly become explosive over trivial issues. Religious people handle stress better because of the power of spirituality which provides a comfortable emotional shelter during difficult times. The best way to avoid mild depression that is preceded by a stressful day is to get the brain congnitively busy doing pleasurable activities like reading a favorite novel, writing, or spending time with a good company or in fellowship with pleasant people.

There are some situations however that cannot be helped like a death in the family or other situations out of a person's control. The greatest source of stress which later lead to depression are those situations where a person feels totally helpless. For example, being responsible for other people's mistakes is highly stressful -- brain-cells killer. People experience intense emotional stress when locked in a no-way-out situation. Most suicides do occur during this time! Transient depression should be handled with counseling and psychotherapy. If these fail, a mild tranquilizer such an anti-anxiety drug like Valium may be introduced. At a point and time where the patient can no longer sleep, experiences continuous anxiety and becomes detached from the environment with suicidal ideation, it is time for the treatment with major neuroleptics like tricyclic antidepressants, monoamine oxidase inhibitors, or the antipsychotic drugs such as the phenothiazine group.

Once a drug is introduced no matter how mild the chemical agent, the physician has to be very careful because of the risk of dependency and tolerance. Chronic antidepressant treatment leads to a decrease in the serotonin receptors in cortical brain tissue. Therefore a patient being treated for transient depression may end up taking the drug for life because of permanent alteration in brain chemistry. Such situations can be avoided if the physician carefully monitors the patient's medication. Enough drug should be given to overcome the emotional trauma, and immediately start a gradual withdrawal once the patient is in control. Learning to wean the patients from the drug may be a battle in itself. Unfortunately, those suffering from major depression may have to take the medications for life due to reasons explained earlier.

Regardless of the agony we encounter in this life, the way we choose to react to personal difficulties may determine whether we will react to stress with sustained anxiety, and whether that anxiety will lead to depression after tearing up the brain -- altering the neurochemistry.

Danger of Sensory Deprivation and Depression

Many people are driven by their desires to achieve or accomplish certain goals in life. During that time of accomplishments they enjoy the euphoria of success because they succeed in their personal self actualizations. Celebrities enjoy the euphoria of fame and being idolized by society and all other selfish motives involved in being adored by people. Similarly, musicians, painters and other artists enjoy great satisfactions at the peak of their accomplishments. Spiritualists derive so much joy from inner peace and serenity while dwelling in spirit --- during church service or devotion, or during spiritual inspiration.

No matter what we enjoy doing or sharing with others, these experiences are always temporary for those moments. Even if we derive so much pleasure from such events as our work, it does not last forever. These experiences tend to nurture the mind and the spirit, however, we can not ignore the pleasuring of the body to maintain an emotional balance. The danger is, people tend to deny their needs for physical sensory stimulation. The more spiritual a person actualizes him or herself, the more a balance is needed to pleasure the body. That's why sex is sometimes so wonderful after the adrenaline-high of doing some of the things we enjoy away from the bedroom. In the absence of nurturing the body to create an emotional balance, the need may manifest itself in another socially unacceptable behavior. It is therefore not by accident that many sexually inappropriate behaviors have been reported even within the clergy against ministers who are in dying need for physical sensory stimulation. However, this is not to conclude that everybody needs physical pleasure for emotional balance, but some people designed for physical pleasure needs this pleasurable stimulation, or they go crazy without it! Some miserable people love to pour a lot of negative energies over trivial issues. Their yelling binge itself is an outcry for help no matter their professions. People may not be listening because, after a while, they tend to tune out yelling people.

Depression can be observed in people deprived of physical sensory stimulation. Over aggressive behavior can also be observed in such people (as norepinephrine takes over -- the satanic evil is ignited) and sometimes leading to murder. Depending on the age of an individual person, people pick different ways to nurture their bodies to satisfy physical needs for pleasure. This type of pleasure can be a biological need to maintain sanity for some people!

Pleasure your Woman and Enjoy Peace!

Many husbands know too well that when their wives orchestrate a fight within the family without concrete reason, it is usually a cry for attention. Husbands please pay attention!

From observational studies and other experiments, both men and women need physical pleasure. But based on the ways some women are wired from head to toe with erogenous zones, it appears this group of women need more physical pleasure and nurturing than men. When husbands refuse to respond, the wives will react with a fight further alienating the man! This behavioral science is important to women who are usually more nurturing within the family and society than men. When drained out of their nurture, women become frustrated, they need to be re-nurtured and be physically pleasured to maintain a state of emotional balance. Husbands who refuse to acknowledge this fact get in trouble with their wives all the time! Although men may not want to admit to the fact about women's neuro-anatomy, women tend to have larger sex organs compared to men. This is very evident by looking at the entire larger surface area of women covered with tactile sensation for pleasure. This is the reason why many wives complained of lack of sexual fulfillment because their husbands either don't understand the neuro-physiology of female sexuality, or they don't want to take time and work harder to cover the entire surface area to bring their wives pleasure.

Compounding the situation, each woman is wired differently regarding the erogenous zones making it more difficult for men's exploration of these sensitive parts. Even after finding the neuro-sensitive pleasure centers on a particular woman, later -- the locations start switching because excessive nerve stimulation leads to dullness. The same nipple stimulation doesn't excite her as much. So, the poor husband is left with the face of a dazed woman in bed, in a state of total submission -- he goes back into the discovery process again -- looking for other sensitive parts on her. The search becomes even more difficult because some wives don't give good directions to their husbands except for some ridiculous moaning sounds in the dark. Sometimes men are not sure whether they are delivering excruciating pain or pleasuring the woman since the moaning sounds are similar. Nevertheless, it is the husband's primary responsibility to find the wife's neuro-sensitive zones. It will save the marriage!

Even Dr. Laura Schlessinger -- the popular radio moral evangelist, believes orgasmic pleasure brings relaxation to women. Poor men -- we are not as lucky! Euphoria of orgasmic pleasure is important for women because, instead of severe migraine headache in the morning, the wife wakes up with a pleasant smile and she is happy! Since women's erotic desire is more hormonally mediated than that of men, the arousal phase can be sustained longer, and the euphoria of the orgasmic pleasure seems to last longer as well. All the seemingly agonizing noise during the pleasure phase by women may not be fake, but due to the intensity of heightened crescendo a man succeeds in taking a woman to an orgasmic explosion! What some men don't understand is, by the time they stimulate all other parts of women's body, a neuro-physiology of chain reactions is ignited. The women are not only set on erotic fire, but the orgasmic experience is always very satisfying and deeply intense!

When women are deprived of such activities, monstrous behavior or drug addition may emerge. Here is the case of a woman who described the way she felt when deprived of pleasure, and how she acted prior to the time of her treatment. "I can see that my aggressive behavior and temper grew in direct contrast to the lowering of the sex drive. By the time my sex life disappeared, my temper was not only violent, but murderous." And some people believe it's okay to deny a divorce woman of sexual pleasure just because her children disapprove her lover? When such a woman is deprived of pleasure, she may be more of a danger to her children than otherwise. Physical pleasure for a previously married woman becomes a biological need such as food and water to maintain a state of emotion balance. Perhaps it becomes a debatable issue if such a woman has not been previously pleasured with the ignition-stimulation of her neuro-sensitive erogenous zones. Sorry Dr. Laura, since we worry about the welfare of children, the emotional sanity of the parent ought to be considered! Consequently over this issue, we may need to put aside the issue of ethics to retain emotional balance and sanity.

Conclusion

Although the effects of serotonin on the human brain is not totally understood, its action in the maintenance of emotional balance, and its altered neurochemistry during both physical and emotional stress can not be underestimated. Moreover, the power of sensory stimulation cannot be ignored in a process of maintaining emotional balance. Research evidence has also indicated that animals deprived of serotonin receptors tend to over eat and are also predisposed to sudden death. Findings also suggest that the power of spirituality and pleasure are paramount not only in creating happiness and peace of mind, but also in relaxation, and longevity. Persistent stress causes human brain cells to fire less efficiently due to decrease neurotransmitters to maintain a state of emotional balance, and thereby causing depression.

Dr. William Salt II, the author of Irritable Bowel Syndrome raised a crucial point when interviewed in Chicago about the ways human mind makes us sick. He indicated that the treatment of psychologically induced illness such as irritable bowel syndrome has to be approached from both the clinical, psychological and the spiritual level in his theory of the mind-gut connection. He amazingly revealed that 50 percent of women suffering from irritable bowel syndrome have been sexually abused. Based on what we now know about the neurochemistry of worry and emotional stress, the cause may not be the trauma of the sexual abuse as much as the emotional after-effects created within the victim. In other words, the irritable bowl syndrome becomes a stress reaction to a lingering emotional pain --- referred to as post traumatic stress syndrome.

I can't finish this article without mentioning the rise in the interest of using S. John's wort for the treatment of depression. There are solid research studies supporting the effective utilization of the herb for depression. For example; St. Johns' wort for Depression -- An Overview and Meta-analysis of Randomized Clinical Trials by Linda K. Ramirez et. al., British Medical Journal 313(7052), 253-258 (1996) reports the efficacy of this herb in the treatment of depression. From the neurochemistry  and public point of view, it sounds like a very fascinating treatment. From the pharmacological and science point however, everybody should be careful and not be running straight to the health food store for a jar of St. John's wort because of the pitfalls. Like any other herb utilized for any treatment, St. John's wort has a dangerous set back! Those who study pharmacognosy (African perspective) or medicinal chemistry and herbs (European perspective) understand well the serious danger and the risk involved in taking such herb as a medication. Although the herb may effectively treat depression, what about other impurities in the herb? According to the article written by Camilla Cracchiolo; Frequently Asked Questions on St. John Wort, December 1997 on Primenet.com, the herb has more than 24 bioactive compounds. It will be unwise to conclude that all these compounds are needed for the treatment of depression. This herb is not approved by FDA for treatment of depression and people should be careful. One striking observation in some African countries where many herbs are used by the local natives for the treatment of diseases, there is a rise in hepatoma -- hepatocellular carcinoma (cancer of the liver). In the United States and Europe as of 1980, the incidents of liver cancer is less than one percent while in some African and Asian countries, the incident is as high as 20 percent.   In other cases, children were born with Endomyocardial Fibrosis -- massive focal endocardial and subendocardial fibrosis. At the age of eight years, some boys or girls are seen with very large and congested hearts with massive ascites looking like eight-months pregnancies. Most of these children died of  congestive heart failure unresponsive to digitalis or any other treatment before their twentieth birthday. Although the causes were not evident when observed  years ago in some African countries, most of the mothers came from the interior villages where pregnant women were made to drink many herbal concoctions during pregnancy. Such cardiac lesions were not observed in the children of mothers from the cities who received conventional OB-GYN treatments. Without augments, the teratogenic effects caused by the ingredients in these herbal-concoctions contributed to the pathology seen in the offspring of these mothers similar to pathologies observed in Thalidomide and DES (Diethylstibestrol) babies.

We can't discount the effectiveness of some of the herbs used by these local herbalists but how does the body deal with the impurities? Since the liver is the center of detoxification and responsible for metabolism of many of these compounds, it is therefore not unusual that hepatocellular carcinoma and teratogenic effects are observed in these natives. Those who choose to take herbs for treatment of any disease or as food supplement should consider the risk. Instead of subjecting one's body to many of these compounds, it may serve the body better to visit the doctor's office for either Xanax or Prozac --  pure ingredients to treat depression.