Resilience, Stress, and the Neurobiology of Aging

By Helen Lavretsky, MD, MS | September 1, 2010

Dr Lavretsky is professor in the department of psychiatry and biobehavioral sciences and Semel Institute for Neuroscience and Human Behavior at UCLA’s David Geffen School of Medicine in Los Angeles. She reports that she has received research grants from Forest Research Institute, the National Institute of Mental Health, the National Institutes of Health, and the National Center for Complementary and Alternative Medicine.

Acknowledgment: This work was partially supported by NIH grants MH077650, MH086481, and AT003480.

Antidepressants have also been shown to promote resilience in patients with posttraumatic stress disorder (PTSD) and in stressed caregivers.^42,43 Connor and colleagues⁴³ undertook a 12-week placebo-controlled trial of fluoxetine(Drug information on fluoxetine) in civil-ians with PTSD and reported better efficacy with fluoxetine than with placebo.

Pooled results from 2 large, multicenter, randomized, controlled trials of patients with PTSD using extended-release venlafaxine indicated that total Connor-Davidson Resilience scale scores and treatment were significant predictors of both response and remission.⁴⁴

In our randomized placebo-controlled pilot study, 10 mg/d of citalopram(Drug information on citalopram) improved resilience and decreased levels of depression and distress.⁴² This is the first trial of an antidepressant directed toward increasing resilience in a high-risk group of chronically stressed older caregivers. Preliminary results of our study of the complementary use of tai chi to augment treatment response in elderly depressed patients who had a partial response to 10 mg/d of escitalopram(Drug information on escitalopram) show improvement in psychological resilience and a decline in inflammatory markers (ie, C-reactive protein).

Conclusion

Research on resilience has shifted the focus of investigation from the illness-based approach to the well-being–oriented approach. A pattern of positive characteristics that could target new interventions to promote successful aging include sound intellectual functioning, the ability to handle emotions, self-esteem, optimism, altruism, humor, and an engaged and active coping style. Prospective biological markers of resilience important for future investigations include neuroendocrine, immunological, neural, genetic, temperamental, and environmental influences.

Resilience can be quantified by using standardized assessments in neurobiological and treatment studies. Multimodal assessment of the biological determinants of resilience will help identify targets for intervention to enhance resilience on both individual and cultural levels. Learning to enhance psychological resilience may help overcome health problems and their resulting disabilities.

Successful stress reduction and management, particularly among the most vulnerable seniors, can prevent serious mental and physical illness. Integrated modalities to improve resilience and reduce stress in combination with pharmacotherapy and lifestyle changes are likely to improve the overall functioning and well-being of older adults.

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by Josephine Later R.T.(Can).A.S.C.P.(U.S.A.) | January 14, 2011 7:02 PM EST

An excellent article re stress in the aging population.The emphasis placed on youth in our culture only exacerbates the problem.Can you imagine Zsa Zsa Gabor with only one leg??or even the youth who actually can't even imagine themselves as "old"?Resilience and an inner life is the key-thanks for the great article-JL.

by Robert Peers | December 11, 2010 9:19 PM EST

Unfortunately, one never sees in any discussions about stress, any mention of anxiety disorder, which affects, in varying degrees, 20-25% of Western people (it is unknown in traditional societies, like the Kaluli in Papua, or in Japanese fishing villages). This widespread misunderstanding may be due to the mistaken popular notion that anxiety and stress are the same thing, and are both caused by traffic jams and other purely external stressors. The proper description of the effect of external stress would be internal strain, which lasts for only minutes or hours, unlike true anxiety, which is lifelong. Anxiety disorder arises during foetal development, and is the result of a fatty maternal diet--that often causes gestational diabetes as well--the direct cause being a leakage of maternal cortisol across a mildly inflamed placenta. This hormone changes the foetal brain permanently, by epigenetically modifying the glucocorticoid receptor gene promoter, thereby reducing negative feedback from adrenal cortisol, which promotes increased CRF and HPA axis overactivity. Anxious folk lack resilience, and also comfort-eat fatty foods, which leads to obesity, diabetes, depression, vascular disease, arthritis, osteoporosis and muscle wasting. Fatty diet causes both insulin resistance and systemic oxidation, and the latter drives cytokine production and low-grade inflammation, and also drives telomere shortening. Low-fat diet turns depression back to anxiety in 2 weeks. To convert anxiety to resilience takes about 7 days: just give the subject 5 gm of Inositol supplement daily: this simple seed sugar allays anxiety by inhibiting serotonin 2A receptors, which blocks CRF action. Within 3 days there is unusual energy, and a shift of appetite from sweet fatty foods to salads and fruit. By the seventh day, there is newfound calmness and mental clarity, followed within weeks by fat loss, larger muscles, a liking for exercise, better libido, and better immunity. Hair and nails grow faster, and appear shinier and stronger. Inositol is ALSO anti-ageing--it is found abundantly in the legumes and whole grains (like oat porridge) eaten by most healthy centenarians (tip: citrus is a good source), and is known to activate 100s of anti-ageing genes (J Barger, 2008). Its IP5 metabolite inhibits the key nutrient-sensing enzyme PI3 Kinase, fooling the cell into thinking that the subject is on Caloric Restriction. Inositol is also directly involved in telomere maintenance (see "inositol and telomere" on PubMed). Remember, diet MUST be low fat, for best effect.

by William Taylor | September 03, 2010 12:55 PM EDT

Normal 0 0 1 250 1429 11 2 1754 11.1287 0 0 0

Wise advice! This post highlights the importance of stress management for children, teens and adults.

Families and school staff concerned about a student with such problems can turn to this link from the American Academy of Child and Adolescent Psychiatry listing free helpful pamphlets for most common emotional conditions affecting youth and families: http://www.aacap.org/cs/root/facts_for_families/facts_for_families

These pamphlets are available in English, Español, Malaysian, Polish, Icelandic, Arabic, Urdu and Hebrew. (Links are on the aacap site listed above.)

Another source of insight is the Stressed Family, Strong Family website,

at this link: http://americanconfusion.com

where you will find many ideas from the e-book,

Stressed Family, Strong Family.

Many can learn to cope with stress more effectively, and support one another.

Also in this Special Report

Who Should Care About Geriatric Mental Health? Check the Mirror . . .

Drugs, Death, and Disconcerting Dilemmas

Palliative Care in Older Adults

Resilience, Stress, and the Neurobiology of Aging

Image by Werwin15

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Resilience, Stress, and the Neurobiology of Aging

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