The education and awareness resources for mental health is dominated by messages of psychosocial and environmental impacts of triggers for mental ill health. Information on friendships, social connections, giving to others, work pressures, volumes of exercise, substance misuse, genetics, personal history and thought processes is plentiful. Occasionally there is acknowledgement that there are also biological effects on mental ill health, but these are often drowned out by the dominance of other factors. Whilst these factors of course are very important the biological influencers need to be taken into consideration to complete the holistic psycho, social, environmental and biological assessment, medical treatment and self-management of mental ill health.
What I present to you here is hopefully going to assist to even out the consideration of factors for mental ill health. The main element I would invite you to take away is that an assessment by a licenced medical practitioner (usually GP) is very important in all cases of suspected mental ill health and I encourage you to ensure that your EAP providers are asking users to seek professional assessment from the GP in addition to their own assessments. It should not be assumed that if someone is experiencing mental health problems that they will have visited the GP for a full mental health assessment. The nutritional deficits may require prescribed treatments and not be amenable to non-prescription supplements or dietary changes and underlying causes of nutritional imbalances may need to be medically explored. Long-term pain, long-term conditions, neurological disorders, cancer, heart conditions, hormonal issues all affect mental health and require medical management.
Many of the nutritional factors are further compounded by mental ill health having dietary and appetite impacts such as reduced eating, excessive eating, diet being dominated by food that is of poor nutritional content for instance comfort eating of high fat, sugar containing foods.
Vitamin B12 & B9 or folate deficiency can directly result in depression, confusion, memory, understanding and judgement. Indirectly it has effects through anaemia which causes apathy; low energy levels meaning that the individual is less likely to be able to do activities that boost mental health such as regular exercise and regular social activities. There is evidence that supports the deficiency of many of the vitamin B group have a mental health effect as they are influential on the creation of chemicals called neurotransmitters that assist in the travel of messages in the brain.
Thyroid disorders this group includes over and under active thyroid, thyroid related eye disease, thyroid cancer. Hyperthyroidism (over-active thyroid) results in anxiety, nervousness and inability to sleep. Whereas hypothyroidism (low thyroid function) can result in low mood. Both can cause mood swings and increased irritability.
Long-term inflammation anywhere in the body can cause mood disorders such as depression and anxiety. The science supporting this claim is growing all the time, it may explain why usual treatments for depression and anxiety do not work for all people; the mental ill health is caused or compounded by a physical disease process.
Magnesium studies have shown that magnesium supplements have led to improvements in depression and anxiety.
Post heart attack the British Heart Foundation reports that 1/3rd of heart attack survivors experience depression or anxiety. The research also found that there was a two-fold increase of those survivors having another heart attack or dying of heart disease. It is beginning to emerge that the underlying causes of this are not just behavioural or thought processes (less exercise, negative or catastrophic thoughts) but linked to biological changes possibly inflammatory (see above).
Menopause can result in changes to mood, anxiety, increased irritability and lower energy levels due to the body adaptions to lowered oestrogen and progesterone. The following link to guidance from the Royal College of Obstetricians and Gynaecologists is very informative:
https://www.rcog.org.uk/en/patients/menopause/mood-changes-and-depression/
Pre-menstrual syndrome includes a variety of psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. The following link is to a patient (employee) leaflet on this condition:
The future
I predict that the future of health will be less dualistic; divided between physical and mental health. There are emerging medical specialists that will be driving this such as nutritional psychiatry https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900051-0/abstract?code=lancet-site
And neuropsychiatry –
https://www.nbt.nhs.uk/our-services/a-z-services/neuropsychiatry/neuropsychiatry-service
Anna Harrington Clinical Lead. Occupational Health Specialist. RGN. SCPHN (OH)
