Depression, Stress and Allostatic Load

00:01 So let's take a look at how OMM could be integrated into treating some psychiatric presentations.

00:07 And so depression is a very common disorder in psychiatry and poses a major public health issue.

00:13 Major depressive disorder is characterized by DSM-5 with 5 or more following symptoms with a specific timing.

00:23 So these symptoms include: weight loss, insomnia, psychomotor agitation, fatigue, feelings of worthlessness or inappropriate guilt, diminished ability to think or concentrate, possible suicidal ideations.

00:44 So there is a growing science and better understanding of the neuro-endocrine immune system and it's response to touch.

00:51 This might help give us a basis as to how OMT could be potentially utilized in helping patients and affecting their neuro-endocrine immune system.

01:01 So procedural touch in patient care has been shown to: elevate mood, shorten hospital stay and help to relieve depression especially in the elderly.

01:12 There is also evidence that the neuro-endocrine system and the neurotransmitters and immune system collaborate.

01:19 And so, behavioral changes could affect this interaction and thus modify immune function.

01:28 There's a direct connection between behavior and the nerves and immune system.

01:33 And so OMM could potentially affect neural transmission and so be reasonable to expect that we may have an impact on behavioral states.

01:43 So this was a pilot study where they utilized OMT in the treatment of patient with newly diagnosed depression.

01:50 So there were 2 groups and both groups did receive antidepressant medication and also weekly psychotherapy but one group received OMT and the group that received OMT, after 8 weeks, 100% of them were tested normal based on the depression scale.

02:09 Whereas the control group that did not receive OMT, 33% tested normal based on the depression scale.

02:16 So in this pilot study, it seems to indicate that OMT might be helpful in the treatment of alleviating depression in women.

02:25 So, how do we approach our patients with osteopathy? So first, you need to assess the patient's stressors and social factors.

02:33 These factors play a big part in the patient's overall level of anxiety and may contribute to their depression.

02:40 You want to assess pain and other contributing factors.

02:43 So pain could be something that really contributes to the patient's inability to perform activtities of daily living.

02:51 They might not be able to do things that they wanna do and that could contribute to their sense of depression.

02:59 If possible, you want to try to address musculoskeletal restrictions that contribute to pain, stress and disability.

03:06 Some key areas that accumulate physical and psychological stress include the pelvic girdle, the abdomen, the lower chest, the head, neck and shoulders.

03:16 So when we feel stress, a lot of times we tighten and tense up.

03:20 And that will tighten our neck and shoulders which leads to increased tension in the head.

03:25 Our abdomen and lower chest, a lot of times, patients may complain a feeling like butterflies in their stomach when they're feeling anxious and stressed.

03:33 And there's really a second nervous system in your gut.

03:39 And so, it's one of the things that you kinda wanna pay attention to and possibly treat if patients have complaints of butterflies, discomfort, abdominal discomfort that we look at and treat with OMM.

03:54 So, Allostatic load is the wear and tear on the body that accumulates in an individual as it's exposed to repeated stress.

04:03 So repeated stress results in increased levels of cortisol resulting in increased sympathetic tone.

04:09 The short term effects include increased myocardial workload, decrease in digestion and increase in coagulation effects which could be beneficial in the short term when you have that fight or flight response.

04:24 But longterm hypersympathetic tone can become detrimental.

04:29 So utilizing OMT, we could try to decrease overall allostatic load.

04:35 We wanna try to balance autonomic tone, decrease that hypersympathetic state, reduce any sort of musculoskeletal restrictions and muscle spasms that could contribute to pain and dysfunction.

04:46 So there've been a couple of pilot studies looking at how OMM could potentially affect patient mood.

04:51 One study looked at how osteopathic treatment help patients suffering from chronic pain.

04:57 And what they found was after OMT, patients with chronic pain had less anxiety, overall pain and less mental health dysfunction and also had improvements in their own self-care.

05:11 Another study looked at a group of patients that had frequent migraines and mood disorders.

05:18 And after four 45-minute OMT sessions, these patients showed significant improvements in their moods.

05:25 So how is OMM helping these patient moods? One theory is that, we are affecting psychoneuro-immunology field.

05:32 This field of research is relatively new.

05:35 It's looking at the relationship between the immune system, the nervous system and the endocrine system.

05:41 And so, the osteopathic philosophy allows for a solid framework for us to better understand the interplay of these different body systems and how behavior, health and disease are all interconnected.

05:53 So let's take a look more closely at how OMT could potentially help patients with increased stress and who might be more emotionally distressed.

06:02 So emotionally distressed patients have multiple issues, such as: visiting their primary care doctor more often, being hospitalized more often, having increased morbidity and mortality, with propensity for poorer health outcomes.

06:16 Patients may not mention anything related to their psychological complaint, but when they present to the physicians, they may only complain about their physical illness.

06:23 So it's improtant that physicians delve in to that psychosocial component.

06:29 Of note, there are many biological diseases that present with psychiatric symptoms.

06:34 Medical issues and illnesses can lead to emotional distress and emotional distress may go unrecognized and untreated in medical encounters.

06:44 So the medical cost is really, really high for patients who are more emotionally distressed.

06:51 And so, one of the things that could be done is that we could try to refer patients for stress reduction, help them with mental health, utilize some hands-on treatment as needed.

07:03 Identifying these patient's stressors can help and improve their response to medical treatments.

07:10 We could integrate OMT into the field of psychiatry. We could look at different possible approaches.

07:17 One approach is to take a look at the application of cranial osteopathic manipulative medicine This is an effective approach for many patients including psychiatric patients.

07:27 We could look at the rate and quality of the CRI or Cranial Rhythmic Impulse.

07:33 Historically, it has been documented that patients may have a lower CRI when they have increased stress, depression, chronic fatigue, chronic infection.

07:44 So the normal rate is between 8-14 cycles based on which reference you're reading.

07:49 But in general, in patients that may have increase anxiety, stress, depression, you want to look at the CRI and see if you could appreciate the rate and quality and potentially treat it.

08:03 Patients that undergo severe trauma can also have changes to the CRI and your cranial strain patterns.

08:10 Some possible additional OMT techniques that we could utilize include: suboccipital release to help address any sort of musculoskeletal restriction at suboccipital area.

08:19 This will help to reduce tension, perhaps decrease pain.

08:23 Decrease some of the compressions on the nerves exiting in that area and help balance parasympathetic tone.

08:29 We want to look at possibly applying the CV4 technique.

08:33 The compression of the 4th ventricle technique is hypothesized to help reset the CRI and improve greater amplitude and help patients potentially with sleep and give them a sense of relaxation.

08:47 We could utilize rib raising to try to decrease any restrictions around the thoracic cage.

08:53 Improve excursion of the ribs, help them with circulation and lymphatics and also help to balance sympathetic tone.

09:00 Paraspinal inhibition is a good technique to utilize to help decrease any muscle spasms along the posterior thoracic and lumbar region.

09:09 This could also help with treating sympathetics.

09:14 Thoracic inlet and abdominal diaphragm release should also be applied to help with reducing any sort of restrictions that may impede on circulatory and lymph flow.

09:25 So psychiatry is a growing field and we're starting to get a better understanding of how all these different systems interact and where there is a possible application of osteopathic hands-on treatment and how that could help patients with psychiatric and mood disorders.

09:41 When applying OMT, care has to be utilized to make sure that there's proper indications and contraindications.

09:48 So if there's any potential contraindications with the patient to OMT, then you have to make sure that you avoid performing OMT.