“When considering the impact of inflammation on mental health, we have to acknowledge the fundamental connection between physical and mental health,” observes Dr. Lucy Chartier, of Life Quality Resources in Raleigh.

“Inflammation—which is the body’s cell-level response to trauma—illustrates this perfectly. Trauma takes many forms; a cut finger, a virus, a poor diet, emotional abuse—all can produce an inflammatory response,” she explains. “And when the response is acute and short-lived—as in the case of a healing response to a wound—inflammation is a good thing. But repeated trauma becomes chronic inflammation; and chronic inflammation—whatever the cause—can result in disease and dysfunction. And just as mental and emotional trauma can result in inflammation, chronic inflammation plays a role in many mental and emotional problems.”

Pain, notes Dr. Chartier, is often the signal that inflammation is a problem. But some forms of inflammation can be more insidious, particularly a type of cellular inflammation where there is an absence of associated pain. “And such inflammation is harmful nonetheless,” she emphasizes. “Indeed, many of the issues we deal with—such as ADHD or anxiety—are inflammatory conditions, but without the symptom of physical pain.”

ADHD and Depression: Inflammatory Conditions

Many studies, notes Dr. Chartier, show a significant connection between chronic low-grade inflammation and mental health issues. “Brain states that produce mental illness,” she points out, “also tend to activate inflammation. And inflammation is capable of producing depression, anxiety, fatigue, and social withdrawal.

“In the case of attention deficit/hyperactivity disorder (ADHD),” she says, “research has identified certain serum biomarkers connected to inflammatory and autoimmune disorders that are more prevalent with ADHD—which is significant. Studies have determined that ADHD may have a close association with allergic disease, for example—an inflammatory condition. And common triggers for ADHD—stress, poor sleep, certain foods and additives, overstimulation—are also triggers for inflammatory response.”

Depression, notes Dr. Chartier, “is another example. There is extensive research showing that depression is associated with a chronic, low-grade inflammatory response—a reaction to a long-term process of taking on more and more of the stress of life without any proper balance. And it’s probably the most widespread chronic illness that comes with life.”

Addressing the Inflammatory Response

As a psychiatric nurse practitioner with doctoral education as a clinical psychologist, Dr. Chartier brings a holistic perspective to her work, appreciating the interplay of mental and physical health issues. “Whether working with patients dealing with depression and anxiety, or with the challenges of attention deficit disorders,” she says, “my focus is always on optimal functional health. This means going beyond medication management and counseling. It means understanding the importance of whole health, and of the lifestyle choices that are the critically important pillars of mental health and wellbeing: good sleep, nutrition, and exercise.”

The Challenges of Adult ADHD

The holistic approach Dr. Chartier uses is particularly effective in working with an increasing number of patients dealing with ADHD. “People often assume this is a childhood issue,” says Dr. Chartier. “But, while it can present differently in adults, ADHD can occur at any age and can interfere—often seriously—with daily functioning.

“Many adults with ADHD aren’t aware they have it,” she notes. “They just know that everyday tasks can be a challenge. Adults with ADHD may find it difficult to focus and prioritize—issues that impact their work. Other symptoms—including impulsiveness, restlessness, and mood swings—also affect quality of life.

“Many of my patients—people in their fifties and sixties—have only recently realized the nature of lifelong challenges. A typical example is a woman who told me, ‘I’ve been struggling with this my entire life. I was never efficient at my jobs, and I contaminated relationships. I’ve always been scattered and could never finish things. But it wasn’t until my granddaughter was diagnosed with ADHD that I realized: I’m just like her!’ 

“But, for other patients, ADHD is a new and frightening experience. I’m seeing adults now who were never diagnosed with ADHD as children and don’t have a history that supports the diagnosis. They were fine, they got through school fine, but now they’re in their forties or fifties and suffering.

“This adult onset of ADHD is especially prevalent in women, due to the hormonal changes they experience in menopause,” notes Dr. Chartier, “because these changes alter the way our neurotransmitters work. So these women struggle cognitively and complain that they can’t do their work; they’re scattered; they can’t focus and concentrate—and these stresses are leading to depression.

“This adult onset of ADHD is especially prevalent in women, due to the hormonal changes they experience in menopause,” notes Dr. Chartier, “because these changes alter the way our neurotransmitters work. So these women struggle cognitively and complain that they can’t do their work; they’re scattered; they can’t focus and concentrate—and these stresses are leading to depression.

Balancing the use of medications with behavioral changes and the use of non-pharmaceutical supplements is critically important in treating ADHD,” says Dr. Chartier. “I try to find that ‘sweet spot’ in the use of stimulants—where the dose is effective but not overpowering. The key is developing a plan for the individual patient.”

Stressed?
Control What You Can

Dr. Lucy Chartier holds a doctorate in clinical psychology and advanced education as a psychiatric/mental health clinical nurse specialist and nurse practitioner. As a nurse practitioner, she prescribes and manages adult patients’ psychiatric medications when necessary to contribute to the total treatment plan of promoting optimal patient mental/emotional health. Yet she remains committed to a holistic approach.  

“I see ‘medication management’ as more than adjusting dosages,” she explains. “Medications are powerful, often essential, tools in helping patients deal with depression or anxiety. But drugs are not going to replace being a healthy human or adopting increasingly healthy behaviors. The challenge is to develop the plan to balance the use of medications with behavioral changes and the use of non-pharmaceutical supplements is critically important in treating ADHD,” says Dr. Chartier. “I try to find that ‘sweet spot’ in the use of stimulants—where the dose is effective but not overpowering. Equally important—perhaps most important—is to find a path that helps each patient to understand their own power to heal.”

Health&Healing: How would you describe that process?

DR. CHARTIER: As a first—and important—response to stress there is a simple and powerful tool—and one available to each of us; and that is meditation. Whether we call it that or we call it something else, it’s the skill of getting still and quiet inside ourselves, of removing ourselves—even briefly—from the stressors plaguing us.

When we live in our heads, dwelling on worries and woes, we’re choosing to live in a world of things we cannot control. Meditation is about controlling what we can. There are plenty of things over which we do not have direct control. How am I going to respond to this chemotherapy? Am I going to have enough money this month to pay my rent? These things are the ones that produce the stress response. The adrenals get going, pumping out the adrenaline. We’re into that loop.

So, learning how to make the choice to unplug ourselves from all of those worries about the things that we do not control is way to stop—at least briefly—the inflammatory response. Taking control for three minutes, or five minutes, or—hopefully, with practice—for 30 or 40 minutes is healing. Inflammation harms us physically and mentally. We cannot control all the stressors that contribute to inflammation, but by controlling what we can—even briefly—we are able to slow the inflammatory response.

H&H: What is that three-minute process like?

DR. CHARTIER: As I said, the process is simple. Just take a few minutes to refocus; begin with your breath. I’m focusing my attention on the feeling of air flowing in and out. I’m putting my conscious mind, my thinking mind on the words “I’m breathing in, I’m breathing out.’ I listen to the sound of my breath flowing in and flowing out.

Note that I’m not saying: ‘don’t think about your worries.’ I am saying do think about the activity of breathing. And in those moments, I am buying myself time away from stress because it’s not stressful to focus on breath awareness. It gets me away from my worrisome thoughts.

If my body is filled with adrenaline because I’ve been in a worrying place for the last three hours, it may take longer than three minutes to reduce stress. It takes some time for adrenaline to metabolize once the adrenals stop pumping it out. So maybe I just sit and notice: I’m aware of my heart beating really fast. I am watchful. In my mind’s eye, I see my heart beating fast and the blood flowing through my blood vessels. I notice that I’m breathing a little bit slower now, and my heart seems to be slowing down a bit.

These moments allow a complete shift from being caught up in the thoughts of worry and fear and to an awareness of my physical self, and trusting that my body’s doing exactly what it’s supposed to do. As I do this, I find after three or five minutes that my whole body feels more relaxed. I’ve spent five minutes not thinking about my worries, and although I can go right back to them any time I want to, but I know I can also get away from them whenever I choose. Making this choice multiple times a day builds resilience.

Developing this ‘stress busting’ skill is a powerful way to take control. It takes practice, but can begin with a few minutes first thing in the morning. Maybe when stopped at a traffic light—taking the two minutes to notice my breath; Use this tool whenever you feel the weight of worries piling up. Few skills are more powerful.