The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It states that “there is no health without mental health.” This is an apt reminder of the importance of mental well-being, in conjunction with physical well-being, and how these should be prioritised.1
According to a recent study, a quarter of South Africans are most likely depressed, with almost a third of the population having experienced a common mental illness in their lifetime.2 There are multiple links between mental health and chronic physical conditions that significantly impact people’s quality of life … yet the stigma attached to mental illness is such that many are too ashamed to get the help they need.
Bada Pharasi, the CEO of Innovative Pharmaceutical Association of South Africa, discusses the link between mental and physical health, how to recognise the symptoms, get the right treatment and make lifestyle changes.
In South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders reveals a need for integrating mental health more comprehensively into chronic care in the country’s healthcare system. The treatment gap in South Africa is also high, with only one in four people with a common mental illness receiving treatment of any kind. Underprivileged South Africans are worse off, due to the lack of capacity, accessibility and resources in the public health sector.3
The brain-body connection
Metabolic hormones such as insulin, cortisol, leptin and others, have been found to impact a wide range of mental illnesses, from ADHD to depression, anxiety, addiction and eating disorders. Research shows that the interaction goes both ways. Metabolic problems like diabetes, hypertension or even prolonged periods of poor nutrition can cause stress-induced changes to the brain that lead to mood and neurodevelopmental disorders.4
Similarly, certain mental health disorders can cause stress that triggers metabolic changes that, over time, can develop into those same metabolic diseases. Research shows that people with a mental health problem are more likely to have preventable physical health conditions.4
Mental health illnesses come with physical symptoms. Depression can present as a feeling of acute sadness, tearfulness or hopelessness or lead to experiencing angry outbursts or irritability; losing interest in most activities; insomnia or even over-sleeping; having a lack of energy to tackle even the smallest tasks; weight loss or gain; feeling anxious; experiencing slow thinking, speaking or moving; having trouble concentrating and remembering; experiencing memory loss; and having suicidal thoughts.4
Anxiety can result in stomach disturbances, feeling weak or dizzy, having headaches or other body pains, breathing more rapidly or with difficulty, experiencing hot flushes, grinding teeth at night, having panic attacks, finding it difficult to manage daily tasks, and more.5
Anxiety is also problematic for the heart. Research shows that living with ongoing and untreated anxiety makes a person more likely to develop heart disease, including tachycardia (rapid heart rate), increased blood pressure, and an increased risk of heart attack. While symptoms of a panic attack can mimic those of a heart attack, anxiety can actually increase one’s chances of having heart problems or a stroke.6
Almost everyone experiences some degree of anxiety or depression at various points in their lives. People sometimes feel lonely, sad or disinterested when faced with difficult, life-changing events. In the appropriate circumstances, anxiety is actually a ‘fight or flight’ response that helps people handle a potentially dangerous or stressful situation with extra care.6 However, when these conditions get out of control, the impact on people’s lives is significant, and they need to be assessed and treated.
When a person begins experiencing these symptoms, there are things they can do to help themselves. These can be effective strategies to help manage the situation:
Make regular exercise a lifelong habit
The physical and mental health benefits of regular exercise cannot be overestimated. All exercise can boost one’s mood by lowering levels of stress hormones, increasing the production of feel-good chemicals known as endorphins, and bringing more oxygenated blood to the brain.7
Exercise improves muscle mass and function as well as metabolic function, reduces inflammation, strengthens the immune system, improves cardiovascular and respiratory health, and even contributes to creating healthy gut bacteria.7
All of these physical health benefits will, in turn, improve mental health, because they’re interconnected. Exercise also has direct benefits for the brain, including improved cognitive function, improved memory and impulse control, reduced depression and anxiety symptoms, and lower stress.7
Many of these benefits are cumulative, so exercising consistently and regularly will manifest long-term benefits. But exercise also has immediate benefits, including an elevated mood for several hours after exercise, improved energy levels, and mild pain relief.7
The idea is to start small so that it’s not overwhelming. Very effective exercises using only body weight can be done at home. Going for walks – even short ones – is highly beneficial. Activities that were once enjoyed can be taken up again at a slow pace, for example, swimming, dancing or taking the dog for a walk.7
Yoga classes at a studio or online are also effective. Yoga can affect mood by elevating levels of a brain chemical called gamma-aminobutyric acid (GABA), which is associated with better mood and decreased anxiety. Yoga is known to calm the mind and stretch out the body and stiff joints.8
Sensible dietary changes are essential. More fruit and vegetables should be included in one’s diet and refined carbohydrates, sugar and salt should be limited – so should processed or fast foods, as these contain added salt, unhealthy fats, sugar and preservatives. Increasing water intake is vital for staying hydrated, which is paramount in treating both mental and physical illness.7
Practice mindfulness and make time for relaxing – just checking in with oneself and taking a break from the noise of life is helpful. More defined mindfulness can be practiced once a habit has been established to carve out time for this practice.7
Part of having a healthy state of mind is connecting with friends and family to avoid becoming isolated, which often exacerbates depression or is caused by depression. Keeping in contact and trying to attend low-key get-togethers to avoid getting overwhelmed, is important.7
If sufferers are not coping with everyday life, work and social activities, despite trying to help themselves, they can make an appointment with their GP to get the professional advice they need. If necessary, their GP may refer them to a psychiatrist to receive medication to help them.9
July is The South African Depression and Anxiety’s (SADAG’s) Mental Health Awareness month. The organisation educates and provides support for people suffering with mental illnesses of all kinds. This month, SADAG will be unpacking the complexities of anxiety, and sharing helpful coping strategies, information and resources. Visit www.sadag.org for more information.10
2. The State of Mental Health in South Africa [Internet]. [cited 2023 Jul 7]. Available from: https://www.eapasa.co.za/the-state-of-mental-health-in-south-africa/#:~:text=South%20Africa%20scored%20the%20lowest,%25%20in%202020%20to%2036%25
3. Petersen I, Fairall L, Bhana A, Kathree T, Selohilwe O, Brooke-Sumner C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry. 2016 Jan;208(Suppl 56):s29.
6. The Effects of Anxiety and Depression on Your Physical Health [Internet]. Advanced Psychiatry Associates. 2019 [cited 2023 Jul 7]. Available from: https://advancedpsychiatryassociates.com/resources/blog/the-effects-of-anxiety-and-depression-on-your-physical-health/
7. Green R. The Connection Between Mental Health and Physical Health [Internet]. Verywell Mind. 2023 [cited 2023 Jul 7]. Available from: https://www.verywellmind.com/the-mental-and-physical-health-connection-7255857
9. Physical health and mental health [Internet]. Mental Health Foundation. [cited 2023 Jul 7]. Available from: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/physical-health-and-mental-health