Chronic Stress–Related Psychiatric Disorders vs. Primary Psychiatric Disorders

From the Author

As always, I am presenting clinically based observations .. Today, we will discuss another emerging healthcare crisis in the field of psychiatric medicine.

Briefly, I receive many referrals from a multidisciplinary neurology medical group. Over the last six months, an increasing number of patients have been referred by psychiatrists for neurological evaluation. These patients often present with multiple symptoms, including cognitive decline, headaches, brain fog, slowed thinking, fatigue, and other neurological complaints that can resemble conditions such as multiple sclerosis (MS).

As part of my intake process, I review each patient's medical history and current medications. Recently, I began noticing a significant increase in the number of patients taking antipsychotic medications. This was not something I commonly observed in the past.

When I asked who prescribed these medications, the answer was often the same: "My psychiatrist." This observation helped me understand that neurologists are now receiving a growing number of referrals from psychiatric practices. I discuss these observations and their potential implications in greater detail in this article.

Attention

Massage schools, certified and licensed massage therapists, and massage organizations throughout Southern California:

If you are interested in working with me to develop a model for addressing chronic stress–related disorders and implementing a truly integrative healthcare approach, please contact me at:

support@medicalmassage-edu.com

I am prepared to offer special participation opportunities, including training, clinical guidance, and instruction on how to effectively collaborate with healthcare professionals and medical practices.

You do not need to be a highly experienced massage therapist. My teaching methodology is designed to significantly advance your clinical skills and understanding of medical massage applications. What is most important is your willingness to learn, your commitment to professional growth, and your desire to help others.

I encourage you to review my published materials and decide whether this is a direction you would like to pursue. The need is enormous. Millions of Americans are suffering from chronic stress–related disorders, Long COVID, autonomic dysfunction, and associated health challenges.

When I say millions, I truly mean millions.

Boris Prilutsky
Medical & Sports Massage Educator
NCBTMB-Approved Continuing Education Provider

The substantial increase in demand for psychiatric services since the COVID-19 pandemic reflects a growing mental health crisis. While many patients present with symptoms such as anxiety, depression, cognitive impairment, sleep disturbances, emotional instability, and behavioral changes, it is important to recognize that not all psychiatric disorders arise from the same underlying mechanisms.

In chronic stress–related disorders, symptoms often develop as a consequence of prolonged activation of the body's stress-response system. Persistent overproduction of stress hormones, including cortisol and adrenaline, may contribute to neuroinflammation, autonomic nervous system dysregulation, endothelial dysfunction, impaired cerebral circulation, mitochondrial dysfunction, and, in some cases, encephalopathy-like symptoms. The result can be a cascade of physical and neurological changes that manifest as anxiety, depression, brain fog, impaired concentration, memory problems, sleep disorders, emotional instability, and other behavioral disturbances.

In contrast, many primary psychiatric disorders—such as schizophrenia, bipolar disorder, and certain severe mood disorders—are believed to involve a stronger contribution from genetic predisposition, neurodevelopmental abnormalities, neurotransmitter dysfunction, and other biological factors that are not primarily driven by chronic stress. Although stress may aggravate symptoms in these conditions, it is generally not considered the primary cause.

This distinction is clinically important. In stress-related disorders, treatment strategies that address autonomic dysfunction, chronic inflammation, sleep quality, physical health, and stress management may play a significant role alongside psychological and psychiatric care. In primary psychiatric disorders, treatment often focuses more heavily on psychiatric evaluation, medication management, and long-term mental health interventions.

While the symptoms of these conditions may overlap, the underlying mechanisms can be very different. Understanding these differences may help healthcare providers develop more targeted and effective treatment strategies for each patient.

Medication Use: Before and After COVID-19

One U.S. analysis found that mental healthcare utilization increased from approximately 20% of adults in 2019 to more than 23% in 2022, representing a 41% higher likelihood of using mental health services in the post-COVID period. Other reports documented a 53% increase in spending on mental health treatment and a continuing rise in psychotropic medication use as the pandemic progressed.

Among the most commonly prescribed psychiatric medications are:

• Antidepressants (SSRIs and SNRIs) – Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac), and Venlafaxine (Effexor).
• Anti-anxiety medications – Alprazolam (Xanax), Lorazepam (Ativan), and Clonazepam (Klonopin).
• Antipsychotic medications – Aripiprazole (Abilify), Quetiapine (Seroquel), Risperidone (Risperdal), Olanzapine (Zyprexa), and Clozapine (Clozaril).
• Mood stabilizers – Lithium, Valproate, and Lamotrigine.

In primary psychiatric disorders such as schizophrenia, bipolar disorder, and certain severe psychotic illnesses, antipsychotic medications primarily work by modulating neurotransmitter activity, particularly dopamine pathways within the brain. Excessive dopamine signaling in specific brain regions is believed to contribute to hallucinations, delusions, and psychotic symptoms. Antipsychotic medications reduce this excessive signaling and help stabilize perception, thought processes, and behavior. However, antipsychotic medications have little, if any, effect on the underlying mechanisms of chronic stress–related disorders and their associated symptoms.

Summary, Overview, and Conclusion

The COVID-19 pandemic and its aftermath have been accompanied by a significant increase in mental health complaints, psychiatric consultations, and the use of psychiatric medications. Many patients now present with symptoms including anxiety, depression, cognitive decline, brain fog, sleep disturbances, fatigue, emotional instability, and other behavioral changes.

An important clinical question is whether all of these symptoms represent primary psychiatric disorders or whether a substantial number of cases are manifestations of chronic stress–related physiological dysfunction. Chronic stress can trigger prolonged overproduction of stress hormones, neuroinflammation, autonomic nervous system dysregulation, sleep disturbances, endothelial dysfunction, and other pathological changes that may significantly affect brain function and behavior.

In my clinical observations, an increasing number of patients referred for neurological evaluation have previously been treated with psychiatric medications, including antipsychotic drugs. While these medications play an important role in the management of primary psychiatric disorders such as schizophrenia and other psychotic illnesses, they may have limited impact on the underlying physiological mechanisms associated with chronic stress–related disorders.

Based on my clinical experience, chronic stress appears to be a major aggravating factor in many chronic conditions, including psychiatric disorders. Therefore, treatment approaches that address both the psychological and physiological consequences of chronic stress may provide additional benefits for many patients.

Conclusion

Healthcare is increasingly facing the challenge of distinguishing between primary psychiatric disorders and chronic stress–related dysfunction. While conventional psychiatric treatment remains essential for many patients, greater attention should be given to the physiological consequences of chronic stress and their contribution to mental and neurological symptoms.

An integrative approach that combines appropriate medical care with medical massage specifically designed interventions, aimed at managing chronic stress and restoring physiological balance may offer a more comprehensive strategy for improving patient outcomes. As the prevalence of stress-related illness continues to grow, addressing chronic stress is becoming not only beneficial but necessary in the management of many chronic health conditions.