Role of Spirituality in the Management of Major Depression and Stress-Related Disorders.

Acknowledgement of the importance of religion and spirituality in medicine is increasing. Several studies have shown a predominantly inverse relationship between faith-based activities and psychiatric disorders. Chronic stress alters autonomic nervous system reactivity, and changes in the dopamine systems of people undergoing chronic stress have been well documented in the literature. In Figure 1, we hypothesize a model regarding the vicious cycle that exists between psychiatric disorders and chronic stress. Brain-derived neurotrophic factor (BDNF) is a brainnourishing molecule that plays an important role in synaptic plasticity, dendritic and neuronal fiber growth, and neuronal survival. People with mental health issues such as depression may improve their mood and behavior through faith-based activities, which are known to increase serum BDNF levels. The stress-related system, which includes the hypothalamic-pituitaryadrenocortical (HPA) axis and the hippocampus, and the reward system, which includes the ventral tegmental area and nucleus accumbens pathway, were found to be associated with altered BDNF expression following stress induction in animal models. Although the data are mixed, few studies have shown that chronic stress exposure decreases BDNF levels in brain regions implicated in mood and behavior such as the prefrontal cortex and hippocampus in rodents. Further, these findings are in agreement with results from postmortem brain studies from depressed suicide completers. The prefrontal cortex (PFC) assists us in completing our daily activities through thinking, reasoning, focusing, and controlling the emotions. Researchers conducted studies in a group that practices glossolalia (the phenomenon of speaking in an unknown language, especially in religious worship, practiced predominantly by Pentecostal and Charismatic Christians) as a form of deeply meaningful and intimate spiritual experience. Glossolalia is an unusual mental state in which individuals appear to be speaking an incomprehensible language during the most intimate praying moment. Functional magnetic resonance imaging (fMRI) scans showed that the frontal lobe, the part of the brain that controls language, was active when the participants prayed in English but fell mostly quiet when they prayed in glossolalia. Frontal lobe activity is known to increase when individuals focus on what they are saying, but this study found that when people speak in glossolalia, the words coming forth originate from a source other than the PFC. In addition, it was revealed that while blood flow to the PFC decreased, activity in the area that controls self-awareness (medial PFC/anterior cingulate cortex and medial parietal/posterior cingulate cortex) was active. On the contrary, it is of interest to note that an fMRI study of Carmelite nuns revealed that remembrance of spiritual, mystical experiences correlated with increased blood flow in the PFC and temporal, caudate, cingulate, and orbitofrontal cortices, which also correlate with religious experiences and positive emotions. These two studies show that