M&D Clinical Corner: Stress Management and Mental Health for Pharmacists

The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Dr. Jesica Mills, PharmD, ND, MBA, RPh, BCES, BCLS, BCNP.

In today’s fast-paced healthcare environment, stress and mental health challenges are becoming increasingly common—not only for patients but also for healthcare providers. As a pharmacist, you are uniquely positioned to help patients manage stress and improve mental health outcomes while also protecting your well-being. At the same time, pharmacists need to manage on-the-job stress. This month, we focus on practical strategies and evidence-based interventions to address this growing concern.

The Impact of Chronic Stress on Health

Chronic stress can lead to a cascade of health problems, including:

• Cardiovascular issues such as hypertension and arrhythmias.
• Metabolic disturbances including weight gain, hormone imbalances, and insulin resistance.
• Mental health conditions such as anxiety and depression.
• Immune system dysfunction, making individuals more susceptible to infections and illnesses. Stress can suppress the immune response, reducing the body’s ability to fight off pathogens. This is particularly concerning during the holiday season when stress levels and exposure to illnesses often increase.

Pharmacists can play a critical role in educating patients about the physiological impact of stress and identifying signs of stress-related disorders, such as frequent headaches, insomnia, or gastrointestinal complaints.

Integrating Stress Management Into Patient Care

1. Identifying Patients at Risk

   • Screening tools such as the Perceived Stress Scale (PSS) link: or the Generalized Anxiety Disorder-7 (GAD-7) link: questionnaire can help identify patients experiencing high stress or anxiety levels. Incorporate these tools during medication therapy management (MTM) sessions or wellness visits.

2. Recommending Evidence-Based Supplements

   • Pharmacists can provide guidance on supplements with growing evidence for stress management, such as:
     • Adaptogens (e.g., ashwagandha or rhodiola): Known to support the body’s stress response.
     • Magnesium: Beneficial for patients with muscle tension or sleep disturbances. Recommend Magnesium Glycinate or Magnesium L-Threonate.
     • Omega-3 fatty acids: Linked to improved mood and reduced stress-related inflammation. Also helpful in decreasing oxidative damage is anti-oxidants like Vitamin C and Polyphenols such as Quercetin and Green Tea.
     • B Vitamin Complex: Supports energy metabolism and may alleviate symptoms of stress and fatigue.
   • Always ensure supplements are of high quality and appropriate for the individual’s medical history and medication profile.
3. Optimizing Medication Therapy
   • For patients with diagnosed mental health conditions, ensure adherence to prescribed antidepressants, anxiolytics, or other medications. Consider signing them up for a synchronization program or placing them on auto-fill. Pharmacists can also monitor for drug-drug interactions, drug-induced nutrient deficiency, side effects, and efficacy.

Common Side Effects of SSRIs and SNRIs:

• Gastrointestinal issues: Nausea, diarrhea, or constipation.
• Sleep disturbances: Insomnia or drowsiness.
• Sexual dysfunction: Reduced libido or difficulty achieving orgasm.
• Weight changes: Weight gain or loss in some patients.

Methods to Avoid or Mitigate Side Effects:

• Take medications with food to reduce nausea.
• Adjust dosing schedules to minimize sleep disturbances (e.g., taking in the morning if causing insomnia).
• Encourage open communication with prescribers for dose adjustments or alternative options.
• Provide support with supplements or lifestyle adjustments, such as probiotics for gastrointestinal issues or regular exercise for mood and energy stabilization.
• To help protect against getting sick, the same supplements that can help with stress management can also help the immune system remain intact. Consider Adaptogens, B Vitamins, Vitamin C, and Probiotics.

Empowering Patients With Lifestyle Interventions

Encourage patients to adopt lifestyle changes that improve stress resilience:

• Mindfulness and Relaxation Techniques: Suggest apps or resources for guided meditation or breathing exercises. I personally like the app Calm and BrainTap, which utilizes Neurolinguistic Programming and Meditation.
• Physical Activity: Educate on the mental health benefits of regular exercise. The pathways that have been linked to anxiety are all inflammatory pathways, such as interleukin-6 (IL-6), and as we know, exercise is beneficial for decreasing inflammation.
• Sleep Hygiene: Provide tips to improve sleep quality, such as consistent sleep schedules and reducing screen time before bed. Adults need at least 6-7 hours of sleep every night to experience baseline health.

Prioritizing Pharmacist Mental Health

Pharmacists often face high levels of stress due to demanding workloads, staffing challenges, and patient needs. To maintain resilience:

• Set Boundaries: Limit after-hours work and carve out time for personal activities. Boundaries also include accepting what we are able to do to help patients, and remembering we are not personally responsible for patient outcomes.
• Seek Support: Engage in peer support groups or professional counseling if needed.
• Practice Self-Care: Incorporate mindfulness, exercise, and hobbies into your routine.

Takeaway for Pharmacists

• As frontline healthcare providers, you have the opportunity to educate and empower patients to manage stress effectively. Integrating mental health screenings, recommending evidence-based therapies, and promoting lifestyle changes can improve patient outcomes and enhance overall well-being. Remember, prioritizing your own mental health is equally vital to continuing your impactful work.

Resources for Further Reading

• American Pharmacists Association (APhA): Pharmacist Wellbeing Index for Pharmacy Personnel
• Anxiety and Depression Association of America (ADAA): Community Resources
• National Center for Complementary and Integrative Health (NCCIH): Evidence on stress management techniques