Thriving at Altitude, Part 3: Why there’s more depression, anxiety and suicide at high altitude

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DSC 5088 e1569181851885 682x1024 - Thriving at Altitude, Part 3: Why there’s more depression, anxiety and suicide at high altitude
Cristen Malia is a clinical mental health counselor at Minds in Motion in Steamboat Springs where she performs human-centered therapy. The talk therapy incorporates several elements, including teaching mindfulness and using techniques from yoga.
Lisa Schlichtman

Editor’s note: This is part three of a four-part Longevity Project: Thriving at Altitude series that will publish on Mondays through Sept. 30. The series also includes profiles on Routt County locals who are thriving at altitude.

STEAMBOAT SPRINGS — Living in a mountain resort community above 8,000 feet certainly has its draws, but also its drawbacks. Rents are higher, affordable housing is hard to find, quality jobs are fewer and cost of living is more expensive.

All those factors contribute to the fact that high altitude living doesn’t always offer the stress-free lifestyle people are seeking or expect of a picturesque mountain community.

Steamboat Springs has a duality issue, in that, the normed behaviors of heavier drinking and drug use stand in stark contrast to an extreme focus on wellness and physical health.

Resort communities, in general, have a higher prevalence of substance use across the board, said Amy Goodwin, a licensed professional counselor and behavioral health counselor with UCHealth Yampa Valley Medical Center. That’s because of the norming trends for drug use.

The idea of being on a permanent vacation when living in resort communities contributes to a mindset that encourages indulgence patterns. Being surrounded by indulgence or overindulgence can influence what is believed to be normal behavior, she said.

Higher altitude can worsen mental health 

Observed behaviors and personal anecdotes suggest the initial mood experienced at altitude is euphoria followed by depression. Multiple symptoms can emerge over time, including irritability, anxiety and apathy.

That’s according to “Hypoxia,” a 1963 study conducted by Edward Van Liere and J. Clifford Stickney.

The initial euphoria is a result of increased dopamine, the neurotransmitter contributing to feelings of pleasure, when entering high altitude. Dopamine is a short-burning fire, and then it’s gone, Goodwin explained. 

“So, when the ‘Rocky Mountain high’ burns off, then what we’re left with is depleted dopamine and serotonin,” she said.

Most of the existing behavioral studies of high altitude effects, however, center on hypoxia, which is decreased blood oxygenation due to higher elevation. Studies suggest hypoxia could negatively alter serotonin metabolism, which, in basic terms, contributes to feelings of wellbeing and happiness.

Emotions, such as anxiety, grief and confusion, are more intensely felt at elevation because of the lower oxygen concentration. Serotonin helps humans put things into perspective. 

“Don’t sweat the small stuff — that’s a serotonin skill,” Goodwin said. “Without serotonin, we can’t put things aside.”

Distress signaling is an alarm, not a disease, she said.

“Whether it’s depression, anxiety, confusion or deep despair, those are alarms from our body that something is wrong,” she said.

The role of mental health providers is to help people figure out what has gone wrong when those signals arise. Goodwin stressed that people shouldn’t be afraid of those alarms but should learn to read and understand them.

Physiological effects of altitude have been studied for decades, but there have been few investigations of the associated mood and behavioral changes.

Goodwin agrees that altitude’s effect on mental health is an understudied area, with the answer to why the effects occur not being as well investigated.

“Philosophically, I think that our focus on mental health has been so much on neurotransmitters and the chemistry associated with that, that we have forgotten to look sometimes for causality,” she said. “Why can’t we look at why?”

It’s an endemic issue to the field of mental health research, she added.

“When we have the pharmaceutical companies running the research, they’re not going to be interested in altitude because they can’t give you a pill for altitude,” she said.

Routt County’s suicide rate

Sixteen people have taken their own lives in Routt County over the past five years, according to Routt County Coroner Robert Ryg. The county had a suicide rate, from 2004 to 2017, of 20.9 suicides per 100,000 people. The national average is 14 suicides per 100,000 people.

Scholars and public health professionals have pointed to numerous contributing factors, from troubled local economies to the isolation that can sometimes accompany the rural settings of the West.

suicide in routt - Thriving at Altitude, Part 3: Why there’s more depression, anxiety and suicide at high altitude

But a main contributing factor points back to elevation and hypoxia.

As the body hits 2,000 to 3,000 feet in elevation, the oxygen concentration in the bloodstream suppresses serotonin production.

A study published March 2018 in the “Harvard Review of Psychiatry” titled “Living High and Feeling Low: Altitude, Suicide and Depression,” authored by doctors Brent Kious, Douglas Kondo and Perry Renshaw, found that higher elevation may be linked to increased rates of suicide. The researchers analyzed 12 studies, most of which reported that high-altitude areas in the United States had increased rates of depression and suicide.

Adjusted for population distribution, average suicide rates were found to be 17.7 at high altitude, 11.9 at mid-altitude and 4.8 at low altitude for every 100,000 people.

suicide at altitude - Thriving at Altitude, Part 3: Why there’s more depression, anxiety and suicide at high altitude

The study’s researchers suggested the reason is tied to chronic hypobaric hypoxia.

If people are already prone to depression and anxiety, whether it is from prior trauma or genetics, it can be exacerbated moving to high altitude. But it doesn’t affect everyone, just like not everyone develops altitude sickness, according to Goodwin.

So, it’s not necessarily that people are coming to high altitude and developing feelings of depression and anxiety. It’s more that it worsens. That’s according to research which was conducted examining people with preexisting mental health conditions.

Another contributor to an increased suicide rate at high elevation is a phenomenon called suicide tourism, which is the practice of traveling to a location away from home to complete suicide. People engaging in this act often take their own lives at famous landmarks, such as the Golden Gate Bridge or in beautiful outdoor environments like Routt County.

Ryg, however, said that hasn’t been the case locally for several years, and there has actually been a downward trend of suicides in the past four years in Routt County. The number of attempted suicides, however, is unknown.

Being mindful

Cristen Malia grew up in Northern California and moved to Colorado when she was 18 years old.

Today, as a clinical mental health counselor at Minds in Motion in Steamboat, she performs human-centered therapy. The talk therapy incorporates several elements including teaching mindfulness.

Mindfulness has become a mental health buzzword. It is the psychological process of bringing one’s attention to experiences occurring in the present moment. It’s meant to focus a person on their thoughts, feelings and body sensations so as not to become overwhelmed by them.

It’s one of Malia’s main practices.

It’s about living life in the moment. Such a simple idea can have dramatic effects on a person’s mental wellbeing, Malia said.

As a longtime yoga teacher, Malia also tends to use the fundamentals taught in yoga during therapy, if a client is comfortable with that.

The mind-body connection is personally apparent to Malia, who developed Lyme disease, a tick-borne bacterial illness, while living in Colorado. Her chronic illness was intensified because of the low oxygen levels at higher elevation. Inflammation isn’t as easy to reduce at altitude.

“In my healing, I would often go to sea level and noticeably feel better there,” she said.

But it was never a mental burden because she was able to find healing at altitude by being outdoors.

“I feel that another element of my healing that made a profound effect was being able to be outside and in fresh air,” she said.

It’s a balancing act, she admitted. She realized the trade-offs she made when opting to live at altitude, specifically in Steamboat — a cost-benefit analysis, as she put it.

“Maybe the altitude compromises my oxygen intake and inflammation, but there are so many other pieces that I get benefit from,” she said of her high altitude surroundings. “There’s less emotional burden for me here because I love the mountains, I love nature, the things that Steamboat can offer.”

A thriving mind

Thriving at altitude isn’t just about physicality. It’s also crucial to focus on mental wellbeing.

Yoga, a globally popular practice, offers tools to encourage mental wellness. It’s not always just about postures but also learning how to breathe in an efficient and nourishing manner, said Malia, who is also a registered yoga teacher at Rakta Hot Yoga and Wellness Studio in Steamboat.

“(Breathing) impacts our nervous system and our mental health; it’s all connected,” she explained.

One of the biggest practices to enhancing mental wellness is rest, according to Malia.

“If we could all just slow down,” she said, “which is hard for people in this town to do — myself included in that. If we can rest as hard as we play, I think that would be really beneficial.”

But Malia is referring to deliberate and intentional rest. It’s not about scrolling through social media or zoning out in front of the TV, rather it’s taking a slow walk, sitting by the river, paying attention to aspens blowing in the wind.

“It’s the little things,” she said.

Mindfulness and meditation play into achieving that rest.

“The practice of mindfulness asks us to pay attention to what’s happening in our present moment experience,” she said. “When we get better at doing that … we can also get better at taking care of ourselves.” 

At that point, people become aware of what they need or come to the realization they’re going too fast or using energy unwisely.

“It doesn’t have to be in a state of meditation, but paying attention to the moment in a kind and compassionate way,” she said.

Despite the negative effects on mental health, people still flock to live in high altitude areas. That’s because, according to Goodwin, the human brain tends to focus on the positives; people want to know where to find happiness. And when considering the many aesthetics of the community and opportunities for recreation, “it would be really hard to talk the human brain out of focusing on that.”

“Hyperbaric hypoxia is a thing,” she said. “But I doubt that’s going to resonate over, ‘I can get a ski pass and hike the mountains every day.’”

To reach Bryce Martin, call 970-871-4206 or email bmartin@SteamboatPilot.com.

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