Stress: an overview of the literature with emphasis on job-related strain and intervention.

Maintained stress produces a constellation of neurochemical and hormonal changes that involve both the hypothalamic-pituitary-adrenal axis and a variety of brain regions. Long-term stress can produce psychological and physiologic consequences including anxiety, depression, hypertension, impaired immune system function, and an increased risk of cancer and coronary heart disease. Negative responses to perceived job-related stress usually occur when an individual has relatively little control over the means to meet high job demands. Among the approaches to reduce workplace stress, changing the coping strategies of challenged employees, particularly by increasing decision latitude, can significantly relieve both the psychological and physiologic consequences. Nevertheless, behavioral intervention is not invariably successful, and benzodiazepines are often prescribed to manage inadequately alleviated anxiety. Evidence that excessive serotonergic neurotransmission may underlie anxiety has prompted the use of compounds such as buspirone. This partial agonist of the 5-HT1A receptor has been demonstrated to be as effective as benzodiazepines in controlling generalized anxiety symptoms and to have a more favorable side-effect profile.