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Do you ever wonder what is going on when you wake up on the wrong side of the bed? Why is it that some people just seem naturally happier or more motivated or driven? In this episode we will take a closer look at some of the main neurochemicals responsible for mood, motivation, learning, libido and hunger.
1. Pharmacology of Recovery: Dopamine, GABA, Serotonin, Acetylcholine Recovery & Resilience International in partnership with AllCEUs.com Co- Occurring Disorders Recovery Coaching Curriculum Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC, CCDC Executive Director, AllCEUs.com
2. Objectives Review the function of the most common neurotransmitters (Dopamine, Serotonin, GABA, Glutamate, Norepinepherine, Acetylcholine) Explore how different drugs interact with brain chemistry to produce the reward Learn how the brain's natural protective mechanisms actually cause withdrawal symptoms, and what that means Identify mental health issues associated with imbalances between these neurochemicals Examine ways to deal with chemical imbalances
3. Why I Care/How It Impacts Recovery Whether it existed before the addiction, or was caused by the addiction, in early recovery, nearly every person’s neurotransmitters are out of balance. This causes feelings of depression, apathy, anxiety, exhaustion. This is part of what is referred to as Post Acute Withdrawal Syndrome Understanding why you feel the way you do is the first step Figuring out how to help yourself feel better is the next
4. What are Neurotransmitters The human brain is composed of roughly 86 billion neurons. (1) These cells communicate with each other via chemical messengers called neurotransmitters. Neurotransmitters regulate Mood cravings, addictions Energy Libido Sleep Attention and concentration Memory Pain Sensitivity,
5. Neurotransmitters Cont… About 86% of Americans have suboptimal neurotransmitter levels — our unhealthy modern lifestyle being largely to blame. (3) Chronic stress, poor diet, environmental toxins, drugs (prescription and recreational), alcohol, nicotine, and caffeine can cause neurotransmitter depletion.
6. Mechanism of action/purpose Movement Memory Pleasurable reward Learning Behavior and cognition Attention Dopamine
7. Mechanism of action/purpose Altered dopamine neurotransmission is implicated in Cognitive control (racing thoughts) Attentional control Impulse control Working memory Dopamine
8. Where is it found Precursor, L-DOPA is synthesized in brain and kidneys Dopamine functions in several parts of the peripheral nervous system In blood vessels, it inhibits norepinephrine release and acts as a vasodilator (relaxation) In the pancreas, it reduces insulin production In the digestive system, it reduces gastrointestinal motility and protects intestinal mucosa Dopamine
9. Symptoms of excess & insufficiency Excess of dopamine Unnecessary movements, repetitive tics Psychosis Hypersexuality Nausea Most antipsychotic drugs are dopamine antagonists Note: Antipsychotic drugs are used for many things other than schizophrenia Dopamine antagonist drugs are also some of the most effective anti-nausea agents Dopamine
10. Symptoms of excess & insufficiency Insufficient dopamine Negative symptoms Reduction in emotional responsiveness Lack of motivation Diminished expressiveness (speech/socialization) Difficulty concentrating or poor memory Pain Restless legs syndrome Attention deficit hyperactivity disorder (ADHD) Dopamine
11. Nutritional building blocks Eating a diet high in magnesium and tyrosine rich foods will ensure you’ve got the basic building blocks needed for dopamine production. Here’s a list of foods known to provide dopamine building blocks: Dopamine Chicken Almonds Apples Avocado Bananas Beets Chocolate Green leafy vegetables Green tea Lima beans Oatmeal Sesame & pumpkin seeds Turmeric Watermelon Wheat germ
12. Sunlight Sunlight also affects both serotonin and dopamine transporter binding activity. Medications Increase Dopamine in blood is unable to cross the blood-brain barrier to reach the brain. Levodopa-Carbidopa combination is actually converted to dopamine in the brain Mirapex & Requip can increase dopamine receptor activity Dopamine
13. Medications Most common dopamine antagonists (positive symptoms) Risperdone, Haldol, Zyprexa, Seroquel Metoclopramide (Reglan) is an antiemetic and antipsychotic Dopamine
14. Mechanism of action/purpose Anti-anxiety, Anti-convulsant GABA is made from glutamate GABA functions as an inhibitory (chillax) neurotransmitter Glutamate acts as an excitatory (get up and go) neurotransmitter There is always a balance of these two neurotransmitters… Like making a warm bath, constantly adjusting the hot and cold GABA
15. Where they are found Close to 40% of the synapses in the human brain work with GABA and therefore have GABA receptors. GABA
16. Symptoms of excess Excess sleepiness Shallow breathing *Increased blood pressure Symptoms of insufficiency Anxiety, feeling dread for no particular reason Depression Difficulty concentrating Insomnia Seizure disorders racing thoughts Cold hands Heart palpitations and shortness of breath GABA
17. Nutritional building blocks Fermented foods sauerkraut, yogurt Almonds & Walnuts Cherry Tomatoes Banana Brown rice Potato Oats Lentils Vitamin B6, if deficient, may impair the production of GABA as it is a cofactor nutrient. GABA
18. Nutritional building blocks Inositol (Vitamin B-8) Wheat germ Brown rice Green leafy vegetables Nuts Navy and Lima beans GABA
19. Medications Drugs that increase the available amount of GABA typically have relaxing, anti-anxiety, and anti- convulsive effect Gabapentin (neurontin) is a GABA analogue used to treat epilepsy and neurotic pain. Benzodiazepines and Barbiturates including GHB, Valium, Xanax GABA
20. Mechanism of action/purpose Helps regulate Mood Sleep patterns Appetite Pain perception Where is it found Brain Gut/Intestines Skin (Melatonin) Serotonin
21. Symptoms of excess Depression Apathy, Emotional flatness or dullness Passivity Insomnia and other sleep problems Difficulty concentrating and learning Poor memory; amnesia Difficulty making decisions and acting on them Sexual dysfunction Serotonin
22. Symptoms of Serotonin Syndrome (Life Threatening) Shivering Diarrhea Muscle rigity Fever Seizures Irregular heartbeat Serotonin
23. Insufficiency Depression Anxiety Pain sensitivity Women are much more likely to experience mood disorders and carb cravings Men are more likely to be impulsive, have ADHD, and drink alcohol in excess. Serotonin and other hormones Estrogen is needed to produce serotonin and serotonin is broken down into melatonin. (BMC Women's Health) Low serotonin and high testosterone levels lead to aggressive behavior. (Isr Med Assoc J. 2003 Sep;5(9):653-8.) Testosterone modulates serotonergic receptor activity in a way that directly affects aggression, fear and anxiety. Serotonin
24. Nutritional building blocks Foods rich in tryptophan, an amino acid that converts to serotonin in the brain. Whole-wheat Potatoes Brown rice Lentils Oats Beans Serotonin
25. Medications SSRIs SNRIs 5-HTP SAM-e Sunlight The skin is actually a sort of neuroendocrine gland, as sunshine exposure stimulates skin production of most neurotransmitters including serotonin, a key compound involved in cognition, regulation of feeding behavior, mood, anxiety, aggression and pain, sexual activity, sleep, and seasonal affective disorder or SAD. Also, melatonin, a hormone most notably synthesized in the pineal gland and most importantly associated in the areas of regulation and the modulation of circadian rhythm, is produced in the skin. Serotonin
26. Their mechanism of action/purpose In lower amounts, ACh can act like a stimulant by releasing norepinephrine (NE) and dopamine (DA). Memory Motivation Higher-order thought processes Sexual desire and activity Sleep Acetylcholine
27. Symptoms of excess Depression (all symptoms) Nightmares Mental Fatigue Anxiety Insufficiency Alzheimers/dementia Parkinsons Impaired cognition, attention, and arousal Inverse relationship between serotonin and acetylcholine Acetylcholine
28. Nutritional building blocks Foods high in choline Meats Dairy Poultry Chocolate Peanut butter Wheat germ Brussels sprouts and broccoli Acetylcholine
29. Medications Anticholinergics Atropine Benzatropine (Cogentin) Chlorpheniramine (Chlor-Trimeton) Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl, Sominex, Advil PM, Unisom) Hydroxyzine (Atarax, Vistaril) Bupropion (Zyban, Wellbutrin) Dextromethorphan – Cough suppressant Acetylcholine
30. Anticholinergic drugs are used to treat a variety of conditions: Gastrointestinal disorders (e.g., gastritis, diarrhea, diverticulitis, ulcerative colitis, nausea, and vomiting) Genitourinary disorders (e.g., cystitis, urethritis, prostatitis) Respiratory disorders (e.g., asthma, chronic bronchitis, and chronic obstructive pulmonary disease [COPD]) Insomnia, although usually only on a short-term basis. Acetylcholine
31. There are a variety of different neurotransmitters involved in addiction and mental health disorders It is not always about increasing a neurotransmitter. Sometimes you need to decrease it. Human brains try to maintain homeostasis and too much or too little can be bad A balanced diet will provide the brain the necessary nutrients in synergystic combinations Summary
32. Apply It Identify 3 ways you could have used this information in the past week. What was the situation? What did you do? How effective was that for you? Short term Long Term If you would have had this new information, what could you have done differently? How would that have changed the outcome? How can you start integrating this knowledge into your routine
33. Summary It is impossible to get an accurate level of different neurotransmitters in the brain Treatment of depression, anxiety, sleep disorders and pain disorders is often like making a good marinara sauce. Identify the symptoms and then decide what you need more (or less) of As you increase certain neurotransmitters, others will decrease This should only be done by a physician…BUT it is imperative that clients understand what is going on so they can better communicate with their doc.
34. Summary Clients may be on medications for physical ailments that are impacting their mood Understanding the interaction between medications is vital
35. An overlooked connection: serotonergic mediation of estrogen-related physiology and pathology Leszek A RybaczykEmail author, Meredith J Bashaw, Dorothy R Pathak, Scott M Moody, Roger M Gilders and Donald L Holzschu. BMC Women's Health BMC series open, inclusive and trusted 2005 5:12 Isr Med Assoc J. 2003 Sep;5(9):653-8. Aggression: the testosterone-serotonin link. Birger M1, Swartz M, Cohen D, Alesh Y, Grishpan C, Kotelr M.
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