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Understanding the Impact of Adrenal Fatigue in the Mental Health and Addiction Recovery Process
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs

CEs for this course can be earned at:

– Define adrenal fatigue
– Identify symptoms of adrenal fatigue
– Learn about the function of the HPA-Axis and cortisol
– Explore how excessive stress may cause adrenal fatigue
– Identify interventions for adrenal fatigue

Why I Care/How It Impacts Recovery
– Adrenal fatigue can cause many symptoms that are commonly classified as depression and/or anxiety.
– Standard antidepressant treatment will likely be unsuccessful in addressing these symptoms in this situation
– Many people suffering from adrenal fatigue self medicate with stimulants and may eventually seek relief through escape provided from addiction
The Effect of Prolonged Stress
– Normal
– Stressor/threat –> fight or flight response which stimulates/excites the person – person eliminates the stressor/threat – recovery period
– Example: Final Exams, Big Project at Work
The Effect of Prolonged Stress
– Abnormal
– Stressor/threat –> fight or flight response which stimulates/excites the person – person cannot totally eliminate the stressor/threat or another stressor threat comes along – continued stimulation – adjustment to high stress “turn down the response” to prevent harm to the person -lack of normal excitement at mild to moderate stimulus (Apathy, Depression)
– Examples: Law Enforcement, Type-A, Negative Self-Talk, Excess Stimulant Intake
Adrenal Fatigue and the HPA
– The HPA (Hypothalamic-Pituitary-Adrenal) Axis controls the stress response.
– The Hypothalamus is the brain center that determines if there is a threat
– The pituitary is the relay switch that turns on or off the adrenal glands
– The adrenal glands are responsible for secreting cortisol/adrenaline that excites and prepares the organism for fight or flight
– Dysfunction anywhere in the system can cause the person to either be too stimulated/stressed/anxious or not stimulated enough/depressed
Symptoms of Adrenal Fatigue
– Restless sleep
– When under significant stress, adrenaline and cortisol levels are high which interrupts the natural 24-hour cycle of cortisol levels, leading to a state of permanent alertness that prevents restful sleep
– Waking up in a panic attack or anxious state
– Difficulty maintaining blood sugar
– In late stage adrenal fatigue cortisol levels are too low (the thermostat turned down). Cortisol is responsible in part for maintaining blood sugar

Symptoms of Adrenal Fatigue
– Excessive fatigue, apathy, depression
– In the later stages of Adrenal Fatigue, your adrenals become unable to produce enough of the hormones that you need.
– This means that your levels of cortisol, along with neurotransmitters like adrenaline and norepinephrine, are lower than they should be.
– Emotionality- Barely holding it together. Any stressor becomes a crisis.

Symptoms of Adrenal Fatigue
– Apathy about or inability to handle even minor stressors due to the low hormone levels associated with late-stage Adrenal Fatigue.
– The adrenals are no longer able to keep up with the continued demand for cortisol, adrenaline and norepinephrine production needed to address the stress.
– These hormones regulate the stress response and allow us to increase our strength, focus and awareness when we need it.
– The adrenal function is constantly hovering around the exhaustion threshold level and the smallest stressor will often trigger an adrenal crash (including coffee)
Symptoms of Adrenal Fatigue
– Immune system issues
– Cortisol has an anti-inflammatory effect that helps to regulate your immune system.
– Joint pain and gastro-intestinal flare-ups
– Food cravings
– Fatigued adrenals produce less –>excrete large amounts of important minerals in the urine –> imbalance in mineral levels like sodium, potassium and magnesium in their blood–> cravings for foods which will replace the minerals that we have lost. (chocolate, peanut butter, salty foods)
– Sodium/potassium imbalances can cause heart problems

What is a Stressor
– Anything that causes your body to speed up, deal with a threat, or do work
– Mental stress/anxiety/fear/anger
– Physical stress: Exercise, recovery after injury or illness
– Anything that prevents your body from recovering
– Lack of sleep
– Poor nutrition
– Continued stress (Type A, yes-man, poor time management, low self-esteem)

– Hypothalamic Stressors
– Cognitive stressors: When you interpret something as a threat it triggers the stress reaction
– Rejection/Isolation
– Failure
– The unknown/loss of control
– Death or bodily harm
– Physical Stressors
– Low blood sugar
– Excessive stimulant intake –> Artificial stress
– Lack of sleep/circadian rhythm disruption
– Excessive exercise (intensity/duration)

– Nutrition
– Frequent small high quality meals
– Excellent food choices: Chicken, tuna, salmon, eggs, yogurt*, black beans raw spinach, broccoli, sesame seeds, sunflower seeds, pumpkin seeds, cashews, walnuts, quinoa, oatmeal, brown rice, whole wheat bread
– Plenty of water
– Minimize sugary soda and juices
– Decaffeinated green tea (or black tea)
– Naturally decaffeinated coffee

– Nutrition
– Ideally eliminate or greatly reduce
– White flour –> Whole wheat or rye flour
– Sugar, corn syrup –> Honey
– Partially hydrogenated fats – organic, cold pressed coconut oil
– Keep a food diary—Target Nutrition
– Magnesium 400mg/day
– Calcium 1000mg/day
– Vitamin C 2-4 grams (2000-4000 mg)
– Supplementation should be equally divided in 4 doses
– Vitamin E 800 IU

– Nutrition
– Keep a food diary—Target Nutrition
– B Vitamins
– Pantothenic Acid 250 mg – 750mg
– Niacin 50 mg
– B6 50mg
– B3 75mg
– B12 200mcg

– Sleep
– Create a sleep routine
– Keep naps under 45 minutes
– Exercise– mild to moderate 30-45 minutes 3x/week
– Helps release serotonin
– Helps relax the body
– Increases blood oxygen

– Address negative cognitions
– Manage time
– Energy Log
– Keep a log of everything you do for a week.
– Identify which things are energy drains, and which bolster your energy
– Mindfulness— Mind-Body Scan
– First thing in the morning
– Before lunch
– Before dinner
– Before bed
Other “Alternative” Interventions
– Licorice root (supplement, not the candy)
– Ashwagandha with somnifera
– Astralagus root
– Siberian Ginseng (not panax)
– Adrenal cell extracts

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
– Adrenal fatigue mimics depression
– Adrenal fatigue is a physical ailment that can be compounded (or caused) by mental stress/anxiety
– Interventions should start with improving lifestyle factors (1 per week)
– Antidepressants, stimulants and steroids will generally have little effect on adrenal fatigue and may even make it worse.
– Kharrazian, Datis. Why Do I Still Have Thyroid Symptoms- When My Lab Tests Are Normal. Garden City, NY. Morgan Jame Publishing. 2010.
– Life Extension: Disease Prevention and Treatment. Hollywood, FL. Life Extension Media. 2003.
– Murray, Michael. Encyclopedia of Nutritional Supplements: The Essential Guide for Improving Your Health Naturally. Roseville, CA. 1996.
– Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping. New York, NY. St. Martin’s Press. 2004.
– Walsh, Bryan and Sean Croxton. The Truth About Adrenal Fatigue. Blog Talk Radio. 2010
– Wilson, James L., N.D., D.C. Ph.D.. Adrenal Fatigue: The 21st Century Stress Syndrome. Petaluma, CA. Smart Publications. 2001.