Neuropsychobiology: Dopamine, GABA, Serotonin and Acetylcholine

Good morning and welcome to the class on
the neurobiology of dopamine, gaba, serotonin, and acetylcholine. Sadly enough
this is one of my favorite topics, so hopefully you’ll enjoy the hour as much
as I will. Over the next hour we’re going to define neurobiology and for the
following neurotransmitters we will look at their mechanism of action, their
purpose, what they do in the brain, and then in the body where they’re found
because not all of them are found just in the brain, symptoms of excess and
insufficiency. We’ll also talk about nutritional building blocks that our
clients need to be ingesting so their bodies can make these neurotransmitters
and medications that are commonly used to affect these neurotransmitters so
what is neurobiology basically it’s the study of the brain and the nervous
system which generates sensation perception movement learning emotion and
many of the functions that make us human as we talk about these few
neurotransmitters and there’s a bunch more but we’re just talking about a
select few today you will figure out that they are involved in all of these
things so it’s not just mood these neurotransmitters are involved in pain
reception movement motivation learning ability to focus attention one of the
things I want you to think about as we’re talking is I want you to think
about your patients because too often we think okay somebody’s depressed it must
be a serotonin deficiency and that’s not always the case a lot of these
neurotransmitters when they are out of balance either too much or too little
will create mood related disorders and symptoms that mimic depression and
anxiety it’s really important that we stress to our clients especially if
they’re just starting to take medications that is an imperfect science
and sometimes we need to take a look at
what’s going on with them their symptoms we’ll try something if it has no effect
then we may try something completely different and it’s important for them to
communicate with their physicians or their prescribing physician I’ve always
had the luxury of working in a clinic where we had an attending and we would
have case conferences with the physician and the client so it was a great
multidisciplinary team not everybody has that luxury but it is important for
clients to be able to communicate what their symptoms are and advocate for
themselves so dopamine we’re going to start out with the big one dopamine is
the one that we really talk about in terms of reward and motivation it’s our
pleasure chemical but it is responsible for movement memory pleasurable reward
behavior and cognition attention inhibition of prolactin production sleep
mood and learning so how it can dopamine be involved in all that well you know
obviously there are a lot of complex mechanisms but dopamine remember I’ve
said previously that we do things that are rewarding and we don’t do things
that are punishing or not rewarding so dopamine is responsible for saying yes
let’s do that again yes let’s focus on this yes let’s pay
attention here yes let’s focus here so when somebody is doing something that is
positive for them or seems to be positive for them the dopamine will
reinforce that behavior and say let’s do that again
so dopamine is responsible for our eating behaviors when we eat a little
bit of dopamine is released not a lot we’re not talking like a
cocaine response we’re talking just a little bit enough to say this is pretty
good so let’s go on and look at this a little bit further alter dopamine
neurotransmission is implicated in cognitive control so somebody has racing
thoughts has difficulty focusing has difficulty paying attention impulse
control and difficulty with their working memory so basically a lot of the
symptoms of ADHD we want to look at what’s going on with
the dopamine system there and I say altered because it can be too much or
too little the brain wants to keep a balance of these all of these
neurotransmitters they work in concert so if you have too much or too little
it’s going to exacerbate or inhibit some of the others that’ll be clearer clearer
as we talk so where do we find dopamine you know we don’t want to have racing
thoughts we don’t want to have attention problems we want to be motivated we want
to learn we want to sleep so where do we find this and how do we make sure it’s
at its optimal levels ideally the person the body is able to create enough
dopamine to maintain its natural optimal level now that can be disrupted when
somebody’s been basically abusing the dopamine system through addictive
behaviors and it is sometimes just a biological insufficiency but for the
majority of people out there the body can maintain its proper level of
dopamine if it has proper nutrition and proper rest and the motivation is there
so the precursor is l-dopa which is synthesized in the brain and kidneys
dopamine functions in several parts of the peripheral nervous system so this is
things other than the brain in blood vessels it inhibits norepinephrine
release and acts as a vasodilator it causes relaxation norepinephrine is
one of your stimulant chemicals so dopamine comes in there and goes chill
just chill in the kidneys it increases sodium and urine excretion okay this is
important because the kidneys help balance that sodium potassium levels in
the body so if it’s increasing the sodium and urine excretion the person
can get dehydrated which can lead to feelings of depression if the sodium and
potassium levels get out of balance they can have irregular heartbeats
tachycardia things like that so it’s important to remember too much dopamine
can cause problems when we have patients who are abusing drugs that greatly
increase dopamine guess what their urine excretion is probably going to be a lot
higher and then electrolytes are probably going to be out of balance
which sets them up to be at higher risk for cardiac problems sets them up to be
at higher risk for panic attacks and things like that in the pancreas
dopamine reduces insulin production okay now think we have a client who is
abusing the dopamine system maybe they are porn addicted okay we’re not even
talking cocaine here we’re talking porn addiction and they are getting that
dopamine rush at 10 15 20 times a day so they’re getting more dopamine than their
brain is really meant to handle they’re overloading that so the pancreas may
reduce insulin production as a result of you know having too much dopamine in the
system now eventually the brain is going to cut it back and say all right that’s
not the amount we’re supposed to have but if you’ve got a patient who’s
diabetic you can see where addictive behaviors can exacerbate the diabetic
symptomatology in the digestive system it reduces gastrointestinal motility and
protects the intestinal mucosa which is a fancy way for saying it keeps
your belly happy again if you’ve got somebody who is flooding their system
with dopamine they may find that they don’t have a lot of gastrointestinal
motility and they may have some digestive problems in the immune system
it reduces lymphocyte activity tells the immune system to kind of chill out which
potentially now they I don’t know of any studies that have done this but you can
extrapolate that if you’re reducing the lymphocyte activity if you’re reducing
those white blood cells from doing their job your immune system could go down so
all these things are reasons we want to protect this dopamine system aside from
the fact that when it’s either has dopamine or not enough is getting to the
receiving neurons that we start feeling depressed and lack motivation you know
dopamine’s a biggie we want to cherish this symptoms of excess and
insufficiency excess dopamine unnecessary movements and repetitive
tics psychosis hypersexuality nausea most antipsychotic drugs are
dopamine antagonists so if you have a client who is experiencing psychotic
symptoms one of the first things you’re going to probably see the psychiatrist
do list put them on on antipsychotic or an atypical antipsychotic these are
probably dopamine antagonists they’re probably there to reduce the amount of
dopamine which you know in theory you’re going okay cool
it fixes them not exactly we also see in people with bipolar disorder which is
why a lot of the atypical antipsychotics also are effective with people with
bipolar disorder and the hypersexuality and sometimes in a manic episode there’s
are some psychotic symptoms so dopamine can be involved in a lot of different
diagnoses dopamine antagonists are some of the most effective anti-nausea agents
okay great why do we care well if you’ve got somebody who’s on a dopamine antagonists an anti-psychotic
drug and they’re also taking anti nausea they’re basically kind of doubling up on
their meds one of the things that I’ve seen a lot over the many many years is
that patients don’t effectively communicate with their doctors what
medications they’re taking so you may have a patient seeing a psychiatrist and
getting an anti-psychotic and you may have them seeing a their general
physician and getting an anti-nausea agent and neither both doctors are
prescribing antagonists dopamine antagonists but guess what neither one
of them knows about the other so this person is actually getting too much of
the dopamine antagonism insufficient dopamine negative symptoms of
schizophrenia and you know just to kind of review psych 101 niggahs negative
symptoms are the things that we see in patients with schizophrenia that should
they should be there they don’t want to talk they are catatonic cognitive
deficits so insufficient dopamine may lead to some of the negatives and
symptoms of schizophrenia which means we want to crank up the dopamine so wait a
minute we have somebody with schizophrenia and we’re prescribing
antipsychotics or anti Bab antipsychotic drug
dopamine antagonists that’s thorn I’m looking for they’re being prescribed an
antagonist but then they also have the negative symptoms and so do we prescribe
an agonist so they’re taking an agonist and antagonist it seems like it would
cancel out which it actually does usually insufficient dopamine is also
implicated in a more acute sense of pain Parkinson’s disease restless leg
syndrome and attention deficit hyperactivity disorder now I had a
client who had restless like restless legs syndrome and was being prescribed
medication for that to increase her dopamine but she was also displaying
psychotic symptoms and symptoms of schizophrenia so the psychiatrist was
prescribing her you guessed it dopamine antagonists so she was taking
medications that were basically working against each other neurological symptoms
that increase in frequency with age such as decreased arm swing and increased
muscle rigidity and age-related changes in cognitive flexibility that we see in
people as just a normal matter of course can be the reductant be because of the
reduction of the dopamine receptors does that mean they all need to be medicated
now but we do need to be more attentive to it and realize that dopamine may be
implicated and you know at some point they may need medication insufficient
dopamine has also been implicated and these will sound familiar to you in lack
of motivation fatigue interval in ability to feel pleasure sleep problems
sense of hopelessness difficulty concentrating sound like the symptoms of
depression yeah certainly does so when we hear these symptoms we don’t want to
automatically say it’s this it could be hypothyroid it could be a dopamine
imbalance it could be a serotonin imbalance it could be a host of things
so we need to not just jump at the first sign of depressive symptoms and go oh I
know it’s causing this because we really don’t
we’re inaccurate at best we found that there is a about 40% of people according
to a recent Yale study about 40% of people with depression major clinical
depression that do not respond to SSRIs why is that because it’s not working on
the right serotonin receptors probably not it’s probably because they’re
depressive symptoms are being caused by an imbalance in a different
neurotransmitter they’re hypothesizing at this point dopamine or norepinephrine
but the link to that article is at the end of this presentation if you want to
go read up on it it’s actually a really well-written article nutritional
building blocks for dopamine now the cool thing is with nutritional building
blocks as opposed to taking mega supplements or medications the body is
going to use what it needs and it’s going to you know excrete the rest so if
we can encourage people to eat a healthy diet the chances of them grossly
throwing one neurotransmitter system or one system out of whack is highly
unlikely they’re not going to eat you know four cups of turmeric or five
watermelons in a day I don’t even know if that would be enough but eating a
diet high in magnesium and tyrosine and again the tendency for a lot of our
patients is to go oh high magnesium will let me go OD on magnesium supplements
and that’s just dangerous in so many different ways they want to eat a diet
high in magnesium and tyrosine rich foods to provide the basic building
blocks the other thing to educate your patients about and you know we can’t
usually in most states I think all but most states at least we can’t prescribe
nutritional guidelines that’s something for a physician or a registered
dietician but we can’t educate our patients that the
way foods occur in nature actually make them more available to our body so if
you eat if you just take a magnesium supplement it may not be taken in but as
well by the body as eating foods that are high in magnesium which are also
high in other vitamins that make it more bioavailable list of foods known to
increase dopamine a lot of these are very palatable foods chicken almonds
apples bananas bananas and chicken and almonds are actually three big ones that
are common among all the neurotransmitters but green leafy
vegetables – two of my favorites chocolate and green tea lima beans
oatmeal wheat germ sesame and pumpkin seeds tumeric and watermelon I think I
read those off in order of my preferences but you can see that
regardless of what whether your patient is a vegan a vegetarian and omnivore
whatever they can probably find some foods in this list that are supportive
of healthy brain chemistry encourage them before they start making major
changes in their diet you know legal caveat here encourage them to talk with
their doctor and/or a nutritionist first medications dopamine in the blood is
unable to cross the blood-brain barrier to reach the brain so we can’t just give
somebody dopamine and go voila you’re going to have more dopamine and be
better what they do is they give a combination of levodopa and carbidopa
which actually the carbidopa prevents the levodopa from breaking down in the
blood stream before it gets to the brain so it’s more available once it gets to
the brain so in order to increase dopamine we’ve got the levodopa
carbidopa combination and it’s actually kind of fun to say but anyway I digress
um when we start looking at the dopamine antagonists we’ve got risperidone Haldol
and a lot of others too but these are the
ones that in my practice I most commonly see you can go to drangus
and you can find a list of all the common dopamine antagonists
metoclopramide or Reglan is an antiemetic and an anti-psychotic it’s
given I know my son was actually given it when he was discharged from the NICU
because it helped with stomach emptying had I realized at that point that it
acted on the dopamine system I probably would have been much more resistant to
giving it to him you know live and learn but some of our patients may be
experiencing especially if they’ve got gastric reflux or something may have
this medication so if they’re taking Reglan in addition to risperidone Haldol
zyprexa not all of those obviously any of those again they may be doubling up
likewise if you have a client who’s taking an antagonist but also has
Parkinson’s symptoms or restless legs and they’re taking something like Mira
pecks or Requip and yes I’m using the trade names just because that’s what we
usually recognize more easily I’m not recommending or showing favoritism
towards any of these they’re just the ones that I see more often in practice
you know you can see if they’re taking one of those drugs plus an antagonist
they may be kind of working against each other patients with schizophrenia let’s
talk about the dopamine hypothesis that said dopamine imbalance causes
schizophrenia not so much we’re figuring out that that was wrong or at least a
very crude hypothesis patients with schizophrenia don’t typically show
measurably increased levels of brain dopamine activity okay so they don’t
have too much by measure and they also don’t have too little by measure it’s
it’s give or take within average so we don’t know exactly additionally other dissociative drugs
such as ketamine and phencyclidine that act on your glutamate receptors we’re
going to talk about that when we get down to gaba can also produce psychotic
symptoms so if there are other receptors that produce psychotic symptoms we don’t
necessarily know that every patient presents with psychotic symptoms has a
dopamine imbalance it could be a dopamine it could be an imbalance in
glutamate or other receptors that we haven’t identified yet so those drugs
that do reduce dopamine activity are a very imperfect treatment for
schizophrenia not only do they only reduce the positive symptoms they also
may produce severe short and long-term effects so we’re just going to jump from
that to gaba dopamine is our pleasure chemical it’s our reward chemical gaba
is our relaxation chemical if we want to just kind of use a gross overview it’s
generally used for anti-anxiety and anticonvulsant purposes the interesting
thing with gaba is that it’s made from glutamate so gaba functions as an
inhibitory neurotransmitter where glutamate the precursor to gaba is an
excitatory neurotransmitter so you need glutamate in order to form gaba but they
actually have opposite effects close to 40% of the synapses in the human brain
work with gaba and therefore have gaba receptors so we can see that for
whatever reason and I’m sure we haven’t identified all of them yet gaba is a
really important neurotransmitter symptoms of excess excessive sleepiness
shallow breathing basically basically getting way too relaxed and in symptoms
of CNS depression the interesting thing with gaba is that you have sort of a
protective effect if you get way too much the blood pressure may go
back up in order to try to self protect symptoms of insufficiency anxiety
depression difficulty concentrating insomnia and sometimes seizure disorders nutritional building blocks fermented
foods like sauerkraut and yogurt almonds again cherry tomatoes bananas again oats
again lentils brown rice potatoes vitamin b6 is also important in the
production of gaba so making sure that your clients are getting you know their
servings of grains where they’re going to get their B vitamins from is going to
be important encourage them to educate themselves about what they’re eating at
the very least inositol is also a nutrient that is found in wheat germ
brown rice green leafy vegetables nuts and beans the same kind of list again
that is in enabling the body to use gaba so we want to make sure they’re getting
those I don’t want to say carbohydrates because there’s carbohydrates and
everything we want to make sure they’re getting their grains their nuts and
their grains medications drugs that act as allosteric modulator zuv gaba
receptors or GABAergic drugs increase the available amount of gaba and
typically have a relaxing anti-anxiety and anti convulsive effect so you
probably have worked with a client who’s been on neurontin or gabapentin
it’s a GABA analog used to treat epilepsy and pain especially with
fibromyalgia and I have a one client who had a double mastectomy and she still
has some neurologic pain and gabapentin has helped her with that your benzos and
your barbiturates including GHB also can be used as GABAergic drugs serotonin mechanisms purpose this is
another one like dopamine there just does so many things and too much or too
little can be bad both both cases bad it helps regulate mood your sleep patterns
appetite and pain we’ll get to mood in a second but one of the interesting things
to understand about sleep patterns is melatonin comes from serotonin melatonin
helps us sleep and relax at night so if somebody is deficient in serotonin guess
what where is it found it’s found in the brain but interestingly the majority of
your serotonin is found in your gut and in your intestines so what does that say
for people who have irritable bowel syndrome Crohn’s disease yada yada yada
how does that impact impact their serotonin availability
I’m just postulating there you can chew on that think about it
symptoms of excess serotonin now I’m not talking serotonin syndrome which is a
life-threatening situation if somebody is showing severe shivering diarrhea
muscle rigidity fever seizures and irregular heartbeat
it is a medical emergency they need to get to the doctor to the hospital right
now we’re not going to the average doctor serotonin syndrome can be brought
on by people taking multiple SSRIs or sometimes the combination of certain
other drugs and again drugs calm is great because it’s got a interactions
checker you can put in the patient’s medications and then you can run a check
and it tells you which ones have been known to cause problems together does it
mean they’re never prescribed together now
but it means there have been some negative reactions if you have a patient
who is just starting to take SSRIs they may experience one or two mild symptoms
generally diarrhea is a big complaint when people start taking serotonin and
kind of feeling light-headed that’s the serotonin the SSRI kind of
getting into the intimate system but muscle rigidity fevers with
serotonin syndrome the fever will go like way high like cook you from the
inside high so it’s important again to get people to the doctor oh the other
thing that can cause it as people are taking over-the-counter supplements that
increase serotonin like Sammy or 5-htp so if you’ve got them taking that plus
SSRIs they’re setting themselves up for potentially a physical crisis other
symptoms of excess depression apathy emotional flatness passivity insomnia
difficulty concentrating poor memory difficulty making decisions and acting
on them and sexual dysfunction and you’re saying to yourself oh that’s the
symptom of insufficiency well yeah interestingly too little or too much can
basically produce very similar symptoms one difference is when there is too much
serotonin we tend to find that that person is a lot more anxious they tend
to be a lot more high-strung a lot more amped up does that always mean if
somebody is depression anxious at the same time but they’ve got too much
serotonin no it doesn’t we can’t ever say anything as always with a person but
we can say that we need to look at whether a whether increasing their
serotonin is probably the best step and talk with them more about their symptoms
how they came on family history those sorts of things
insufficiency depression anxiety and pain sensitivity people with low
serotonin have a higher pain sensitivity or a lower pain tolerance in general we
want to look at our patients who are in methadone clinics as they are detoxing
off the methadone we want to look and say ok well you know they’re not
producing the endogenous opioids right now we know that but is their serotonin
system also wonky as they’re detoxing because you know the detox from
methadone suboxone or any of your opiates is unpleasant at best so other
things may be getting out of whack including their serotonin system which
in addition to not having their natural painkillers if their serotonin is out of
whack they may be more sensitive to that pain something to consider something to
look at if you’ve got a patient who is at risk of relapse um who is detoxing
from opioids have them talk with their doctor nutritional building blocks I’m
going to sound like a broken record here whole wheat potatoes brown rice lentils
oats and beans I told you it was a pretty short list that was just going to
repeat which is good because you know what a short list is easy for people to
remember and most most people can find something on here that they like medications to adjust serotonin your
SSRIs your selective serotonin reuptake inhibitors make sure that there’s more
serotonin in the synaptic space to get absorbed your SNR is also work
selectively on some of your serotonin receptors SNR is a selective
norepinephrine reuptake inhibitors 5-htp I mentioned that earlier that is
over-the-counter supplement that is supposed to increase and
you know studies have shown it does increase levels of serotonin in certain
people now if they already have too much serotonin whether they’re not whether or
not they’re taking SSRIs this could further influence or make a problem
worse I really discourage my patients from
just randomly taking supplements especially ones that are purported to
affect their mental health without talking to their doctor first and being
medically supervised because it is so easy to create a situation that is where
they bring on a a psychotic crisis or they bring on a physical crisis and
finally acetylcholine acetylcholine is one of those interesting ones that we
don’t talk about a lot in lower amounts acetylcholine can act as a stimulant it
causes the body to release more norepinephrine and dopamine so I’m
thinking oh I want more acetylcholine so I get more dopamine doesn’t exactly work
that way because remember I said it they all work in concert and imbalance
acetylcholine is implicated in memory motivation higher order thought
processes sexual desire and activity and sleep just like all the others symptoms
of excess and I just shorten this because pretty much the entire DSM list
of depressive symptoms was a symptom of excess acetylcholine nightmares
especially vivid ones mental fatigue and fogginess and anxiety so remember we’re
talking about all this stuff as a symptom of excess serotonin can also be
a symptom of excess acetylcholine ask your patients
you know sometimes they’re more willing to tell us than they are they’re fit
their medical doctors which I wish wasn’t the case but ask them that
they’re taking any supplements because sometimes they’ll say yeah I read online
that this is supposed to help me with my anxiety or my depression or my
motivation my mental clarity make sure to make a note of those and make sure
that they’re attending physician is aware of what they’re taking there is an
inverse relationship between serotonin and acetylcholine
so as acetylcholine goes up serotonin goes down so if we’re increasing and
let’s go back here if somebody’s taking an SSRI and increasing their serotonin
then they’re going to have lower acetylcholine now if the increase in
serotonin lowers the acetylcholine to the point where it’s releasing a good
amount of norepinephrine and dopamine then we’ve reached that happy balance
but if the serotonin gets too high and the acetylcholine gets too low then
potentially we could have some suppression of norepinephrine and
dopamine which is not good we like dopamine and norepinephrine is actually
one of our motivation chemicals so we don’t want to get rid of that either insufficiency of acetylcholine
Alzheimer’s and dementia Parkinson’s symptoms impaired cognition attention
and arousal clinic cholinergic and GABAergic pathways so acetylcholine and
gaba are connected in the brain and are responsible for helping us remember
things think clearly and be motivated and awake so if one of those symptoms
are one of those neurotransmitters is at a wack we’re going to have a problem so
this is acetylcholine and gaba nutritional building block this is a
little bit more open meats dairy poultry I like the fact that chocolate keeps
coming up but we don’t want to encourage our clients to go out and stir
at binging on Reese’s Cups we’re talking about chocolate cocoa powder is a better
substitute because it doesn’t have all the fat in it I personally put cocoa
powder in my coffee all the time but I’m sort of a chocolate fiend chocolate is
not the best thing for people to use as a replacement because you have to eat so
much of it to have any sort of notable impact and nobody’s going to eat half a
cup of cocoa powder and I’m talking the dark unsweetened unfastened cocoa powder
it’s kind of bitter but a little bit you know a little bit can help peanut butter
wheat germ and Brussels sprouts and broccoli and in response to a question
there are some blood tests to identify that have been used to identify neurotransmitter levels so yes there are
some blood tests that have been used to identify that but they are inefficient
at best it’s better if they can talk with their doctor and be monitored very
very closely at the beginning getting a good psychosocial history and getting a
good history of the development of the disorder will probably get the doc a
better idea of where to start with these patients so medications cholinergic SAR used to
treat glaucoma bladder control and severe muscle weakness glaucoma is one
we hear about but not as much as all of the commercials that advertise the
bladder control medications so remember cholinergic SAR going to
increase the amount of acetylcholine that’s available so going back here if they already have too much they may
be having symptoms of depression nightmares mental fatigue and anxiety
combine that with medications meant to increase the acetylcholine those
symptoms make it worse so medications that they’re taking for
disorders other than their mental health can have pretty significant mental
health side effects that they just need to watch for anticholinergics may worsen
things like gastro esophageal reflux disease GERD that sphincter that closes
and keeps the stomach contents from coming back up is weak so if somebody is
taking an anticholinergic it may make that muscle not tighten quite as much anticholinergics are used for extra pure
metal symptoms in schizophrenia so when you have a client who has restlessness
agitation we will have occasionally clients who are taking antipsychotics or
atypical antipsychotics and they will be restless they’ll switch from one side of
the seat to the other they’ll be jittery agitated they may or
may not have muscle spasms may or may not have drug-induced parkinsonism and
tardive dyskinesia the involuntary muscle movements in the lower face and
distal extremities the ones that we always associate with high levels of
antipsychotic medication with people smacking their lips tongue movements
finger movements those sorts of things so all of these may be addressed with
anticholinergics but we’re getting to the caveat here some of your
anticholinergics are atropine cogent in’ i know i’ve worked with patients who’ve
been on cogent and before chlor-trimeton ah you know that’s one of those and
histamines that we hear about thinking about that and patients who are taking
over-the-counter medications not even thinking that it will impact
they’re prescription medications dimenhydrinate or Dramamine
so if you’ve got somebody who’s got and I personally get get movement sick
pretty much everywhere I’m not the fun person to have in the car but if
somebody takes Dramamine it may have some significant mood side effects I
know when I take Dramamine I get really really depressed
not just lethargic but again I’m even less fun to be around than when I’m sick
diphenhydramine if you look on the side of nyquil if you look on the side of any
of your quote sleep medications like sominex or Advil PM or unisom benadryl
PM Tylenol PM they have diphenhydramine in them this
is benadryl benadryl is is a mild anticholinergic hydroxyzine I haven’t
seen a Durex but I do see visceral quite a bit
I do see wellbutrin and zyban quite a bit and extra myth orphan I’m going to
go off on a little tangent on des Trump dextromethorphan right now because not
only is it one of those drugs that’s in most coughed preparations and most cold
preparations that people use and it may be counter indicated with the meds
they’re on but use have figured out that you can take dextromethorphan rectally
and it is directly absorbed into the bloodstream a lot faster than orally and
it’s got the anti anti anticholinergic effects gives them a buzz so be aware
dextromethorphan is starting to become one of those that’s abused so think
about if you’ve got a client I mean it wouldn’t be uncommon for me to see
clients that are on um zyban they’re they’ve got a cold they’re taking
dextromethorphan and diphenhydramine and maybe they’ve also got
allergies and they’re taking chlor-trimeton so we you know you can
see where we’re kind of doubling up here because you think benadryl is an
antihistamine dextromethorphan is a cough suppressant
so they wouldn’t work in concert or with one another when actually they kind of
do so encourage your clients to take it seriously when the docs say what
over-the-counter medications and what supplements are you taking because they
can have a significant effect on prescription medications anticholinergic
drugs are used to treat a variety of conditions from gastrointestinal
disorders to genitourinary disorders and respiratory disorders a lot of our
clients have those being aware of what they’re taking for these disorders and
what they’re taking for their mental health is important I know I beat that
one into the ground at this point so one last little thing on homeostasis because
you know that I totally love how the body tries to protect itself and
maintain homeostasis higher acetylcholine and norepinephrine so your
ACH and any with low serotonin so high acetylcholine high norepinephrine low
serotonin produces anxiety emotional lability irritability anger
aggressiveness rumination impatience and impulsiveness that describes most people
I see it does not necessarily mean that they exclusively have a serotonin
imbalance or this always describes them but it’s interesting to see what happens
when you start changing the balance of these neurotransmitters when
norepinephrine dopamine and serotonin or low that’s just bad and acetylcholine is
high the result is for lack of a better explanation simply depression and
increasing Cera tone and lowers acetylcholine we talked
about that earlier but it also lowers norepinephrine and dopamine so as one
increases these other three go down you’re upsetting the Apple truck if you
will we need to make sure that things are in balance it’s important to
remember that it’s not necessarily always about increasing something too
often as a society our first thought is we don’t have enough fill in the blank
so I need to get more filling a blank sometimes it’s that you got too much and
it’s causing everything else to be suppressed which is why it’s really
helpful for patients to keep a food diary chart out their moods chart out
what happens when they take their medications and we can make it pretty
simple as clinicians we can give them charts where they’re just checking boxes
so it’s not taking you know 20 minutes 4 times a day but it’s really helpful to
be able to look at patterns see whether there are certain patterns that have to
do obviously with work with sleep time with nutrition with number of hours of
daylight anything that might be impacting it in addition to looking at
how it came on and when they start taking the medication what happens to
their symptoms both immediately and over four to six weeks so there are a variety
of different neurotransmitters involved in addiction and mental health disorders
it’s not always about increasing a neurotransmitter sometimes you need to
decrease it the human brain tries to maintain
homeostasis because too much or too little of anything can be bad noise
whether its water or dopamine too much or too little can be bad a
balanced diet will provide the brain the necessary nutrients nutrients in
synergistic combinations that will help it have the building blocks it needs and
what it doesn’t need it’ll just excrete so there are several slides worth of
resources that you can go back and look at if you have questions or if you’re
really interested in this a couple of them that I found really interesting
we’re on diet soda and aspartame consumption looking at the inositol
chemical or not chemical but nutrient bio factors looking at gaba and then
that textbook i told you about that talked about nerves
neuropsychopharmacology it is free it is online it is available it is not the
most exciting read in the world but if you’re fascinated by the way things work
in the brain like I am you might find it’s interesting reading you know when
you’re on the train on the way to work or whatever the case may be so in
response to your question earlier about the blood tests I will find the
references that I was looking at when I made this class and I will message you
with them in the next couple of hours so you have information on ways we can test
and what we can and cannot do with as far as determining in a live patient
their level of neurotransmitters any other questions okay um let’s see I stopped the share

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