The Chemical Imbalance Ppt

5/22/2018 The Chemical Imbalance Ppt

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The Chemical Imbalance in

Mental Health Problems


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Introduction

Over the years, advances in neurology and researchhave simplified the way psychologists, psychiatrists, andothers diagnosis and treat mental health problems. Inover one hundred years of mental health treatment, the

symptoms and behaviors associated with certain mentalhealth conditions have remained the same. Psychoticdisorders, where the individual often cant distinguishbetween reality and their fantasies, still have auditoryhallucinations. Depressed individuals still cant sleep and

remain preoccupied with the past. Hyperactive children(Attention-Deficit Hyperactivity Disorder or ADHD) stillexhibit uncontrollable restlessness.


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Introduction

When patients first began reclining on the couches of psychoanalyticpsychiatrists, the depressed folks talked about their past. This ledthe founders of psychology and psychiatry to believe that issues thatbegan in childhood caused many mental health problems. Butquestions were still not answered. Why would a bad relationshipwith your mother create the appetite loss found in depression,

especially when eating problems only started several months prior tothe session? By what strange mechanism would a childhood issuecreate an auditory hallucination, often years after the reportedtraumatic event? Many people had difficult childhoods, but theydidnt hallucinate and have a great appetite. It became clear thatmany mental health problems also had a physical component thatinvolved changes in concentration, sleep, appetite, speech pattern,energy level, perceptions (hallucinations), and motivation. Studiesbegan to determine the connection, if indeed one was present,between the condition of the patient and the physicalsigns/symptoms that were also present.


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Introduction

The picture became easier to understand when chemicals in the braincalled neurotransmitterswere discovered. The brain consists of billionsof neurons or cells that must communicate with each other. Thecommunication between neurons maintains all body functions, informs uswhen a fly lands on our hand, or when we have pain. The communicationbetween neurons is controlled by the brains type and level ofneurotransmitters. Neurotransmitters are chemical substances that controland create signals in the brain both between and within neurons. Withoutneurotransmitters, there would be no communication between neurons. Theheart wouldnt get a signal to beat, arms and legs wouldnt know to move,etc.

As we discovered more about neurotransmitters, we began to identify whichneurotransmitters controlled certain bodily functions or which were relatedto certain emotional/psychiatric difficulties. Serotonin, a neurotransmitter,was found to be related to body temperature and the onset of sleep.Research also identified Serotonin as related to depression and later to avariety of mental health conditions such as anorexia and obsessive-compulsive disorder.


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Introduction

As research in neurotransmitters continued, studies betweenneurotransmitters and mental conditions revealed a strongconnection between amounts of certain neurotransmitters in thebrain and the presence of specific psychiatric conditions. Using aneveryday example, our automobile operates by using a variety offluids such as engine oil, transmission fluid, brake fluid, and coolant

(anti-freeze). Every automobile has a way to measure the levels oramounts of each of these needed liquids such as the dipstick for oiland transmission fluid and marked indicators for anti-freeze andbrake-fluid levels. Using our dipstick to measure engine oil, for anexample, we can find our engine to be found one, two, or even threequarts low. After a recent oil change, the dipstick may also tell usthat we have excessive oil in the engine. To work properly, all fluidlevels must be in the normal range as indicated by the dipstick.When we receive a blood test, values of certain blood componentsare given with the normal range also provided, indicating if a bloodchemical is below or above the average range.


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Introduction

Neurological research has identified over fifty

(50) neurotransmitters in the brain. Research

also tells us that several neurotransmitters are

related to mental health problemsDopamine,Serotonin, Norepinephrine, and GABA (Gamma

Aminobutyric Acid). Too much or too little of

these neurotransmitters are now felt to produce

psychiatric conditions such as schizophrenia,depression, bi-polar disorder, obsessive-

compulsive disorder, and ADHD.


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Introduction

Unfortunately, the body doesnt have a built-in dipstickfor neurotransmitters, at least one thats inexpensiveenough for community mental health practice. There areadvanced imaging techniques such as Positron Emission

Tomography (PET Scans) that are being utilized inresearch and in the development of medications thatdirectly influence changes in specific neurotransmitters.Lacking a PET Scanner, most professionals evaluateneurotransmitter levels by looking for indicators in

thought, behavior, mood, perception, and/or speech thatare considered related to levels of certainneurotransmitters.


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Introduction

This is perhaps best illustrated in individuals withdepressed mood. The mental health professional is oftenrequired to separate those who would benefit fromcounseling and those who may require counseling and

an antidepressant medication. The key is looking forthose symptoms that are known to be related tochemical changes in the brain. For example, situationaldepression often produces sad expressions, worry,pessimistic attitude and other features but does not

create prolonged changes in the physical symptomssuch as changes in sexual interest, appetite, or sleep.The continued presence of physical symptoms tells usthat the brains neurotransmitter levels have changed


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Introduction

The technical aspects of neurotransmitter levels, thepsychiatric symptoms they produce, and howmedications have been developed to raise or lower thebrain levels of these neurotransmitters can be very

complicated. For this reason, the same procedure ofexplaining other medical conditions where medicationbrings symptoms back to the normal range is oftenused. Medical patients with high blood pressure, highblood sugar, or high cholesterol are informed that their

body chemistry is too high, or in some cases, too lowand must be corrected with medication.


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Introduction

For many years, mental health professionals have usedthe term chemical imbalance to explain the need formedications that are used to treat mental healthconditions. This simple and commonly used explanation

recognizes that the condition is a medical problem andthat it can be treated with medication. The chemicalimbalance explanation also reflects the overall theme oftreatmentidentifying what neurotransmitters areinvolved in the clinical symptom picture and with

medication, attempting to return that neurotransmitterlevel back to the normal range.


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Your Neurotransmitter Levels

and Emotional Health

Your emotional health is a combination ofattitudes, personality, support systems, and yourbrains neurotransmitter levels. Positive attitudesand a healthy personality help us through lifesdifficulties and a good support system of familyand friends is also valuable during times oftrouble. Despite having these resources, thereare times when coping with our experiences and

life events changes our neurotransmitter status.Like an overheated automobile, we begin tohave difficulty operating properly.


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We are all at-risk for changes in ourbrains chemistry. Mostly commonly, wewill experience depression, anxiety, or

stress reactions. As our neurotransmitterschange, they bring with them additionalsymptoms, behaviors, and sensations thatadd to our on-going difficulties.

Recognizing these changes is animportant part of treatment and returningyour life to normal and reducing our stress.


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This discussion is offered to explain how

the neurotransmitter system in the brain

can create psychiatric conditions and

mental health problems. It is hoped thediscussion will provide information that will

be of value to those who suspect their

neurotransmitter system is creatingproblems.


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The following is a discussion of

neurotransmitters and current thoughts

about how these neurochemicals are

involved in psychiatric illness. Fourneurotransmitters, out of over fifty, are well

researched and known to be related to

psychiatric conditions.


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Dopamine:

Dopamine is a neurotransmitter linked to

motor/movement disorders, ADHD, addictions,

paranoia, and schizophrenia. Dopamine strongly

influences both motor and thinking areas of thebrain.

One type of Dopamine works in the brain

movement and motor system. As this level of

dopamine decreases below the normal rangewe begin to experience more motor and gross-

movement problems.


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Dopamine:

Very low levels of Dopamine in the motor areas of the brain are known toproduce Parkinsons Disease with symptoms such as:

Muscle rigidity and stiffness

Stooped/unstable posture

Loss of balance and coordination

Gait (walking pattern) disturbance

Slow movements and difficulty with voluntary movements

Small-step gait/walking

Aches in muscles

Tremors and shaking

Fixed, mask-like facial expression

Slow, monotone speech

Impairment of fine-motor skills

Falling when walking

Impairment in cognitive/intellectual ability


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Dopamine:

Dopamine in the thinking areas of the brain might beconsidered the neurotransmitter of focus and attending.Low levels impair our ability to focus on our environmentor to lock on to tasks, activities, or conversations. Lowlevels of Dopamine make concentration and focus very

difficult with low levels also associated with Attention-Deficit Hyperactivity Disorder (ADHD). On the other endof the Dopamine dipstick, as Dopamine levels in thebrain begin to raise, we become excited/energized, thensuspicious and paranoid, then finally hyperstimulated by

our environment. With low levels of Dopamine, we cantfocus while with high levels of Dopamine our focusbecomes narrowed and intense to the point of focusingon everything in our environment as though it weredirectly related to our situation.


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Dopamine:

Mild elevations in Dopamine are associated with

addictions. Nicotine, cocaine, and other

substances produce a feeling of excited

euphoria by increasing Dopamine levels in thebrain. Too much of these chemicals/substances

and we feel wired as moderate levels of

Dopamine make us hyperstimulatedpaying

too much attention to our environment due tobeing overstimulated and unable to separate

whats important and what is not.


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Dopamine:

In an ADHD child, low levels of Dopamine dont

allow the child to focus or attend to anything in

the environment, looking very physically

hyperactive when running about the room orswitching from activity-to-activity due to their lack

of focus. As Dopamine levels increase above the

normal range, our ability to focus increases to

the point of being paranoid. Mild elevationsmake the environment overly stimulating and

excited.


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Dopamine

Moderately high Dopamine levels make us on-guard, suspicious,and prone to misinterpret experiences in the environment. Known asan idea of reference in psychiatry, we begin thinking unrelatedexperiences are suddenly directly related to us. People observedtalking across the street are now talking about us. As Dopamineincreases, it can become so intense that we feel the radio,

television, and newspaper contain secret messages directed at usfrom Hollywood or elsewhere. Its as though we are attempting toincorporate/add everything we witness into our life. Planes flyingoverhead are snapping pictures of us and motorists talking oncellular phones are calling in a report on us. Our mind speedincreases and races in an attempt to add all we see into our life. Inan attempt to make sense, we may become extremely religious,paranoid, or feel we are a very important person. IncreasedDopamine also increases the perception of our senses, as thoughturning up the volume in all our senseshearing, vision, taste,smell, and touch.


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Dopamine

As Dopamine levels increase, the noises we heardloudly suddenly become auditory hallucinations. Ourinner thoughts are now being heard outside our body.These voices begin talking to us, known to take

different forms such as derogatory (putting you down),religious topics, command (telling you to do something),or sexual content. Hallucinations (experiencingsomething that is not truly there in reality) will soondevelop in all our senses. We may begin seeing faces in

clouds, carpets, or patterns. We may sense the touch ofspirits or movements inside our body. We mayexperience unusual smells or tastes.


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Dopamine

High levels of Dopamine in the brain often cause us tolose our contact with reality. As though living in ascience-fiction movie, we begin to develop unusual if notbizarre ideas about what is happening to us. With our

paranoia, we may experience delusions (false beliefs) ofpersecution or may think we have super powers(delusions of grandiosity) and can predict the future orread minds. High levels of Dopamine are found inSchizophrenia, drug intoxication, and other psychotic

conditions where the ability to distinguish the inner worldfrom the real world is impaired.


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Dopamine

Treatment for psychiatric/medical conditions associatedwith Dopamine imbalance, as you might expect, involvesincreasing or decreasing Dopamine levels in the brain.Low-Dopamine disorders are treated with medications

that increase Dopamine in the brain. For ParkinsonsDiseaseL Dopa is prescribed and for ADHD,medications that are psychostimulants. Amphetaminesand medications with similar action actually slow downthe hyperactive (ADHD) children by increasing

Dopamineboasting their level into the normal range,allowing them to now focus and attend.


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Dopamine

Mildly elevations in Dopamine are associated

with addictions such as narcotics, speed, and

nicotine/smoking. Thus, medications used in the

treatment of addictions actually block or lowerDopamine production. If a medication blocks

dopamine, it also blocks the effects of the

addicted substance as well as blocking the

craving sensation. The medication to helpsmokers, Zyban, is actually the antidepressant

Wellbutrin that is known to block Dopamine.


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Dopamine

Moderate to high levels of Dopamine, associated withsevere psychiatric conditions such as Paranoia andSchizophrenia, are treated with medications that block orlower Dopamine in the brain. These medications, calledantipsychotics, have been available for many years.

Early antipsychotic medications however, loweredDopamine throughout the brain, including the Dopaminelocated in the motor/movement areas. For that reason,older antipsychotic medications producedmotor/movement problems that looked like ParkinsonsDiseaseshort-step gait, fixed facial expression,tremors, poor balance, etc. Newer medications havefewer side effects in motor areas, as they are able tospecifically target one type of Dopamine.


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Dopamine

DopamineWhen an individual becomes psychotic,paranoid, and hallucinates in only a few days, we muststrongly suspect medication/drug intoxication orneurological eventssomething that could increaseDopamine levels dramatically and almost instantly. The

prolonged use of amphetamines (speed) or steroids canproduce a loss of reality and sudden paranoia. As itmight happen, a construction worker taking streetspeed to increase his work productivity finds his hand orfoot talking to him (auditory hallucinations) and decidesto cut it off. The sudden presence of psychosis(hallucinations, delusions, paranoia, etc.) in an individualwith a history of prior normal adjustment would suggestthe need for intensive medical and neurological workup.


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Serotonin: From Bliss to Despair

Serotonin, first isolated in 1933, is the

neurotransmitter that has been identified in

multiple psychiatric disorders including

depression, obsessive-compulsive disorder,anorexia, bulimia, body dysmorphic disorder

(nose doesnt look perfect after ten surgeries),

social anxiety, phobias, etc. Serotonin is a major

regulator and is involved in bodily processessuch as sleep, libido (sexual interest), body

temperature, and other areas.


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Serotonin

Perhaps the best way to think of Serotonin is

again with an automobile example. Most

automobiles in the United States are made to

cruise at 70 miles per hour, perfect for interstatehighways and that summer vacation. If we place

that same automobile on a racetrack and drive

day-after-day at 130 mph, two things would

happen. Parts would fail and we would run theengine so hot as to evaporate or burnout the oil.

Serotonin is the brains oil.


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Serotonin

Like a normal automobile on a race track, whenwe find ourselves living in a high stress situationfor a prolonged period of time, we use moreSerotonin than is normally replaced. Imagine a

list of your pressures, responsibilities, difficultiesand environmental issues (difficult job, badmarriage, poor housing, rough neighborhood,etc.). Prolonged exposure to such a high level of

stress gradually lowers our Serotonin level. Aswe continue to hang on we develop symptomsof a severe stress-produced depression.


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Serotonin

An automobile can be one, two or three

quarts low in oil. Using the automobile as

an example, imagine that brain Serotonin

can have similar stages, being low (onequart low), moderately low (two quarts

low), and severely low (three quarts low).

The less Serotonin available in the brain,the more severe our depression and

related symptoms.


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Serotonin

When Serotonin is low, we experience problems

with concentration and attention. We become

scatterbrained and poorly organized. Routine

responsibilities now seem overwhelming. It takeslonger to do things because of poor planning.

We lose our car keys and put odd things in the

refrigerator. We call people and forget why we

called or go to the grocery and forget what weneeded. We tell people the same thing two or

three times.


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Serotonin

As stress continues and our Serotonin

level continues to drop, we become more

depressed. At this point, moderately low or

two quarts low, major changes occur inthose bodily functions regulated by

Serotonin. When Serotonin is moderately

low, we have the following symptoms andbehaviors:


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Serotonin

Chronic fatigue. Despite sleeping extra hours and naps, we remain tired.There is a sense of being worn out

Sleep disturbance, typically we cant go to sleep at night as ourmind/thought is racing. Patients describe this as My mind wont shut up!Early-morning awakening is also common, typically at 4:00 am, at whichpoint returning to sleep is difficult, again due to the racing thoughts.

Appetite disturbance is present, usually in two types. We experience a lossof appetite and subsequent weight loss or a craving for sweets andcarbohydrates when the brain is trying to make more Serotonin.

Total loss of sexual interest is present. In fact, there is loss of interest ineverything, including those activities and interests that have been enjoyed inthe past.

Social withdrawal is commonnot answering the phone, rarely leaving the

house/apartment, we stop calling friends and family, and we withdraw fromsocial events.

Emotional sadness and frequent crying spells are common.

Self-esteem and self-confidence are low.


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Serotonin

Body sensations, due to Serotonins role as a body regulator,include hot flushes and temperature changes, headaches, andstomach distress.

Loss of personalitya sense that our sense of humor has left andour personality has changed.

We begin to take everything very personally. Comments, glances,and situations are viewed personally and negatively. If someonespeaks to you, it irritates you. If they dont speak, you become angryand feel ignored.

Your family will have the sense that you have faded away. Youtalk less, smile less, and sit for hours without noticing anyone.

Your behavior becomes odd. Family members may find you sitting

in the dark in the kitchen at 4:00 am.


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Serotonin

Individuals can live many years

moderately depressed. They develop

compensations for the sleep and other

symptoms, using sleeping medication oralcohol to get some sleep. While

chronically unhappy and pessimistic, they

explain their situation with Its just my life!They may not fully recognize the

depressive component.


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Serotonin

Very low levels of Serotonin typically bringpeople to the attention of their familyphysician, their employer, or other sources

of help. Severe Serotonin loss producessymptoms that are difficult to ignore. Notonly are severe symptoms present, butalso the brains ideation/thinking becomes

very uncomfortable and even torturing.When Serotonin is severely low, you willexperience some if not all of the following


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Serotonin

Thinking speed will increase. You will have difficulty controllingyour own thoughts. The brain will focus on torturing memories andyoull find it difficult to stop thinking about these uncomfortablememories or images.

Youll become emotionally numb! You wouldnt know how you feelabout your life, marriage, job, family, future, significant other, etc. Its

as though all feelings have been turned off. Asked by others howyou feelyour response might be I dont know!

Outbursts will begin, typically two types. Crying outbursts willsurface, suddenly crying without much warning. Behavioraloutbursts will also surface. If you break the lead in a pencil, youthrow the pencil across the room. Temper tantrums may surface.

You may storm out of offices or public places. Escape fantasies will begin. The most commonHit the Road!The brain will suggest packing up your personal effects and leavingthe family and community.


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Serotonin

Memory torture will begin. Your brain, thinking at 100 miles an hour, willsearch your memories for your most traumatic or unpleasant experiences.You will suddenly become preoccupied with horrible experiences that mayhave happened ten, twenty, or even thirty years ago. You will relive thedeath of loved ones, divorce, childhood abusewhatever the brain can findto torture you withyoull feel like it happened yesterday.

Youll have Evil Thoughts. New mothers may have thoughts aboutsmothering their infants. Thoughts of harming or killing others may appear.You may be tortured by images/pictures in your memory. Its as though thebrain finds your most uncomfortable weak spot, then terrorizes you with it.

With Serotonin a major bodily regulator, when Serotonin is this low yourbody becomes unregulated. Youll experience changes in bodytemperature, aches/pains, muscle cramps, bowel/bladder problems,smothering sensations, etc. The Evil Thoughts then tell you those

symptoms are due to a terminal disease. Depressed folks never have gasits colon cancer. A bruise is leukemia.


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Serotonin

Youll develop a Need-for-Change Panic. Youll begin thinking achange in lifestyle (Midlife Crisis!), a divorce, an extramarital affair, anew job, or a Corvette will change your mood. About 70 percent of

jobs are lost at this time as depressed individuals gradually fadeaway from their life. Most extramarital affairs occur at this time.

As low Serotonin levels are related to obsessive-compulsive

disorders, you may find yourself starting to count things, becomepreoccupied with germs/disease, excessively worry that appliancesare turned off or doors locked, worry that televisions must be turnedoff on an even-numbered channel, etc. You may develop ritualsinvolving safety and counting. One auto assembly plant workerbegan believing his work would curse automobiles if their serialnumber, when each number was added, didnt equal an evennumber.


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Serotonin

Whatever normal personality traits, quirks, or attitudes you have,they will suddenly be increased three-fold. A perfectionist willsuddenly become anxiously overwhelmed by the messiness of theirenvironment or distraught over leaves that fall each minute to landon the lawn. Penny-pinchers will suddenly become preoccupied withthe electric and water consumption in the home.

A trigger event may produce bizarre behavior. Alreadymoderately low in Serotonin, an animal bite or scratch may makeyou suddenly preoccupied with rabies. A media story about theharmful effects of radiation may make you remember a teenage tourof the local nuclear power plantsuddenly feeling all yoursymptoms are now the result of exposure to radiation.


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Serotonin

When you reach the bottom of severely lowSerotonin, the garbage truck will arrive. Everyone withseverely low Serotonin is told the same thing. You will betold 1) Youre a bad spouse, parent, child, employee,etc., 2) You are a burden to those who love or dependon you, 3) You are worsening the lives of those aroundyou, 4) Those who care about you would be better if youwerent there, 5) You would be better if you werentaround, and 6) You and those around you would be

better off if you were totally out of the picture. At thatpoint, you develop suicidal thoughts.


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Serotonin

Clinical Depression is perhaps the most common mentalhealth problem encountered in practice. One in fouradults will experience clinical depression within theirlifetime. Depression is the common cold of mentalhealth practicevery common and much easier to treat

today than in the past. Treatment for depression, as might be expected,

involves increasing levels of Serotonin in the brain. Sincethe mid-eighties, medications have been available thatattempt to specifically target and increase Serotonin.

Known as Selective Serotonin Reuptake Inhibitors(SSRIs), these medications such as Prozac, Zoloft, andPaxil are felt to work by making more Serotonin availablein the brain.


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Serotonin

Like all neurotransmitters, we can have too much Serotonin. Whileelevated levels of Serotonin produce a sense of well-being, bliss,and oneness with the universe too much Serotonin can producea life-threatening condition known as Serotonin Syndrome (SS).

Likely to occur by accident by combining two Serotonin-increasingmedications or substances, Serotonin Syndrome (SS) produces

violent trembling, profuse sweating, insomnia, nausea, teethchattering, chilling, shivering, aggressiveness, over-confidence,agitation, and malignant hyperthermia. Emergency medicaltreatment is required, utilizing medications that neutralize or blockthe action of Serotonin as the treatment for Serotonin Syndrome(SS).


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Serotonin

Like Dopamine, Serotonin can be accidentallyincreased or decreased by substances. Onemethod of birth control is known to producesevere depression as it lowers Serotonin levels.

A specific medication for acne has also beenlinked with depression and suicidal ideation. Forthis reason, always inform your physicians if youare taking any medication for depression. Also

avoid combining antidepressants with any herbalsubstances reported to be of help in Depressionsuch as St. Johns Wort.


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Norepinephrine: From Arousal to

Panic Norepinephrine (NE) is the neurotransmitter often

associated with the fight or flight response to stress.Strongly linked to physical responses and reactions, itcan increase heart rate and blood pressure as well ascreate a sense of panic and overwhelming fear/dread.This neurotransmitter is similar to adrenaline and is feltto set threshold levels to stimulation and arousal.Emotionally, anxiety and depression are related tonorepinephrine levels in the brain, as this

neurotransmitter seems to maintain the balance betweenagitation and depression.


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Norepinephrine

Low levels of norepinephrine are associated witha loss of alertness, poor memory, anddepression. Norepinephrine appears to be theneurotransmitter of arousal and for that reason,

lower-than-normal levels of this neurotransmitterproduce below-average levels of arousal andinterest, a symptom found in several psychiatricconditions including depression and ADHD. It isfor this reason that medications for depression

and ADHD often target both dopamine andnorepinephrine in an attempt to restore both tonormal level.


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Norepinephrine

Low levels of norepinephrine are associated witha loss of alertness, poor memory, anddepression. Norepinephrine appears to be theneurotransmitter of arousal and for that reason,

lower-than-normal levels of this neurotransmitterproduce below-average levels of arousal andinterest, a symptom found in several psychiatricconditions including depression and ADHD. It isfor this reason that medications for depression

and ADHD often target both dopamine andnorepinephrine in an attempt to restore both tonormal level.


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Norepinephrine

Moderately high levels of norepinephrine createa sense of arousal that becomes uncomfortable.Remembering that this neurotransmitter isstrongly involved in creating physical reactions,

moderate increases create worry, anxiety,increased startle reflex, jumpiness, fears ofcrowds & tight places, impaired concentration,restless sleep, and physical changes. Thephysical symptoms may include rapid fatigue,

muscle tension/cramps, irritability, and a senseof being on edge. Almost all anxiety disordersinvolve norepinephrine elevations.


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Norepinephrine

Severe and sudden increases in norepinephrine are associated withpanic attacks. Perhaps the best way to visualize a panic attack is toremember the association with the flight or fight response. Theflight or fight response is a chemical reaction to a dramatic andthreatening situation in which the brain produces excessive amountsof norepinephrine and adrenalinegiving us extra strength,

increased energy/arousal, muscle tightness (for fighting or running),and a desperate sense that we must do something immediately.This animal response was activated in early man when a bearshowed up at his cave or when faced with a tiger in the woods. Inmodern times, imagine your reaction if while calmly watchingtelevision, someone or something started trying to knock your frontdoor in to attack you. In the flight or fight reaction, your brain and

body chemistry prepare you to either run from the situation or fight tothe death!


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Norepinephrine

A panic attack is the activation of the flight orfight chemical reaction without a bear at thedoor. Its as though the self-protection animalresponse is kicking-off accidentally, when no

real life-threatening situation is present. Knownnow as panic attacks, they can surface at thegrocery, at church, or when you least expect it.

As norepinephrine is a fast-acting

neurotransmitter, the panic attack may last lessthan ten minutes (feels like hours however!) butyoull be rattled/shaken for several hours


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Norepinephrine

Panic attacks are strong physical and chemical events and include thefollowing symptoms:

Palpitations, pounding heart or rapid heart rate

Sweating and body temperature changes

Trembling or shaking

Shortness of breath of smothering sensations

Choking sensations Chest pain and discomfort

Nausea or stomach distress

Dizziness, lightheadedness, or feeling faint

Sense of unreality, as though you are outside yourself

Fear of losing control or going crazy

Fear of dying Numbness and tingling throughout the body

Chills and hot flushes


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Norepinephrine

If we think about the automobile example, a

panic attack is the equivalent of your dashboard

warning lights coming onyour stress level is

too high. Panic attacks, or surges ofnorepinephrine, can also occur by accident as

when created by the use of certain medications.

The medications for certain medical conditions

can cause a panic attack or increase our level ofanxiety. Medications often used for asthma, for

example, can create anxiety or panic attacks.


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Norepinephrine

Treating low or elevated levels of norepinephrine

in the brain involve different approaches. Low

levels of norepinephrine are often treated using

newer antidepressants. Many newantidepressants, known as Serotonin-

Norepinephrine Reuptake Inhibitors (SNRIs)

with brand names like Effexor and Serzone, treat

depression by increasing levels of bothserotonin and norepinephrine neurotransmitters


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Norepinephrine

Treatment for high levels of

norepinephrine, as found in anxiety and

panic disorders, involves decreasing

neurotransmitter levels directly or usingmedications which increase another

neurotransmitter that inhibits or decreases

the action of norepinephrine. One of thoseinhibiting neurotransmitters is GABA, also

known as Gamma-Aminobutyric Acid.

GABA M i d S i t


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GABA: Mania and Seizures to

Relaxation and Impulse Control

Gamma-Aminobutyric Acid (GABA) is aneurotransmitter that is inhibitory, that is, itdecreases the ability of other neurotransmittersto work. GABA is involved in our level of

excitability. Rather than encouragingcommunication between cells such asDopamine, Serotonin or Norepinephrine - GABAreduces, discourages, and blocks

communication. This neurotransmitter isimportant in brain areas involving emotion andanxiety.


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GABA

When GABA is in the normal range in the brain,we are not overly aroused or anxious. At thesame time, we have appropriate reactions tosituations in our environment. GABA is the

communication speed controller, making sure allbrain communications are operating at the rightspeed and with the correct intensity. Too littleGABA in the brain, the communication becomesout of control, overstimulated, and chemically

unstable. Too much GABA and we are overlyrelaxed and sedated, often to the point thatnormal reactions are impaired.


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GABA

Low levels of GABA are associated with Bipolar Disorder, Mania.With GABA levels below average, the brain is too stimulated. Webegin talking rapidly, staying up for days at a time, and develop wildand grandiose ideas. In a Manic state, we are so high and out ofcontrol that social problems are quick to develop, often due tohypersexuality, excessive spending, reckless decisions, risk-taking

behavior, and grandiose ideas. We may feel so good that we thinkwe are a heavenly spirit, an intellectual genius, or possessingextraordinary powers. I personally had one patient who lockedhimself in his mobile home and spent one week rewriting the NewTestament in hillbilly. Another, with limited education, beganpurchasing books on the Theory of Relativity by Albert Einstein,sensing he may be able to use the information to invent warp drive


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GABA

Low levels of GABA are also associated

with problems of poor impulse control,

including clinical conditions such as

gambling, temper tantrums, and stealing.When GABA is low in the brain, impulsive

behaviors are not inhibited (stopped) by

logical or reasonable thinking.


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GABA

Low levels of GABA are also associated with epilepsy orseizure disorders. If we imagine a seizure as a type ofelectrical storm, the seizure begins at one location in thebrain then rushes across and through the brain like asudden storm. Low levels of GABA make it easy for thebrain to develop seizures which is why seizures are partof the withdrawal syndrome for many substances thatwork with GABA such as alcohol and tranquilizers(benzodiazepinesXanax, Ativan, Librium, Valium,

etc.). Substances that artificially maintain a high level ofGABA, when stopped, create a dramatic drop in GABAlevels, thus creating the risk for withdrawal seizures dueto the chemical instability that is created.


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GABA

High levels of GABA produce more control,relaxation, and even sedation. Alcohol works byincreasing GABA levels, which is why all bodysystems are relaxed at firstthen sedated to the

point of slurred speech, unsteady gait, and foggythinking. Alcohol withdrawal, or the suddensevere drop of high GABA levels, produce a lowGABA level and the possibility of seizures.Withdrawal from benzodiazepines is known to

follow the same pattern. Taking forty milligramsof Valium for two years, suddenly stopping allmedication, will likely produce a seizure.


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GABA

Medications for anxiety create relaxation and a decreasein anxiety by increasing GABA levels in the brain.

Alcoholic beverages work in the same manner; thealcohol increasing GABA levels to produce mildeuphoria, loss of social anxiety, and other symptoms ofintoxication. Excessive intake of benzodiazepines and/oralcohol is extremely dangerous as the high GABA levelactually smothers the communication between brainneuronssometimes to the point of a total lack ofcommunication between neuronsalso known as death.


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GABA

Medications for seizures, impulse control

problems, and Bipolar Disorder, Mania all work

by increasing the GABA levels without

accompanying euphoria. Lithium and anti-seizure medications all increase GABA into the

normal range, thus lowering the possibility of

seizures and producing brain chemical stability.

As GABA is the neurotransmitter policeman,changes in GABA can influence all

neurotransmitters but especially norepinephrine.

Medication Treatment of the


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Chemical Imbalance

Understanding these four neurotransmittersprovides a window to understanding the majorityof psychiatric conditions, ranging fromdepression to schizophrenia. Mental health

professionals use psychological testing,interviews, questionnaires, and patient history todetermine first, if a change in theneurotransmitter system is present, then second,

what neurotransmitters are involved. A properclinical diagnosis then leads to propermedication treatment.



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Chemical Imbalance

Medications are prescribed in an effort to

return the brains neurotransmitter status

to normal. Much like a physician may

prescribe a medication to lower yourcholesterol or increase another body

chemical, mental health professionals are

concerned with returning yourneurotransmitter levels to normal.



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Chemical Imbalance Medications for mental health conditions work in several ways: Some imitate the neurotransmitter, triggering a response as though

the original neurotransmitter were present

Some block the neurotransmitter from being absorbed by thesurrounding neurons, known as blocking the reuptake. Reuptakeinhibitors block the reabsorption/reuptake of Serotonin or

Norepinephrine and thus make more neurotransmitter available Some force the release of the neurotransmitter, causing an

exaggerated effect. Cocaine does this to Norepinephrine andDopamine while MDMA (Ecstasya club drug) does this toSerotonin.

Some increase neurotransmitters known to slowdown or reduce

the production of other neurotransmitters. Some block the release of neurotransmitters completely

Some interfere with the storage of neurotransmitters, allowing themto come out of storage and lose potency



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Chemical Imbalance

Based on the neurotransmitter theory of

psychiatric illness, we can plot clinical

conditions and see how mental health

professionals determine medicationtreatment by recognizing which

neurotransmitters are involved:



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Chemical Imbalance Diagnosis: Stress-Produced Depression Neurotransmitter: Low Serotonin

Medication: Selective Serotonin Reuptake Inhibitor (SSRI)

Diagnosis: Agitated/Anxious Depression

Neurotransmitter: Low Serotonin

Elevated Norepinephrine Medication: SSRI and Antianxiety Medication or

Serotonin Norepinephrine Reuptake Inhibitor (SNRI)

Diagnosis: Major Depression with Psychosis

(Severe depression with hallucinations/paranoia)

Neurotransmitter: Elevated Dopamine

Low Serotonin

Medication: Antipsychotic medication

SSRI



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Chemical Imbalance

Diagnosis: Bipolar Disorder, Mania

Neurotransmitter: Low GABA

Medication: Anticonvulsant or Lithium

Diagnosis: Bipolar Disorder, Depressed

Neurotransmitter: Low GABA

Low Serotonin

Medication: Anticonvulsant or Lithium

SSRI


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Final Thoughts

A variety of conditions and circumstancesencountered in life can produce changes in ourbrain chemistry. These changes can then createmental health problems. We have known for

years that chemical and substances in the bodycan become unregulated as in high bloodpressure, high cholesterol, low/high blood sugar,etc. There is no stigma associated with using

medications to return these bodychemicals/substances back to their normallevels.


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Final Thoughts

It is the hope of mental health professionals thatthe public can understand the medical and

neurochemical nature of various emotional and

psychiatric conditions, thus eliminating the

stigma often associated with treatment. Modern

treatment is very effective and can eliminate

years of emotional suffering with very little in the

way of intervention or treatment. Mental healthtreatment is available in every county in the

United States.

The Chemical Imbalance Ppt

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