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Nutritional Neurotransmitter Support

May 15, 2012

Improving Mood, Clearing Perception & Breaking Addictions with Nutritional Neurotransmitter Support

Neurotransmitters-Venn-Diagram

The human body uses chemical messengers in the form of neurotransmitters to relay signals between and within our nervous system and our somatic body. Various neurotransmitters jump across the synaptic space between our nerves or other effector cells (muscles, sensory organs, glands…) in a highly controlled and specific manner.

The concert of making, transporting, releasing, binding, degrading and reuptaking various neurotransmitters controls everything from our breathing & heart rate, appetite & digestion, all voluntary and involuntary movement, our reflexes and all five of our senses.

(Aside: If this feels like it is seriously downgrading the importance of the undulations of your very personal personality, you’re not alone. Startling as it may be, we can pretty much boil down every detail of our personality to the interplay of the anatomy of our brains with neurotransmitters. Don’t let this ruin the mystery of life for you though. We still have absolutely no idea how DNA ever came into existence and found it’s way into primordial cells 2 billion years ago. How (or why) that single cell gave rise to a collective of 50-trillion cooperating human cells each packed with six feet of DNA is also pretty much a complete mystery.)

Back to our little story: Neurotransmitter signaling basically accounts for every nook and cranny of our personality: including all of our thought patterns, moods, emotions, desires, and the clarity (or warping) of the perceptions of our various “realities”. Neurotransmitters also underlie the storing and recollection of all our memories, our dreams and even allow us to perceive and record our imaginations. Suffice it to say that no part of life as we know it as animals would be possible without them.

Each day, we boot-up a human personality within the confines of a fantastic, but inherently limited, human body. Our moods, personality, perception, and awareness are all mediated by the production, passage and binding of fluctuating levels of a variety of neurotransmitters. These tiny molecules are created and managed by enzymes, hormones, macro-nutrients (protein, fat, carbohydrates), vitamins, minerals and the body’s myriad interactions with our physical and chemical environment all according to our phenomenally complicated and highly adapted individual genetic designs.

In order to awaken and realize our power to create our reality and perception, I think many people (especially those struggling with mood disorders and addiction) could benefit from a leg-up in the form of nutritional neurotransmitter support.

Let’s be clear: When we experience being excited, alert and focused it’s largely because of neurotransmitters. Feeling happy, relaxed and peaceful? This is also due to particular combination of neurotransmitter signaling. Likewise, when we experience typically less desirable emotions like boredom, irritation, anxiety, depression, obsession, or going WILD for a cigarette, coffee, or sugary donut (or all three), we can point to high or low levels of certain neurotransmitter signals as the cause and mechanism.

More about cravings: When we crave a certain food, experience or chemical such as alcohol, nicotine, and other drugs, it’s all because of how our nervous system is producing and receiving neurotransmitters and how the food, stimulation or chemical interacts with our neurotransmitter symphony.

While it’s easy for most people to prefer the more pleasant mental/emotional states to the less pleasant ones, there’s little doubt in my mind that we all need some ebb and flow between contentment and discontent to keep us in balance. Frequent anxiety, depression or irritation can lead us to change our immediate environment or location—hopefully for the better. Alternately, consistent ease and contentment indicate a favorable environment or condition and can lead us to greater investment in a certain life environment and more successful reproduction. Without the positive and negative signals from our perception and personality, we might never really progress as individuals–or a species.

Ostensibly, it’s possible exert a deep control of our mental-emotional states by modulating our neurotransmitter signaling. For better or worse, we are already well on the way to doing this. On the surface this kind of intervention might sound desirable. Over the long term, I am certain it would obliterate too much of the texture of the human experience.

Be that as it may, the primary neurotransmitters are as follows:

Monoamines

  • Dopamine (DA)
  • Norepinephrine (NE)
  • Epinephrine (adrenaline)
  • Serotonin (5-HT)
  • Melatonin
  • Histamine

Amino acids

  • γ-Aminobutyric Acid (GABA)
  • Glutamate
  • Aspartate
  • Glycine
  • D-Serine

Other Neurotransmitters

  • Acetylcholine (ACh)
  • Adenosine
  • Endorphins
  • Anandamide
  • Nitric Oxide (NO)

There are probably at least 50 more neurotransmitters, and we are still discovering more of them all the time.

If you doubt the effect of modifying neurotransmitter levels, consider that caffeine is a competitive inhibitor of the inhibitory neurotransmitter adenosine. When the caffeine we ingest crosses the blood brain barrier, it competes with adenosine for spots in the post-synaptic adenosine receptors. When caffeine occupies the limited adenosine receptors it blocks the normal inhibitory effects of adenosine causing greater central nervous system stimulation. Only then do we experience the potentially strong stimulatory effects of caffeine on this single neurotransmitter.

The use of antidepressants and other psychotropic drugs (those that affect neurotransmitters) has skyrocketed over the last decade. In a recent study, the U.S. Centers for Disease Control and Prevention (CDC) looked at 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005. Of those, 118 million were for antidepressants, the most out of all drug categories. Blood pressure drugs were the second most common with 113 million prescriptions.

Neurotransmitters-Venn-Diagram-2

The most common family of antidepressant drugs are in the selective serotonin reuptake inhibitor (SSRI) class of drugs. The prominent SSRI examples are household names now: Prozac, Paxil, Zoloft, Celexa. All of the SSRIs work by blocking the reuptake of the neurotransmitter serotonin from the synapse, thereby increasing the amount of serotonin available for binding to a post-synaptic receptor and having the serotonin effect on the CNS: contentment, ease, and general happiness.

Can you get too much of the serotonin effect? Absolutely. Ask anyone who has experienced or had a close relationship with someone on a Prozac induced mania. It’s all about balance.

That’s serotonin in a nutshell. Now let’s talk about dopamine. The effect of dopamine binding on the human CNS is related to many functions, but of primary interest in this article is dopamine’s effects on motivation and pleasure: the “reward pathways”. Indeed anything we do repetitively that produces pleasure is probably related to dopamine. Chemicals and activities that increase dopamine signaling promote the experience of euphoria, and can become… you guessed it: highly addictive.

Many addictive drugs, such as cocaine, amphetamines and PCP decrease the action of the dopamine active transporter (DAT), a membrane-spanning pump that normally acts to move dopamine out of our synapses. When DAT activity is blocked, dopamine levels rocket up and increase dopamine binding and dopaminergic effects. When this flood of extra dopamine binding occurs, particularly in a part of the brain called the nucleus accumbens, users will feel the highly pleasurable “reward stimulus” and can be motivated to keep doing whatever they were doing over and over and over.

The conditioning of this dopaminergic pathway is why crack-cocaine, meth-amphetamine, nicotine, other psychoactive chemicals and pleasurable behaviors are so incredibly addictive. How do we feel after the drugs have washed through and the DAT has bounced out the rowdy dopamine party? Because dopamine surges are the very mechanism behind addiction, many people (especially those with addictive personalities) feel let down and can’t wait for more of whatever will bring the dopamine party crashing back in.

(Now we don’t have to wonder why recovering alcoholics and drug addicts are so fond of coffee, cigarettes and cookies. Look no further than overworked and unresponsive dopamine pathways. The recovering addicts may be off the big dopaminergic players, but they are often still desperately trying to wind up their burnt out dopamine pathways.)

Dopamine parties cannot last forever. How does the body respond when the dopaminergic pathways are getting overworked? By downregulating the production or function of the dopamine receptors. What does this lack of dopamine sensitivity push “users” to do? The only way for the user to keep the “high” going and avoid the unpleasant “coming down” of withdrawal is to increase amounts of whatever they are on (or to begin using stronger substances or combinations of substances) to keep pinging the dopamine-mediated pleasure pathway.

This is where the rubber of tolerance and addiction hits the road. Obviously, it’s a loosing battle, and users can easily fall into a cycle where they are caught in a futile cycle: seeking to reach an unattainable high and avoid inevitable lows. Herein lies the core of addiction.

Adults with attention-deficit hyperactivity disorder (ADHD) often have a blunted response to amphetamines (like Ritalin and Dexadrine) which increase synaptic dopamine levels. This finding suggests that dopamine dysfunction may be involved with ADHD symptoms and may also explain why ADHD and substance abuse often go hand in hand. Those people with low dopamine sensitivity are naturally drawn to chemicals and activities that boost dopamine. Sadly for these addictive personas, down-regulation of dopamine receptors can and does occur springing the addictive trap more readily than for others.

Wellbutrin/Bupropion is a norepinephrine & dopamine reuptake inhibitor (NDRI). This drug works much in the same was as SSRIs by blocking synaptic reuptake and thereby increasing the amount of neurotransmitters in the synapse, and binding. As the moniker NDRI indicates, the transmitters in question are the excitatory catacholamine neurotransmitters dopamine and norepinephrine. For the record, Wellbutrin also has a very slight reuptake inhibition effect on serotonin.

In 1997, bupropion was approved by the FDA for use as a smoking cessation aid, and the producer (GlaxoSmithKline) the started marketing the drug under the name Zyban. The drug works by increasing the levels of dopamine in the synapse and thereby reducing the severity of the patient’s cravings and withdrawal symptoms. Bupropion can be used in combination with nicotine replacement therapies (gums and patches). Bupropion treatment typically lasts for 2-3 months, with the patient stopping tobacco use ~10 days into the course.

Hormones cannot be discounted in this perception-mood-addiction game. Most hormones (thyroid, estrogen, progesterone, cortisol, etc.) affect our cells through complicated pathways that up- or down-regulate the production of proteins that then alter energy metabolism, electrolyte balance, and (you guessed it) neurotransmitter production and signaling. The point is that nothing can make you see, feel or want anything without first somehow affecting neurotransmitter levels. That’s where the rubber hits the road and that’s why I focused on them in this limited piece.

Are there other ways to support the body’s capacity to make and release serotonin without compromising control? Yes. We can give patients L-Tryptophan or an extract of the African Griffonia simplicifolia seed (5-Hydroxy Tryptophan of 5-HTP), which is a few enzymatic conversion steps further, down the road to serotonin from the basic amino acid. What is the benefit? Much the same as the SSRI drugs, but generally with far fewer negative side effects because control of release and uptake was left in nature’s hands.

In my opinion, nutritional neurotransmitter support is the best way to fundamentally support people suffering from chronic depression, anxiety, OCD, chemical addictions and addictive behaviors. Hand in hand with lifestyle modification and cognitive/behavioral therapy, nutritional neurotransmitter support trumps the tragically commonplace standard of “care” option of using prescription drugs to mask mental-emotional symptoms and the underlying problems alike.

L-Tyrosine, 5HTP, GABA, Glutamate, Aspartate, Glycine are all basically nutritional amino acids that are fundamental building blocks for some of the most important neurotransmitters. These and other nutritional supplements found at many local vitamin stores can profoundly affect mood & mental-emotional status.

Am I suggesting that anyone with anxiety, depression, OCD, or alcohol, cigarette or drug addictions run out and start taking these nutritional neurotransmitter supports? No. Although benefits can be had, it’s not that simple. For starters, they are best taken on an empty stomach at least 30 minutes before meals. Otherwise their benefits can be muted or inconsistent.

Of more primary importance is that nutritional neurotransmitter supports can be abused–just as foods, coffee, alcohol, nicotine, street drugs and pharmaceutical drugs can be abused. Whatever the substance(s) de jour, the goal should never be to mask symptoms without addressing the underlying causes.

In the same way that mixing drugs alcohol and pharmaceuticals is often problematic. Nutritional neurotransmitter support should NEVER be haphazardly mixed with alcohol, street drugs, antidepressants or other pharmaceuticals with modes of action that alter neurotransmitter physiology. It can be done to therapeutic or disastrous effect, and so it must be done very carefully. Effective programs could be developed, but this is not for amateurs! More than just noting the drugs, modes of action, and supplements involved, individual diet, lifestyle, health history and nutrigenomics and detoxigenomics are involved.

The list of psychoactive medications that affect neurotransmitter levels includes: SSRIs (e.g. Celexa, Lexapro, Prozac, Paxil, Zoloft…), atypical antidepressants like Wellbutrin/Bupropion (a DNRI), Amitryptaline (a TCA) Effexor/Venlafaxine (an SNRI). Anti-psychotics, antisiezure medications, muscle relaxants, anti-anxiety medications… all must also be considered carefully.

A word about anti-psychotics and our good friend dopamine: Thorazine is a powerful anti-psychotic medication that bocks dopamine receptors causing the body to make more dopamine receptors on the post-synaptic membrane. This causes the dopamine system to become hyper-sensitized. If the thorazine is stopped, the dopamine blockade ends, then even average amounts of dopamine can cause spasmodic ticks known as the movement disorder: tardive dyskinesia.

This is just one reason why if a patient is taking anything psychoactive, they should receive qualified personal counseling with a knowledgeable orthomolecular physician before trying nutritional neurotransmitter support. This is not your average MD/DO/ARNP or even ND. This training is critical in order to get the most benefit and to avoid potentially dangerous interactions between the nutritional neurotransmitter supports and the drugs.

For patients using alcohol, cigarettes, street drugs or prescribed drugs, I first look into the individual’s lifestyle and health history and determine what constellation of factors brought on the symptoms and “self- medicating” in the first place. Then I support my patients getting off any nonessential medications by various lifestyle supports and, when appropriate, titrate in specifically tailored nutritional neurotransmitter programs at the right time and pace based on a holistic snapshot of their entire situation.

Done carefully and correctly, the nutritional neurotransmitter support can often replace pharmaceutical and recreational drugs and other chemical addictions altogether while at the same time supporting optimal mental health and laying the foundation to breaking addictive habits. Even better news is that nutritional neurotransmitter support is inexpensive, safe, has few if any side effects and, unlike pharmaceuticals are rarely indicated for lifelong use.

One of the most valuable aspects of boosting neurotransmitters nutritionally to affect perception, mood, or addiction is that the patient’s normal transmitter production, release and reuptake systems are still in control. Better still is that once the desired neurotransmitters are up and running, the neural pathways and connections strengthen themselves (AKA learning) to the point where the nutritional supplementation can often be tapered and discontinued after 6-8 months of sustained improvement.

If you are suffering from mental health issues like anxiety, depression, OCD, chemical substance addiction of any kind, or if you are tired of the expense and side effects associated with psychoactive pharmaceutical drugs, please let me know if you think I can be of assistance.

May we all be well!

trmorrisnd headshotDr. T.R. Morris is a licensed naturopathic medical doctor (ND). He is currently serving as faculty and consultant to the Institute for Functional Medicine (IFM). The IFM mission is to revolutionize medicine by teaching the latest genetic, nutritional, hormonal and other biochemically-based integrative medicine techniques to MDs and other practitioners looking for new tools to prevent and treat chronic disease. In the past, T.R. served as the medical director of a large integrative clinic and taught (genetics, physiology, biochemistry, microbiology, cellular & molecular biology) for 10 years for various medical programs in the Puget Sound. He sees patients in person (or long-distance via Skype consultations) from his home office in Seattle’s Ballard district.
Contact Dr. Morris

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