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this episode was pre-recorded as part of a live continuing education webinar on demand CEUs are still available for this presentation through all CEUs register at all CEUs comm slash counselor toolbox
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I'd like to welcome everybody today's presentation on neurobiology dopamine gaba serotonin acetylcholine norepinephrine and glutamate so we're really going to be hitting the big six today the PowerPoint is a little bit longer than it usually is in terms of the number of slides but there are a lot of things that I'm going to go through quickly because you'll be able to go back and reference them and they don't need a whole lot of explanation as always if you have
0:55
something to add if you have a comment question please feel free to type that in the chat window and I will answer it or segue it in as soon as I can so we're gonna define neurobiology and for the following neurotransmitters you know the big six we're gonna look at their mechanism mechanism of action what's why are they there where are they found and I know yet the brain but where else are they found symptoms of excess and insufficiency because when we're looking at
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anxiety when we're looking at fatigue when we're looking at difficulty concentrating there are a lot of symptoms that are trans diagnostic they're present in multiple diagnoses and you know they can be caused by different things we'll look at nutritional building blocks for each neurotransmitter because I always harp on having reasonable nutrition and reasonable is you'll see as we go through really shouldn't be that hard and then we'll look at some medications that are
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used to increase and decrease or medications that may inadvertently increase and decrease the neuro transmitters in the brain so neurobiology is the study of the brain and the nervous system which generates sensation perception movement learning emotion and many of the functions that just make us human when we have an emotion where does that come from well it's a chemical reaction that whatever happens kicks off a chemical reaction and if we're getting upset or getting stressed or
2:25
getting excited then we're going to have glutamate and norepinephrine and dopamine probably going out if we're excited for example so we want to pay attention to that if we're calming down then we're gonna have gaba serotonin kind of coming in and saying alright now it's the time to rest and relax so our emotions are what we label as emotions are triggered by neural chemicals and why is that important well because if somebody comes in and they're trying to address their
2:58
depression you know whatever that looks like for them well that's great but they need to understand where that's coming from there are some cognitive things that can trigger that their brain to think that there's a threat which sets off the stress response and but they need to understand that there is a neurochemical a biological component to it so it's not just about changing their thinking
3:20
they also need to be making sure that their body machine is in top working order so think about it as we go through this presentation you have a client who presents with apathy loss of pleasure sleep disturbances fatigue and difficulty concentrating yeah my first thought is major depressive disorder or persistent depressive disorder what would your diagnosis be and you may say too little information yet that would be a great answer too if somebody presented to their
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physician with these symptoms what medication would you expect the doctor to put him or her on my experience has been with most physicians the first thing they do SSRIs let's increase serotonin and as you'll learn as we go through this these symptoms are trans diagnostic and they can be caused by either too much or too little of most of the big six so we don't necessarily know whether the person has too little serotonin so if we start increasing it and that's not their
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problem then we're gonna have symptoms of too much serotonin which can be really unpleasant and it's also whatever else was lacking down here more serotonin means that's even more lacking so to speak because everything needs to be in a balance like I always make the analogy of a good marinara sauce you know if you taste it and not enough oregano you know or it's just not right and you start dumping oregano in then maybe it was garlic and and not oregano so now the
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oregano is even stronger and the garlic tastes comparatively is even weaker so we want to pay attention to what's going on and obviously we're not making diagnosis and none of this presentation is meant to tell patients to change the medication regime or start eating a certain way or take any supplements all of that should be covered through their primary care physician but it's important
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for us to be aware so if clients are struggling because we know that antidepressants only work for 30 to 40 percent of the people who take them we want to look at why is that well maybe it isn't serotonin that's out of whack for this person maybe there's an underlying biochemical cause maybe it's a different neurotransmitter so we can help people sort of advocate for themselves you know maybe they need a norepinephrine reuptake inhibitor so they can talk with their doctor about
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what the options are we can help them educate themselves they need to do the advocacy and work with their physician so dopamine we're gonna start out with the pleasure chemical because well its first in the alpha no it's not first anyway it's the first one that comes to mind for most people mechanism of action it is involved in movement memory pleasurable reward behavior and cognition
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attention inhibition of prolactin production sleep mood and learning so it's involved in everything so if your dopamine levels are out of whack you're probably going to experience some difficulty in one or more of these areas now obviously if you're having difficulty focusing attention your memory is probably going to falter as well as well as your cognition you know you're not going to be
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thinking as well if you're your mind's racing if you're having racing thoughts so all of these can come together if you're not getting a good sleep you may start feeling sort of depressed and blue and not be motivated to focus and learn so we want to pay attention to dopamine's impact in the person and look at our clients who are experiencing some of these symptoms that seem depressive in nature and take a look at especially if they start on an SSRI or they've been on them
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before and it hasn't worked you know we may want to look at is there something else causing it alter dopamine neurotransmission so if you're not getting enough or you're getting too much cognitive control people will have racing thoughts attentional control can't focus impulse control self explanatory working memory is going to kind of go which you would expect with the problems with attentional control and cognate and racing thoughts mood motivation and sleep are all going
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to be impacted so where is dopamine found you know okay we realize that there may be a problem with it where do we find it well it's in the brain and the kidneys kidneys so if you have a client who has kidney disease or has is taking any kind of medication that alters kidney functioning or and or maybe engaging in high intensity activity that are causing fluctuations in hydration it can alter
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to a certain extent dopamine levels definitely can alter medication levels dopamine functions in several parts of the peripheral nervous system in blood vessels it inhibits norepinephrine which is our motivation and focus chemical and excitatory chemical and it acts as a vasodilator so it helps us relax so if you have a client who's kind of stressed high-strung dopamine may be part
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of it in the kidneys it increases sodium and urine excretion so it keeps the kidneys functioning well if you don't have the right sodium balance you can have something called rhabdomyolysis which can be really bad and we want them so we want to make sure that clients are going to the bathroom enough in the pancreas it reduces insulin production if we're working with a client who is diabetic paying
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attention to their moods their sugar levels and you know all of that may be important and if they're having difficulty stabilizing their sugar levels looking maybe at dopamine in the digestive system it reduces gastrointestinal motility and protects the intestinal mucosa so it slows things down in them in the immune system it reduces lymphocyte activity so why do we care we're mental health because it can be implicated in autoimmune diseases and I've
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linked to several articles through here that have indicated that if dopamine is increased they found an increase or is it is decreased I'm sorry they found an increase in lymphocyte activity so people who have autoimmune diseases may not have enough dopamine so if dopamine's increased then that lymphocyte activity that overactive immune system is blunted sometimes symptoms of excess and when we think about dopamine one of the first things we often
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think about is schizophrenia not necessarily the only thing and we don't know that dopamine problems actually cause schizophrenia because when we address schizophrenia with dopamine antagonists toward open dopamine agonist depending on whether you're looking at positive or negative symptoms it only partially addresses the problems people are having and then the side-effects are horrid there are other medications and I'm getting ahead of myself that also produce psychotic
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like features so we're not for sure whether dopamine is it we think dopamine is involved but there are probably other neuro chemicals that are also involved in the development of schizophrenia so too much dopamine unnecessary movements repetitive tics psychosis hypersexuality nausea this can also kind of overlap a little bit with hypomania or mania if you've got somebody who is really you know physiologically agitated and they may with mania they're gonna have some
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psychotic features there's hyper sexuality as common so these are all common in when there is is too much dopamine most antipsychotic drugs are dopamine antagonists so they're going to make these things go away they're gonna slow the person down get rid of the psychosis reduce the sexuality reduce the nausea in order to bring it back in line with what the person wants as a quality of life dopamine antagonists drugs are also some of the most effective anti nausea agents if
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you have somebody who's going and going out and on a boat on a cruise and they're gonna they're afraid they're going to be seasick and they start taking anti nausea agents women who are pregnant sometimes take anti nausea agents if there have really bad morning sickness so there are a lot of times where you may see this used when my son was got out of the NICU he had gastric reflux disease and they prescribed him Reglan which I didn't realize at the time how powerful of
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a drug that was but it increased gastric emptying so if the food got out of his stomach faster so it didn't repeat if somebody doesn't have enough dopamine they may have blunting of affect and apathy loss of motivation increased pain symptoms of Parkinson's disease or restless leg syndrome attention deficit hyperactivity disorder because dopamine helps us focus neurological symptoms that increase in frequency with age such as decreased arm swing and increased rigidity and changes
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in dopamine levels may also cause age-related changes in cognitive flexibility so as dopamine goes down we lose some cognitive flexibility but thinking again if we have a client who has normal dopamine levels and they start taking a powerful anti-nausea agent for some reason and they start feeling sort of depressive symptoms or restless legs or ADHD type things we want to try to connect the dots as a side effect of that potentially a side effect of that
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anti-nausea agent that they may need to talk over with their doctor if they didn't have the symptoms until they started taking the medication and then all of a sudden they're having them other symptoms of insufficient dopamine lack of motivation fatigue apathy procrastination low libido sleep problems mood swings hopelessness memory loss and difficulty concentrating I think I covered those on the other slides leading up to this but a lot of this looks like on a
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quick glance looks like depression which again a lot of times doctors are going to go straight for a selective serotonin reuptake inhibitor so that might not be the best thing for that person nutritional building blocks eating a diet high in magnesium and tyrosine magnesium is obviously a vitamin actually mineral and tyrosine is an amino acid if you eat a good-quality diet that has decent quality proteins you're going to get the tyrosine but it ensures you've
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got the basic building blocks needed for dopamine production chicken almonds apples avocados bananas chocolate I like chocolate and you know you can get the chocolate powder the Hershey's cocoa dark chocolate powder and it has like I think it's ten calories per tablespoon so it's not the same as eating a chocolate bar so if people are trying to increase their chocolate consumption that's one way to do it where they're not getting all those saturated fats and everything green leafy
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vegetables green tea lima beans oatmeal sesame and pumpkin seeds turmeric which is a spice you're not going to eat enough tumeric to really increase your dopamine levels unless you're really experimenting with your cooking watermelon and wheat germ so most people can find two or three things on this list that they're willing to eat and you know that's all we're talking about we're not talking about anything huge in terms of altering their diet again they need to
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talk it over with their nutritionist if they're on any sort of medications especially Mao is or typical antipsychotics it's going to be even more important that they talk with their nutritionist or physician because there's a lot of dietary restrictions with those medications dopamine in the blood is not able to cross the blood-brain barrier to reach the brain so people can't just take a supplement a dopamine and go okay cool I'm good so they need to have provide their
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body the building blocks so their brain can make the dopamine the most common dopamine agonists so this is what increases dopamine and is going to get rid of negative symptoms which are your apathy your depressive type symptoms you're not wanting to speak your catatonia restless legs Parkinson's Mira pecs and Requip are the name brands of two of the more common medications that are prescribed levodopa carbidopa and there's that's the generic is converted to
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dopamine in the brain so that's another drug that they often prescribe but a side one to consider and a lot of our clients are on boosts barone so a side one to consider and just to learn a little bit about is boosts purim because it does increase freely-available dopamine in the brain in the brain so that might be one it's not nearly as powerful as the other two but it might be one that our clients look towards if you're not familiar with boost barone it's not
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a benzodiazepine or a barbiturate but it has a lot of anti-anxiety type properties it's one that takes time to get into the system like an antidepressant takes 2 to 4 weeks to build up in the system but it's not addictive in the same way you know it's not addictive like xanax or valium or any of those are so it is one option especially for clients who have co-occurring issues that they can consider for anxiety if some of the other things make them too
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tired like some of the antidepressants that are also used for anxiety at high levels and what's the other one I was thinking of Seroquel that's another one I've seen prescribed for anxiety so these are options for them most common dopamine antagonists these are the ones that get rid of the positive symptoms such as the hypersexuality and nausea and things like that risperidone Haldol and zyprexa they will also get rid of the hallucinations the delusions
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things that you don't want to be there that are there Reglan is the one i told you about that metoclopramide is an anti-nausea medication it also helps speed up gastric emptying so some of your clients especially your elderly clients who are people who have gastric esophageal reflux disease GERD may be on this so being aware that this this medication will blunt and slow people down a little bit so if they're starting to feel depressed take a look at side
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effects and medications supplements which can increase dopamine l-theanine is another amino acid that's found in green tea so if people are just drinking green tea they're not going to get enough l-theanine to you know cause any problems or negative interactions with their medication but you can get it as a supplement so if clients are talking about taking this as a supplement especially if they're taking other psychotropic meds they need to let their doctor
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know rodeos rhodiola rosea or golden root also increases dopamine by enhancing the stability of it and supporting its reuptake which has been shown to produce decreases in depression anxiety and fatigue and an increased ability to handle stress so it's an herb that's used a lot in Eastern medicine in order to provide anti-anxiety antidepressant type effects
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blood levels of antipsychotic medications and lithium are especially sensitive to hydration levels so if your client is taking any of those it's important that they are aware of aware of this fact but they don't get too dehydrated but they also don't get too hydrated neuroma lignans syndrome is caused by a sudden marked reduction in dopamine activity either from withdrawal of dopant dopaminergic agents or from blockade of dopamine receptors symptoms include high fever confusion
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rigid muscles variable blood pressure sweating and fast heart rate now this is also very similar to the symptoms that you're going to see when we talk about serotonin syndrome so it's important to pay attention when these symptoms are there because it's life-threatening complications can include rhabdomyolysis the kidney problems high blood potassium kidney failure or seizures so we want to be aware of what's going on with our clients we want to talk with them about any symptoms
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that they're having this can be caused you know by any sort of sudden reduction and it doesn't have to be just from a reduction in a dopamine type medication they've shown it with some other medications as well dopamine levels declined by around 10 percent per decade from early adulthood and have been associated with declines in cognitive and motor performance dopamine levels are also impacted by the availability of estrogen so here's another age-related change
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if you're working with a woman who is older a woman who is experiencing premenstrual dysphoric disorder a woman who is recently postpartum it's important to look and realize that hormone levels are fluctuating widely which also means dopamine levels are going to fluctuate widely as far as wellbutrin as an agonist I'm not aware I don't know the answer to that norepinephrine this is my favorite neurochemical if you will it's your fight-or-flight excitatory neurotransmitter
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it's implicated in motivation and focus so norepinephrine goes out you get that kind of laser focus when people don't have enough norepinephrine then it causes problems with arousal and a lot of other things when faced with severe stress the stress response system activates raising norepinephrine as well as other stress hormones which increases arousal increases insomnia you know you don't want to be sleeping if you're under threat it increases anxiety irritability emotional
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instability and if it goes on for too long it can also increase depression so cortisol if you remember from from other lectures cortisol causes the body to say you know we're going to reduce estrogen right now because we don't have a need for procreation there's a threat out here which tells you from the last slide that dopamine levels you're going to go down to ooh ok so but we also know that serotonin availability is affected by estrogen levels so serotonin is a
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calming chemical and helps with mood so dopamine and serotonin go down when estrogen goes down norepinephrine goes up which increases heart rate and respiration and focus and all kinds of stuff like that we also know that a lack of serotonin or less serotonin is going to be implicated in in sleep problems so norepinephrine and serotonin are kind of teeter totters you know when one goes up the other one tends to go down prolonged stress leads to underactivity of the stress
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response system desensitization so your brain over prolonged stress is going to start saying you know what I've only got so much energy and I can't fight or flee from everything right now I have to conserve it for what's really the most important so people may not have norepinephrine sent out as much which is when you start feeling depressed or seeing depressive symptoms symptoms of excess norepinephrine ADHD or problems with concentration remember you saw that in dopamine
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to depression if people are too wound up for too long they may start experiencing some some depression anxiety and poor sleep nutrition again tyrosine rich foods you want to look at bananas beans and legumes chicken cheese chocolate eggs fish and seafood meat and oatmeal so tyrosine we're seeing repeatedly making sure that people are getting access to some of these and I included I made sure to include vegetarian options as well as other options in case people aren't good with
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eggs fish or chicken a daytime nap they found can also double your levels of norepinephrine now naps should never be well ideally longer than 45 minutes you don't want people to go into a full REM cycle because that just throws their circadian rhythms completely off a 20-minute nap where you're resting your eyes some people find that that makes them feel a ton better I can't seem to shake it if I lay down for 20 minutes or sit sit in the easy chair for 20 minutes I feel groggy
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afterwards so people will have to figure out for themselves if that works for them so glutamate is another excitatory neurotransmitter so dopamine is our pleasure neurotransmitter it helps keep us motivated norepinephrine is our motivation and our fight-or-flight neurotransmitter glutamate is also another excitatory neurotransmitter it's going to rev people up glutamate is actually a an amino acid which is present in most high protein foods so you don't even have to go out of
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your way to find this one if you're eating protein you're probably getting it it's the most prevalent excitatory neurotransmitter and it's used to make gaba the brain breaks down glutamate to make gaba so if you don't have enough glutamate which revs you up you're not going to be able to likely make enough gaba calm you down and GABA is our primary chillax neurotransmitter it facilitates learning
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and memory it keeps us alert too much glutamate though is associated with panic panic attacks and anxiety impulsivity obsessive-compulsive disorder and sometimes depression
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glutamate availability declines with age and it's affected by serotonin availability so you know if there's more serotonin than there's not going to be as much glutamate and and vice versa too little gluten glutamate can lead people to feel agitated have memory loss sleepless low energy level and depression
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glutamate we don't talk about a lot we talk more about gaba and gaba is designed as an anti-anxiety anticonvulsant sort of neuro chemical it's made from glutamate and functions as an inhibitory neurotransmitter so it inhibits our functions it slows our breathing slows our heart rate lowers our blood pressure you know it's just a great neurotransmitter gaba does the opposite of glutamate and instead of telling all the nerves to fire it says don't fire just relax close to
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40% of the gaba synapses in the human brain work with gaba and therefore have gaba receptors so think about that in your brain not just in one little partier brain but in your brain close to 40% of the synapses work with gaba so if you don't have enough gaba then you could have some significant side-effects insufficiency anxiety depression difficulty concentrating insomnia and seizure disorders one of the medications that we'll talk about in a few minutes klonopin is
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an anticonvulsant and it increases GABA levels symptoms of excess and sometimes you'll see klonopin prescribed for anxiety as well you know because the prescribing physician doesn't like some of this traditional benzos for some reason symptoms of excess excess sleepiness shallow breathing decreased blood pressure memory problems dizziness blurred vision slurred speech and weakness so all the symptoms of what you would see with an opiate opiate overdose what
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you would see with a gaba overdose what you would see in somebody who's intoxicated you know these are the things that we're going to be looking for nutritional building-blocks fermented foods now that's that's you know this is the only one that nutritional building block is a fermented food almonds and walnuts cherry tomatoes tomatoes with a thicker skin have more of what's needed to improve GABA levels bananas again brown rice again potatoes oats lentils if the
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person's deficient in vitamin b6 it can impair the production of gaba even if they have all the building blocks it's kind of like trying to build a brick house without mortar so they need to make sure that they're getting enough b6 most people get enough in their diet and/or with a multivitamin but that's between them and their doctor b8 is another one that's really important for gaba you can find that in wheat germ brown rice green leafy vegetables nuts and navy and
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lima beans specifically so that may be a little bit harder to get if you don't like brown rice or green leafy vegetables but it's possible and you know you will find it in some of the better nutritional multivitamins medications that increase the available amount of gaba typically have a relaxing anti-anxiety and anti convulsive effect gabapentin is one of the more common ones that we think of or neurontin is a GABA analog and is used to treat epilepsy and neurotic pain
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benzodiazepines and barbiturates including GHB Valium and Xanax also increased GABA levels baclofen and klonopin well bacliff baclofen as a muscle relaxant my dog is actually on that right now she's 14 so but it's a newer muscle relaxant and and painkiller sort of thing and klonopin is the anticonvulsant that I told you about before this is not an exhaustive list but it gives you an idea that we're kind of covering a broad spectrum if you're working with somebody who
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has co-occurring issues the doctors are probably going to steer away from the blast three and more towards neurontin for chronic pain and and muscle problems now serotonin our favorite chemical to talk about not mine but in general it helps me regulate mood symptoms mood sleep patterns appetite and pain so how you feel how you sleep whether you're hungry and if you're in pain it's a big one and there are a lot of other things that it does if you go here let me see if I get it to
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come up maybe maybe not and this is far too small for you to really read right now but if you go to this Wikipedia page on serotonin it talks about all the different serotonin receptors and binding profiles and talks about what it's involved in like 5h t1a is responsible for dopamine release in the prefrontal cortex in addition to being a serotonin receptor so it gives you an idea about how broadly some of these neuro chemicals can affect someone anyhow where's it found its found
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in your brain but 80% of your serotonin is found in your gut and intestines so if you're working with somebody who has gut and intestinal problems that are reducing bioavailability reducing absorption you could have some problems here so brief little talk about serotonin syndrome because we don't talk about it enough and it's so important one dose too much one time it's not something that has to build up over time like most SSRIs do if you overdose one time you can
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develop serotonin syndrome now it generally goes away when the offending chemical is gets out of your system but it can cause shivering diarrhea muscle rigidity fever high high fever like 108 plus seizures irregular heartbeat agitation high blood pressure stroke so it's important to be aware that too much serotonin can be really really bad and people who take supplements like 5-htp can easily get too much serotonin there are also a lot of other things that you're going to find out
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in a minute that increase serotonin that people aren't aware of as being serotonin increases so it's really important to educate clients about the side effects so they're more cognizant so too little in serotonin leads to feelings of depression anxiety pain sensitivity serotonin is involved in regulating our pain threshold when our serotonin is low our pain threshold is lower same thing again with dopamine when our dopamine 'slow our pain threshold is lower because dopamine
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helps with pain poor sleep because melatonin is made by breaking down serotonin if somebody doesn't have enough serotonin and they may not be able to get quality sleep difficulty concentrating carb cravings our body when we eat high sugar high carb foods tends to release serotonin and dopamine see how these things are so hard to ferret out especially since since we can't really experiment on the human brain anyhow carb cravings are common in people who have or we believe in
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people who have low serotonin and constipation serotonin keeps everything moving if somebody is has hypothyroid loss or low serotonin they could have constipation caused by either one of those among other things nutritional building blocks are foods rip rich and tryptophan the body cannot make tryptophan so you have to get tryptophan from what you eat whole wheat potatoes brown rice lentils oats and beans I feel like a broken record when I read this so hopefully your clients
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willing to look at something in here and if they don't like these options you know obviously they're working with their nutritionists they can go online and Google Worlds I believe it's world's healthiest foods and find out which foods are high in tryptophan and find something that suits their fantasy a little bit better I just listed the top ones medications and supplements that increase
36:45
serotonin selective serotonin reuptake inhibitors obviously we know that's the first line for a lot of people when they're depressed doctors give them SSRIs your paxil prozac Zoloft lexapro yada yada selective norepinephrine reuptake inhibitors also make the serotonin more available they prevent the reuptake of serotonin as well as norepinephrine 5htp increases serotonin Sammy st. John's wort
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the last three five HTTP Sammy and st. John's wort people can buy over-the-counter which can be really scary because they can accidentally get too much and atypical antipsychotics have been used in people for whom the first-line SSRIs and SNRIs didn't work so some of the serotonin receptors are responsible for sleep regulation feeding thermoregulation so people are getting cold a lot or too hot hyperactivity hypo activity locomotion muscle tone learning peripheral vasoconstriction
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stomach contraction nausea and vomiting and gastrointestinal motility in your leg okay why do I care because oops where did it go when we I'm gonna jump around a little when somebody has serotonin syndrome there are three things that we're going to look for and it's the acronym or mnemonic can cognitive changes including agitation confusion euphoria insomnia hypomania and hallucinations a stands for autonomic changes including racing heart fever arrhythmias which is
38:37
an irregular heartbeat sweating and dilated pupils and n stands for neuromuscular changes including tremor rigidity in coordination and seizures if you see this it's a medical emergency that just don't even think about well is it dopamine is it serotonin is it alcohol what's going on if you see these it's likely that there's a problem and they need to be evaluated by a medical professional ASAP so how do we increase serotonin because this is another thing that trips people up they
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think the only way you can do it is by taking a psychotropic drug you can increase serotonin synthesis like taking l-tryptophan through supplementation so you can get pure l-tryptophan and you can ingest it the likelihood of causing serotonin syndrome from supplements from amino acid supplements it's really pretty low but it's not something I'd want to play with reduction in serotonin breakdown so instead of increasing the serotonin available we just keep what's there
39:46
from being broken down your mao is due that we can increase serotonin release things that cause that include your end and fetta means ADHD medications MDMA anorectic s' any of your appetite suppressants weight loss drugs like dexedrine anti migraine medications and this is a big one such as triptans anti migraine medications prevent the serotonin or increase the release of serotonin and
40:16
if somebody is also taking a selective serotonin reuptake inhibitor then they're given themselves a double whammy so they need to make sure that they're aware and their doctors aware if they're on an SSRI and prescribed anti migraine medication we can also stimulate postsynaptic receptors boost barone does this so it increases dopamine and it can increase serotonin lithium and pain medications so again you wouldn't have thought opiates increased serotonin but they
40:49
do so it's important and tylenol with codeine fentanyl hydrocodone oxycodone and tramadol are some of your more common pain medications if you have a client who goes in for surgery even oral surgery outpatient surgery and they're taking an SSRI or they're taking 5htp as a supplement make sure they know that the pain medications that they may be prescribed could also increase serotonin and what to look for in terms of serotonin syndrome and serotonin reuptake inhibitors
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the last one we have it we keep it from being broken down and then we keep it in a synapse longer your typical SSRIs ultram is also a it's a painkiller as well as an SSRI so that can be a double whammy trazadone is a serotonin agonist and reuptake inhibitor so it increases serotonin and it prevents reuptake which makes it more available your tricyclic antidepressants your serotonin and norepinephrine reuptake inhibitors and bupropion which is wellbutrin or zyban is also
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a norepinephrine dopamine reuptake inhibitor all of these can increase serotonin as well as norepinephrine and dopamine for the for the last one other drugs that act to raise serotonin elicit drugs including LSD ecstasy cocaine and amphetamines herbal supplements st. John's wort ginseng nutmeg are added to the list of 5-htp and Sammy over-the-counter cough and cold medications containing dextromethorphan they'll some mucinex diem and others some of the youth today are using
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dextromethorphan rectally in order to get high off of it and so knowing that they can actually cause serotonin syndrome by overdosing on dextromethorphan there's a really fine line between getting high and causing yourself to go into serotonin syndrome worth being aware of anti-nausea medications such as metoclopramide which is Reglan I'm not gonna enzo fran i can read that one so again you see Reglan which we talked about under dopamine also may increase
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serotonin so it's important to be aware that if somebody is on an SSRI or you know a dopamine agonist it's important that they also be aware that Reglan is possibly contraindicated so vox is an antibiotic who knew an antibiotic could increase dopamine or not dopamine but serotonin it's not one that I've ever seen prescribed but obviously it is and nor vier which is an antiretroviral medication used to treat HIV and AIDS and I have seen this one prescribed a lot
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doctors need to be aware clients need to be aware because not all doctors are aware of all of these things that increase serotonin and unfortunately right now the studies still show that only about sixty percent of doctors are really aware of serotonin syndrome and think to look for it serotonin does change with age it goes down when estrogen or testosterone go down so you know guys you don't get a beat get a pass on this one melatonin however doesn't seem to decline as we
44:35
age unless they're tonin declines significantly so generally the amount of serotonin we need to make enough melatonin to sleep through the night even as serotonin goes down it doesn't go down enough to affect our melatonin production some people find that melatonin supplementation does help them sleep that's something to consider with their doctor there are new studies out as an aside that long-term taking of benzo day and my pen soda a subpoena of sleep aids what am I thinking of
45:09
like benadryl antihistamines can increase risk of dementia so people are advised not to use sleep aids for long periods of time and they need to talk with their doctor about other options and you know try to figure out why they're having difficulty sleeping acetylcholine see I told you we would whip through these things the mechanism of action in lower amounts acetylcholine can act like a stimulant by releasing norepinephrine and dopamine it also enhances memory motivation
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higher order thought processes sexual desire and activity and sleep one other thing well I don't want to get ahead of myself if there's too much acetylcholine the person may have all the symptoms of depression nightmares mental fatigue and anxiety there's an inverse relationship between serotonin and acetylcholine so as serotonin goes down acetylcholine goes up so somebody doesn't have enough serotonin then they might start experiencing depression nightmares
46:17
mental fatigue and anxiety if they take an SSRI increases their serotonin theoretically their acetylcholine is going to go down so then they'll start feeling better whether it works that way for your particular client is really going to depend on which neuro chemicals are out of balance for them too little acetylcholine leads to symptoms of Alzheimer's and dementia Parkinson's impaired cognition attention and arousal so this is another one of our sort of it's not they call
46:54
it a modulating neuro neuro chemical it's not necessarily excitatory but it's not necessarily inhibitory but we do see when there's not enough acetylcholine that people start experiencing you know tremors cognitive problems and difficulty with attention nutritional building-blocks foods high in choline that's easy to remember meats dairy poultry chocolate peanut butter wheat germ Brussels sprouts and broccoli now I don't know about you I've never developed a taste
47:27
for Brussels sprouts but broccoli I can work in wheat germ is pretty easy to get most people to consider chocolate poultry and dairy there's also a lot of acetylcholine in eggs so the medications cholinergic cholinergic medications are used for glaucoma bladder control and severe muscle weakness so we see this sometimes in especially moreso in older adults than in younger adults so they may be on medications that increase their acetylcholine so we could go back here to symptoms
48:05
of excess if they start having anxiety mental fatigue depression or nightmares that may be a side effect to the medication and they need to talk with their doctor anticholinergics cholinergic sorry may worsen gastro esophageal reflux disease so if they're taking it and their acetylcholine is reduced they may have more reflux problems these medications anticholinergics are used for Eckstrom pyramidal symptoms with schizophrenia such as muscle spasms a feeling
48:42
of motor restlessness tension nervousness or anxiety drug-induced parkinsonian ism trembling shaking loss of muscle control and tardive dyskinesia which is the involuntary muscle movements in the lower face and extreme distal extremities so if people are having side effects up from some of their and it's generally your your antipsychotic occations then well obviously with schizophrenia then acetyl choline maybe they may be getting too much acetylcholine so the doctor
49:20
may prescribe medication to reduce that too now depending on the person you know they may not be able to come off whatever antipsychotic they're on so we have to medicate the side-effects that is probably going to produce some side-effects which is how people end up on like seven different medications medications that are anticholinergic atropine bends atropine and I have the brand names over here so you may have seen Oman on client charts chlorpheniramine which is chlor-trimeton
49:55
demin hydron 8 which is Dramamine it you know seasick medication diphenhydramine which is benadryl sominex all your sleep aids hydroxyzine bupropion and dextromethorphan are all anti colon colon urge ik in their own way so again they're taking a prescription drug for something for a neurotransmitter and they start taking any of these over-the-counter ones or prescribed drugs it's important that they're aware of the interaction because people will not think twice
50:35
about taking a benadryl if their allergies are acting up or taking Dramamine if they're getting ready to go on a flight and they can have really unexpected side effects from that dextromethorphan you know I haven't seen any reports that have indicated that when taken as prescribed you know if you've got a cold that it interacts negatively with any of the SSRIs or anything to produce problems but knowing that it is a common drug of abuse right now you know
51:11
that's when you start getting into problems when people are taking double and triple and quintuple the amount of medication that they're supposed to take anticholinergic drugs are used to treat a variety of additions including gastrointestinal disorders which you know think about your clients what they have genitourinary disorders respiratory disorders such as chronic bronchitis and COPD
51:38
something else we see in older adults especially and possibly insomnia usually only on a short-term basis so going back to these drugs thinking about what may be going on diphenhydramine not uncommon for insomnia on a short-term basis so there are a variety of different neurotransmitters involved in addiction and mental health disorders it's not always about increasing a neurotransmitter
52:10
sometimes you need to decrease it the human brain tries to maintain homeostasis and too much or too little can be bad if you think about it I mean let's go back to acetylcholine for a second I can get there how many of the neurotransmitters did we talk about today that either an insufficiency or an excess impairs cognition attention and arousal pretty much every single one of them so the cause of your clients depressive symptoms or anxiety symptoms we're really good at you know
52:50
theoretically at helping them figure out the cognitive distortions that may be contributing to turning on their threat response system or maintaining their depression but as far as what neuro chemicals might be out of whack especially for somebody who appears to have long-standing organically involved depression it's not situational but they've had depression since they were you know in grade school well then we want to look at what might be where might a
53:21
problem be in the plumbing so to speak where might not enough of a particular neurotransmitter be getting through this is something that a really awesome psychiatrist is going to help them kind of sort through but one the things I do with my clients is I have a check sheet of the different symptoms that they're experiencing and I encourage them to keep track of their symptoms on a daily
53:46
basis if they're especially if they're working with the doctor trying to get on a good medication regime for them identify you know when they start taking this medication if there are side effects if it starts helping them feel better and anything that they want to talk with the doctor about so they can figure out if they put them on a SNRI a selective norepinephrine reuptake inhibitor if they put them on that and that just makes them feel anxious as all get-out then they may
54:20
try an SSRI or or something else but it's sort of the whittling down which is you know some of our clients we see with treatment resistant depression as they call it the doctors often wait until you know they've tried three or four or seven other things before they start looking at seroquel and so you're a typical antipsychotics and I can understand why I mean there seroquel is extremely sedating and does have some side effects however you know for some people it may be a
54:55
matter of getting the dopamine system back online so encouraging clients not to give up to recognize that unfortunately and I had this question come up when I taught this class before there is no way to measure neurotransmitters in your brain while you are alive so people who advertise that you can measure your neurotransmitters through your blood or your urine or whatever yes you can but what you're measuring is free circulating neurotransmitters remember I said eighty percent
55:30
of your your rum serotonins in your gut well that doesn't do your mood any good well except for when your belly doesn't hurt but that number is really irrelevant to helping doctors figure out which neurotransmitters might be precipitating moods gums so it's a waste of money I mean people can do it if they want you know no harm no foul you also have the possibility of a placebo effect but
56:00
in reality there is no way that we have right now at least that I'm aware of to measure the actual levels of the neurotransmitters specifically in the brain so encouraging clients and I use a much less technical presentation when I when I go through it with with clients and I do the mind-body connection but helping clients see how important it is to eat decently you know pizza is fine you know a couple of times a week even if that's what you want but you need to get some of
56:33
that brown rice and vegetables and other things when we start thinking about some of our clients who are going on the trendy nutritional plans where they're cutting out all grains you know no rice no wheat no oats no nothing and they're just eating meat and vegetables what impact is that having on the availability of neurotransmitters since most of these neurotransmitters can be formed from building blocks that are found in green leafy vegetables or gram your grains as
57:10
long as they're getting a fair amount of green leafy vegetables they're probably going to be okay but you know again once you start monkeying with cutting out entire food groups it can cause unexpected side effects so making sure that clients are aware of that not saying not to do it they're going to do whatever they want to do but encouraging them to talk it over with their doctor and an or and or a nutritionist and I always say a nutritionist but most of them well I haven't
57:43
yet had a client that has actually gone to see one because they kind of roll their eyes and they go well that's not covered by insurance and well so at least talk about it with your doctor before you start monkeying with things just to make sure that you're not going to make anything worse
58:02
human brains try to maintain homeostasis too much or too little can be bad and a balanced diet will provide the brain the necessary nutrients in synergistic combinations and that's something I didn't talk about earlier taking a pill is not a substitute for eating you know nutritionally balanced foods because those amino acids for example are in a very specific ratio in terms of what's absorbable I will give you an example we think of turkey and Thanksgiving and we think
58:42
well turkeys high in tryptophan so when I eat turkey I get sleepy and it's it's because of the tryptophan in the turkey research has actually shown that that's not true research has shown that yes turkey does have a high amount of tryptophan but it also has a high amount of other amino acids that are preferred by your body so you don't get very much actual tryptophan synthesized when you eat turkey so they hypothesize that it's actually the sugar crash from the sweet
59:11
potatoes and everybody everything else as opposed to Turkey chicken is actually higher in available tryptophan than turkey is so these little things that you know people don't don't take into consideration necessarily and they can get obsessive about it trying to figure out you know micronutrients and proteins and amino acids and everything down to the nth degree and its really talking to a dietitian friend of mine is it's really not that necessary if
59:45
you eat three colors on your plate at every meal you know you can have fruit at breakfast because most of us don't want to eat Brussels sprouts at breakfast and and you eat enough calories and you eat quality foods and you know pizza has a lot of colors but that doesn't count as you know a well-rounded meal for every single meal then you're probably going to get adequate nutrition
1:00:12
are there questions and I will look up that question about wellbutrin as a dopamine agonist I just don't know the answer to that
1:00:27
there is another book let me see
1:00:37
see if I have it linked if I don't I will put it in the additional resources course or section of your course that goes over all the neurotransmitters so if you like reading that kind of stuff it's a really awesome book it's free it's online let's see what we have here
1:01:22
okay one of the slides at the end suggested it hey cool that's not it okay so let's go back here yes Thank You Carl neuropsychopharmacology the fifth generation of progress editors Kenneth L Davis at all this link will take you directly to it whoops and I love it it is written in you know journal ease so it's not something that you want to plan on sitting down and reading a hundred pages at a time because
1:02:04
you'll probably go cross-eyed but it is a fascinating read and it does kind of break down each individual neurotransmitter to help you get an idea about you know what it does so and then some of the other articles I just found very interesting in terms of increasing our understanding and increasing our clients understanding of neurotransmitters
1:02:38
I did like this study and it's you know only tangentially related to the neurotransmitters about whether diet soda causes depression because it really does talk about the difference between causation and correlation you know there is there a correlation between depressive symptoms and low serotonin yes do we know whether lowest low serotonin causes depression no not necessarily so we need to be cognizant of what other things might be causing these symptoms and we talked
1:03:39
a lot today about neuro chemical imbalances but there are a ton of physical things like just even hypo or hyper thyroid or imbalances in sex hormones that can cause fatigue difficulty concentrating low libido apathy you know so you know we don't want to assume necessarily alrighty if there are no other questions then I will look up that one thing and I will put that in your additional resources of your class in the next you know hour and everybody have an amazing weekend
1:04:27
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