Category: Health

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 allceus.com/counselortoolbox I’d like to welcome everybody to today’s presentation of addiction and co-occurring disorders   part two the physiology of addiction and mental health issues over the next hour we’re going to   discuss somewhat generally because there’s a a lot of stuff to go over neurotransmitters which   we’ve talked about some before but then we’re also going to talk a little bit more today than we’ve   talked in the past about sex hormones thyroid hormones and stress hormones and how all of those   interact in the body to increase or decrease the availability of certain neurotransmitters we’re   going to go on from learning about the different hormones and neurotransmitters to discussing   the physics all the physiology of emotion and motivation and again we’ve kind of covered that   but we’re going to go over it real quick again we’ll talk about the physiology of sleep what   happens during sleep and what happens to those hormones or neurotransmitters when you don’t   get enough sleep what happens when you eat why is eating sometimes rewarding what happens when   people take stimulants whether it’s caffeine or methamphetamine what happens when we turn up the   system and how does that affect the availability of certain neurotransmitters and then we’ll talk   about the physiology of depressants so we’re looking in general at what these things do as   far as the physiology of addiction we’re going to talk generally about that right at the very   end so your inhibitory neurotransmitters are those brain chemicals turn down   the system so instead of being hyped up and awake and yadda-yadda your calm you are relaxed you are   maybe even sleepy too drowsy so your inhibitory neurotransmitters are the ones that kick   in or counteract the excitatory ones serotonin is your primary inhibitory neurotransmitter it’s   broken down to make melatonin and help you sleep okay so we know that it’s also responsible   for a lot of our bowel function angle and also for not it’s implicated in nausea and motion   sickness and they found that there are a lot fewer side effects to serotonin antagonists than there   are to dopamine antagonists when we’re talking about helping people who have motion sickness   and nausea so anyway just a little aside there but serotonin is 80 percent of it is actually in your   GI tract and it is implicated in bowel function so when we’re thinking about clients who may have   an imbalance in serotonin and who may have greater pain sensitivity we want to start thinking about   you know how is their GI working and is are some of their problems with you know stomach problems   pain irritable bowel that kind of stuff is that caused by a serotonin imbalance or is that causing   a serotonin imbalance or maybe serotonin is not implicated at all and it’s something completely   different serotonin is also implicated in anxiety and aggression if you don’t have enough of it you   tend to be more anxious and aggressive because you’re not having the turn down if you will low   serotonin has also been implicated in poor impulse control so we like serotonin but we   found and we’re gonna talk about that throughout this class of serotonin has often been given the   go-ahead or been implicated for a whole lot of things and we’ve said okay if this happens then   it’s low serotonin if this happens then it’s low serotonin and as it goes but no the research is finding that that’s rarely true that most of our problems whether it be GI problems   or mental health problems or addictive issues don’t necessarily involve serotonin at all there   is a subset of people for whom it does but the majority of people which is why antidepressants   are ineffective for about 70 percent of the population for them shortie of the people it’s not   serotonin so we do want to keep that in the back of our mind yes serotonin is everywhere throughout   the body 80% of it is in our gut and our gut is not necessarily going to communicate directly   with our brain we cannot measure neurotransmitter levels effectively in a live human being just not   how it works right now there are tests out there that say they can measure your neurotransmitter   levels and that’s true but it’s not telling you how much of that neurotransmitter is in your gut   or your muscles or wherever versus in your brain so those tests for our purposes as mental   health clinicians and people who come to us who may want to know well what antidepressant should   I be on they’re not all that effective okay so depression has been debunked as   being linked to serotonin in the majority of cases serotonin is implicated as one of those   neurotransmitters involved in pain control in people with lower serotonin tend to have a lower pain   threshold so it hurts more and that doesn’t mean that they’re sissies or anything like that   it just means that they are more reactive or they feel more pain because they don’t have the same   level of serotonin and maybe endogenous opioids kind of coursing through their system serotonin is   also like I said involved in sleep an interesting fact is that alcohol impairs the body’s ability   to convert tryptophan which is an amino acid to serotonin so when you have somebody who’s   an alcoholic let’s think about how this works if they are drinking and maybe they’re eating   a perfectly healthy diet and they just happen to drink a lot if their body can’t convert tryptophan   to serotonin then all of these problems up here that may be implicated by low serotonin can start   to rear their ugly head because the body can’t To make serotonin out of anything else it has to make   it from tryptophan and if it can’t make serotonin then it can’t make melatonin which is involved in   sleep and you’re gonna see how important all that is later so the take-home message with that is   that alcohol is something to be considered for moderation especially if we have a client who   is struggling with depression maybe they’re not an alcoholic but they need to consider the long-term   impact if they want to feel better is preventing their body from making using the building blocks   to make the neurotransmitters that they may need is it worth that drink remember that serotonin has been found in research to be implicated in low serotonin is implicated in   people with generalized anxiety disorders so it hasn’t been completely just been debunked   for everything but researchers and clinicians finally are starting to realize that there are   a multitude of reasons that somebody could have a mood issue that somebody could have even low   serotonin okay if the person has low serotonin alright that’s fine let’s address it but what   is causing the low serotonin we’ll look at that more in the next few slides GABA is your   other major inhibitory neurotransmitter it has sedative depressive and anti-anxiety properties   to them the really interesting thing it’s and when I say depressive I mean it slows down everything   it’s not that it makes people depressed but it’s your anti-anti-anxiety natural anti-anxiety   neurotransmitter helps improve concentration by filtering out background noise so you’re able to   focus a little bit better when you’ve got normal levels of gaba help with impulse control   think about when you’re anxious when you’re a little bit revved up when you’re stressed out   and somebody scares you maybe you’re a little bit more jumpy well think about if you have GABA at   the right levels in your system and you’re not stressed out and somebody scares you are you as   jumpy are you as impulsive a lot of our impulses are associated with wanting to make a threat or   a pain go away so if you’re not perceiving as many threats you’re probably not going to be as   impulsive another little interesting side thing is that glucose you know sugar is necessary for the   formation of GABA so people with hypoglycemia can have a reduction in GABA and an increase   in anxiety so think about if your blood sugar gets low even if you are not hypoglycemic but   you know you got to work back-to-back patients you didn’t take time for lunch yet back-to-back   patients you’re on the drive home from the office your blood Sugar’s low you are you more likely to   respond with some anxiety or irritability to things that happen versus when you are well   nourished and your blood sugar is kind of stable for most people, they’re gonna say yeah I tend to   be a little bit cranky err when my blood sugar is low and shake gear alright so those are our   two inhibitory neurotransmitters glutamate is generally acknowledged to be the most important   neurotransmitter for brain functioning and it’s excitatory it gets you up it gets you   going it gives you energy and it’s responsible for helping us learn and remember things so if   you’ve got low levels of glutamate you know you might have difficulty concentrating and learning   now the interesting thing is that glutamine which is an amino acid you eat glutamine   is converted into glutamate all right well that makes sense so you eat something it is turned   into this neurotransmitter that’s excitatory the interesting thing is gaba is made by the breakdown   of glutamate so you have if you have glutamate then you can have Gaba if you don’t have enough   glutamate then you’re not going to have enough GABA so it’s a balance like taking a warm bath   and you know this is important to remember simply because we want to know what’s rubbing   us up and what’s slowing us down norepinephrine or noradrenaline depending on where you are is what   they call a catecholamine it increases arousal and alertness promotes vigilance and focuses attention   so you’re hearing a theme here about attention and memory it enhances the formation and retrieval   of memories so in your norepinephrine that’s your motivation chemical is secreted it encourages you   to pay attention to remember and to be able to go and file things away and access them easily it can also promote restlessness and anxiety if you have too much so it’s all about moderation   when I talk about too much or too little of a neurotransmitter everything is always about all of the other neurotransmitters and hormones so we can’t just necessarily get a measurement and   go well you’ve got too much of this well we have to know what the levels of everything else are it   would be kind of like making a marinara sauce and saying you a teaspoon of garlic is how much you   need but that teaspoon would be enough if you were making maybe two quarts of marinara sauce   but if you are making 4 gallons all of the other spices and everything would be in much   larger proportions so what a teaspoon be enough so we need to know what proportions all the other   chemicals are at in order to know how much we need and since we can’t measure them we’re just kind of   left guessing dopamine is another catecholamine and it’s broken down to make norepinephrine now   normally we think of dopamine as our pleasure reward chemical which it is don’t get me wrong   it’s that’s what is there for and it tells us I want to do that again but it’s broken down to   make our focus concentration motivation chemical interesting so we need dopamine to make   norepinephrine we need norepinephrine to want to get up and go so if we are draining our dopamine   system through addictive behaviors or some other reason guess what we’re not going to be able to   make enough nor epinephrine or those receptors that usually receive the norepinephrine and the   dopamine are going to be basically unresponsive and you’re going to knock on the door and nobody’s   going to open so dopamine is broken down to make norepinephrine which is your motivation chemical   high levels of dopamine in the brain generally enhance mood and increase body movement too   much dopamine may produce nervousness irritability aggressiveness and paranoia so think about cocaine   if somebody takes a whole lot of really good cocaine this is probably what we’re going to   see because the levels of dopamine in their brain just skyrocketed and everything else didn’t catch   up there was no signal to all the other chemicals to go okay we’re gonna have a surge here so we   have all of those neurotransmitters that are responsible for helping us feel happy serotonin   helps us feel theoretically calm and content and focused gaba is an anti-anxiety medication   or not medication but a neurotransmitter and then dopamine glutamate and norepinephrine are all   of our excitatory ones they’re the ones that get us guess what excited happy excited mad excited   whatever the excited is they Rev us up and that’s what we label with our emotional feeling states   so what is this HPA axis thing that I talk about every once in a while in response to stress the   level of various hormones change and reactions to stress is associated with an enhanced secretion   of several hormones including your gluta Co corticoids which is cortisol your catecholamines   to increase mobilization of energy sources which is blah blah blah blah blah you get   stressed your body sends out the message that we need some energy we need some fuel for this   fight-or-flight response cortisol is activated and it’s a glue to co corticoid which tells your body   we need to prepare we need to get some glucose going so got energy for this fight-or-flight   thing catecholamines adrenaline and dopamine are released that’s your body going okay we have this   energy now let’s get the team revved up the other thing that happens though is jörgen a door opens   are suppressed your body goes you know we don’t really have time for sex right now so let’s not   worry about it so your sex hormones tend to be suppressed under high stress levels okay well   who cares you’re gonna find out in a little while but that’s kind of a big deal because there is a   strong relationship between the amount of and the balance of our sex hormones and the availability   of serotonin-norepinephrine and dopamine in our bodies oh well sweet this here we are androgen or   testosterone what we want to look at is what does it do it helps helps us with concentration mood   and not enough of it can result in an increase in belly fat they found that in men depending on the   research that you look at somewhere between 30 and 40 years of age they start losing somewhere   between 1% and 1.5 percent of their testosterone each year and so you’re thinking well you know   that’s not that much but you’ve also got to remember that everything’s in a balance so   they’re losing their testosterone but what else is not decreasing estrogen so some articles have kind   of termed it manopause if you will the increase in estrogen can increase irritability difficulty   concentrating and belly fat as well as Gyna mastika or the development of excess fat in   the breast area so something interesting to look at if you’re dealing with patients male patients   who are over the age of 40 who are having suddenly if you will depression or anxiety issues or are   talking about their midlife crisis that those all of those things could be precipitated by in their neurochemistry because of a drop in testosterone not necessarily but it’s one   positive or one possible reason estrogen believe it or not is a neuro stimulant estrogen revs us   up receptors for estrogen are very abundant in the emotional center of the brain called the   amygdala and the hypothalamus which is involved in what we just talked about the HPA axis which   tells us to fight flea or freeze estrogen increases serotonin receptor responsive ‘it   increases the number of serotonin receptors in the body and enhances serotonin transport   and uptake so we might hypothesize and we don’t know any of this for sure that if someone’s mood   disorder started or fluctuates in response to fluctuations in their estrogen then there might   be a serotonin component to this mood disorder because estrogen is so intimately connected with   serotonin availability high levels of estrogen are associated with anxiety one thing that they found   in American culture and industrialized nations but especially American culture is we have a   lot of chemicals and stuff that we eat that tend to and habits that we do that tend to increase   our levels of estrogen creating something called estrogen dominance but high levels of estrogen are   associated with anxiety so one thing clients may want to do especially female clients but   you know if you have a male who is feeling like estrogen may be increasing too much I have them   look at what they’re doing as far as lifestyle factors to see if there’s anything that might be   increasing their estrogen levels low levels of estrogen are associated with depression because   there’s not enough serotonin going around but also because estrogen is a neuro stimulant and if it’s   not there then there’s no stimulation so alright so now looking at first we started implicating   just neurotransmitters and going well if you don’t have enough of this or too much of this then you   might be depressed well now we’ve added to the mix and said well guess what these imbalances   over here in the neurotransmitters may be caused by something completely different such as sex   hormones progesterone is another sex hormone an imbalance in the ratio with estrogen is implicated   in mood disorders so progesterone kind of calms down estrogen they’re yin & yang if you will kind   of like GABA and glutamate it’s referred to as the relaxation hormone the interesting thing here is   synthetic progesterone which is present in a lot of birth control is associated with depression   whereas naturally occurring progesterone levels haven’t had that same associate association drawn   in the research literature so another thing to look at with our female clients is possibly to   ask them have they and if they’re presenting with depressive symptoms have they changed their birth   control regimen or have they recently gotten pregnant or had a baby or stopped nursing and   that was one I learned you know when I stopped nursing my first child was your body actually   maintains different levels of hormones and makes sense maintains different levels of hormones when   you’re nursing so you’re producing milk and stuff and then when you stop nursing there’s a whole   different hormonal cascade that happens so there are multiple different times that estrogen can   change and progesterone levels can change ganado trope ins hormones synthesized and released by   the anterior pituitary promote the production of sex hormones so remember earlier I said that when   we’re under stress our body releases cortisol and cortisol tells our body you know what we   don’t need to produce those sex hormones right now so let’s connect it all if you’re under a lot of   stress you may not be producing enough estrogen which is why a lot of women when they’re under a   lot of stress tend to have more erratic cycles but even in men when your sex hormones are not being   produced because your body’s focused on fight or flee it makes the availability of serotonin   and norepinephrine and dopamine less available so chronic stress can alter the availability   of sex hormones which alter the availability of neurotransmitters okay you wanted some good news   we got some good news oxytocin is our bonding hormone and they found that it can counteract   cortisol and vice-versa it’s not just getting a hug though so I mean hugs are great don’t get me   wrong but a lot of research has indicated that people who have companion animals and pet their   companion animal it can be a horse it can be a dog it can be a cat a bunny rabbit whatever it   is that does it for you where you feel that sensation of bonding 15 minutes of petting   that animal raises oxytocin levels and which counteracts cortisol sweet thyroid hormones   yet a whole nother category so we’re moving off of the sex hormones onto our thyroid you have   two types of thyroid hormones thyroxine and the other one that I can’t pronounce t4 and   t3 t4 is broken down to make t3 they are always in a balance they’re always in a ratio too much   thyroid hormone which typically is t3 speeds things up and too little slows things down so   think about somebody who’s hypothyroid they have symptoms of depression one of the things we want   to rule out early on with our patients who present with the pressive symptoms is thyroid problems   the patients with too much thyroid hormone may present with anxiety symptoms so again we want   to look and say is there a physiological cause to the neurotransmitter imbalance the pituitary gland   hypothermic hypothalamic-pituitary-adrenal axis so this is the middle of that stress axis here   the pituitary gland releases thyroid stimulating hormones to get the thyroid to release t4 and t3   majority of the thyroid hormones produced by the thyroid are t4 but t3 is the most usable form so   it sends out t4 which is kind of you know it’s just kind of there it’s not a real hard worker   at all but along the way it gets converted to 3 t3 which is a workhorse this conversion is the   critical element because a lot of times doctors will test thyroid secreting hormone and t4 alone   and they’ll say well you’re secreting enough and there’s plenty of t4 to be broken down to t3 so I   don’t know why you have hypothyroid symptoms but the piece that they’re missing is they may not be   we may not be adequately converting t4 to active t3 so it’s important if you think you have thyroid   issues going on to work with an endocrinologist who’s going to do more than just a superficial   test or if you go to a GP you have and they do just a TS h t4 test comes back normal but you’re   like no something’s not right there are more tests that can be done to be more specific about what’s   available because if we’ve got a client who goes to the doctor and says doc you know I feel awful I   can’t wake up I’ve got no energy they run these tests they say well there’s nothing wrong with   you that just disempowers the client the clients going well nothing’s wrong with me I don’t know   why I feel this way I have no hope for getting better because I don’t know what’s wrong so I   want to make sure that we educate them about all the possible things that they might be able to   look into I don’t dump all this on my clients at first you know when I go through the assessment I   start listening for things and then I encourage them to get a full blood panel done and then we   talk about all that when they come back and then narrow it down to other things that they   may want to look at further testing for if the general assessment didn’t come back with anything overactive thyroid produces anxiety feelings of nervousness butterflies heart racing trembling   irritability and sleep difficulties under activity depressive symptoms the other interesting thing   and I don’t know what other word to use is if it’s either overactive or underactive the   person can have mood swings and have sleeping difficulties so we don’t want to just say well   you’re having mood swings it must be hyper we don’t know so we want to look at maybe the   thyroid gland is sputtering and giving a little bit and then not enough and then a little bit   and then not enough it’s just important for them to understand what the thyroid hormone   does other cognitive issues difficulties with concentration short-term memory lapses and lack   of interest and mental alertness are also common in hypothyroid but they’re also common in a whole   bunch of other things I mean most of these sound like what the criteria for depression   so we’re trying to sort through and figure out what may be going on with that particular client hypothyroidism led to a significant decrease of responsiveness of the serotonin system so again   here’s something else if you don’t have enough estrogen or if you don’t have enough thyroid the   serotonin system may be implicated and we know that serotonin insufficiency is implicated in   generalized anxiety disorder so one of those little paths to kind of be aware of optimal   thyroid function may be necessary for optimal response to antidepressants antidepressants   mean the serotonin is still there but if estrogen and thyroid are responsible for transporting it   around and making sure it gets taken up in the right places then if those two systems   aren’t working no matter how much serotonin is in the system of it’s not getting to the   right places it’s not do the job hypothyroidism generally increases enzyme activities and GABA   levels now you may go well sweet we want more gaba but we don’t too much gaba has too much   of a depressive effect so the person may not be motivated may feel apathetic about things they   can’t get excited about anything so there is such a thing as being too chill thyroid hormone plays   a role in the output of dopamine the precursor to norepinephrine our motivation chemical not enough   thyroid hormone not enough excretion of dopamine not enough get up and go and norepinephrine has   also insufficient norepinephrine has also been implicated in depression so you know   serotonin is not even in there we’re talking about thyroid dopamine and norepinephrine stress hormones so we’ve moved on cortisol it’s released from that HPA axis cortisol   triggers a decrease in leptin and an increase in gralen which increases appetite and food intake   cortisol is telling you there is a threat we need energy we need to mobilize the sugars   because it’s a glucocorticoid but we also need to get more sugars in here so we have energy for the   fight-or-flight as long as it goes on which is why a lot of people who are chronically stressed also   feel like they’re chronically hungry they’re just like I’m famished all the time and it may not be   that their body needs all that energy all those calories right now their body may be hoarding it   because they think they’re going to have to it’s gonna have to fight or flight flee for a long   time cortisol also affects the endocrine system including thyroids insulin regulating blood sugar   and your sex hormones all right well that’s not good so when people are stressed they maintain   higher levels of cortisol when they maintain higher levels of cortisol basically every bodily   system and all the neurotransmitters are impacted adrenaline is another stress hormone you know we   think about it when somebody gets really upset or excited or whatever they have a rush of adrenaline   alright sigh Roxon is also released from the kidneys and are from the thyroid and helps you   get fatty acids which are long term long term energy fat has nine calories per gram sugar has   four calories per gram so fat is a much denser source of energy effective chronically elevated   cortisol includes impaired cognitive performance you’re not thinking as well dampen thyroid   function yep eventually the body goes there’s no point the stress is not going to go away there’s   no point in continuing to fight so I’m going to turn down the sensitivity of the symptom blood   sugar imbalances sleep disruption elevated blood pressure lowered immune function and increased   abdominal fat so if a client starts talking about how they’re stressed they’re hungry all the time   and they keep suddenly gaining all this weight in their belly we might start looking at chronic   stress and interventions that we might use for chronic stress including mindfulness meditation   exercise you know anything that we can throw their way in addition to having them get a full   physical to make sure there’s nothing else going on like you know actual hyper hypothyroid caused   by a physiological problem low levels of cortisol brain fog cloudy headedness mild depression low   thyroid function again blood sugar imbalances such as hypoglycemia and remember when you’ve   got blood sugar imbalances and not enough sugar then your body cannot produce enough gaba which   means you’re not going to have enough naturally relaxing chemicals fatigue especially morning and   mid-afternoon sleep disruption low blood pressure lowered immune function and inflammation so these   are all things that we can produce to work our clients to say cortisol it’s not public   enemy number one but it’s pretty close to it so let’s look at how your cortisol levels how you’re   sustained chronic stress might be impacting your mood your health and your sleep and think   about different ways we can reduce that because that’s more tangible and cortisol is measurable   obviously the doctor has to do that but it is measurable in general when we feel emotions a   stimulus is received by our peripheral peripheral nervous system the brain responds by triggering   the amygdala which is our emotion center and the hypothalamus assesses if you will the need   for fight or flee it goes there’s a threat or there’s no emotional memory that helps the brain   determine the types of neurochemicals to secrete and in what amounts if the hypothalamus goes   yeah no big deal then you’re going to have more inhibitory neurotransmitters then if you have your   hypothalamus going that’s a problem what we need to look at and this adds another layer is when   there is too much of a chemical or hypersensitive receptors so hypersensitive receptors are like the   person that you know that jumps when you tap them on the shoulder somebody who’s hyper vigilant when   they are activated they go from 0 to 100 and it’s just like in sensitive receptors on the   other hand when they’re activated they may not do anything at all so you may have enough chemical in   the system but if the receptors are not receptive then the chemical can’t do its job so if serotonin   is sitting outside the receptors door just kind of knocking on it going let me in and that door   never gets opened then it doesn’t matter how much serotonin is sitting in the synapse it’s not going   to do any good so as I said before all every time I talk about too much and too little it’s   always relative to the proportions of the other hormones and neurotransmitters for that person anxiety irritability and anger our fight-or-flight response can be caused by dot dot dot too little   serotonin where you have anxiety coming on because serotonin is not there to help   the person calm too little GABA again not enough calming too much norepinephrine too much estrogen   too much testosterone or too much thyroid so any of these too much is going to cause one   symptom either anxiety or irritability or anger and too little will probably produce something   more on the depressive continuum now happiness and excitements an interesting one because happiness   and excitement are excitatory neurotransmitters they’re going to get your heart rate going they’re   gonna get your blood blood flowing they’re gonna get your breathing a little bit faster think about   Christmas Christmas morning when you run down the stairs in order to see what’s under the Christmas   tree or something else that is really exciting your body is secreting dopamine norepinephrine   glutamate and maybe a little bit of serotonin in there but these are the same chemicals that   are going out during a stress response it’s how the amygdala processes everything so we still   need these excitatory neurotransmitters we can’t just shut them down and go well that’s causing too   much problem let’s turn it down well if we turn it down we’re also turning down the body’s ability to   Spahn to happy stimuli and like I said depression can be caused by serotonin insufficiency or excess   and why is it excess when you have too much serotonin or too little serotonin you can   have high levels of anxiety they found and high levels and anxiety trigger the stress response   system after a certain period of time the stress response system goes you know what I can’t stay   this hyped up for this long I’ve got to turn down my sensitivity I’ve just got a you know let it all   go which starts leading to feelings of apathy and depression it can be caused by nor norepinephrine   insufficiency dopamine insufficiency thyroid insufficiency or gain too much or too little   estrogen the good thing is I Roy dand sex hormones can be measured so we can easily   or somewhat easily help the person rule those in and/or rule those out as can cortisol so if they   have chronically elevated or chronically low levels of cortisol they’re going to have some   mood symptoms but we can figure out that that’s going on and we can help educate the patient to   why they’re having the symptoms they are it’s not all in their head the New England Journal   of Medicine on major depression said numerous studies of norepinephrine and serotonin in   plasma urine and cerebrospinal fluid as well as post mortem Studies on the brains of patients   with depression so we’re talking about humans not just rats studies have yet to identify the   purported deficiency reliably so while we’re talking about depression being caused by if   you will norepinephrine or serotonin deficiency there’s no real research that can reliably say   yes this is it 100% of the time or even 95% of the time it’s more like yeah 15 percent of the time   so yes deficiencies in norepinephrine and and or serotonin does cause depression in some people but   that is a small subset and they found that there are 20 or 30 small subsets of different causative   factors estrogen and progesterone modulates sleep and too much estrogen can cause insomnia so again   if you have too much estrogen well you may have plenty of serotonin going on you also may not be   able to sleep sleep deficiency promotes elevated cortisol and further disrupts our feeding hormones   now for cortisol is elevated we’re not going to get good restful sleep sleep deficiency is   related to a 30% reduction in thyroid hormone levels so again remember that the body finally   after chronic stress will start turning down the thyroid it’s just like there’s no need to   exert any more effort because this is a losing proposition with sleep deficiency the thyroid   hormone levels go down cortisol levels go up which is your stress chemical so everything’s   starting to get out of whack when people eat serotonin suppresses appetite and increases   with feeding so as we eat our serotonin levels go up especially for eating carbohydrate-rich foods   but anytime we’re eating so if there’s not enough serotonin people’s appetite suppression may be off   but that’s also one of the reasons that people eat for comfort is because serotonin helps them feel a   little bit better so when they’re eating serotonin goes up dopamine is associated with safety ATP   handy which is great but if you don’t have enough dopamine then you may never feel satisfied as we   talked about before cortisol increases appetite and neurons involved in the regulation of feeding   are located in the hypothalamus so when you’ve got that hypothalamus pituitary adrenal axis all   activated all the time the HPA axis you’re feeding is going to be probably way up here   because the hypothalamus is going there’s a threat we need food we need we need energy and all of   these chemicals are involved in stress response stimulants stimulants set off the stress response   system by causing the body to kind of dump if you will sigh roid hormones stress hormones and   suppress sex hormones you know that HPA axis it’s activated excitatory neurotransmitters dopamine   and norepinephrine gets secreted so if you’ve got a lot of pleasure reward focus and concentration   going on and you’re just like woohoo yeah you’re probably gonna want to do that again but when   that wears off when stimulants wear off they wear off a whole lot faster than what our normal neuro   chemicals would normally do so when they wear off there’s a sudden lack of stimulation pleasure and   reward and there’s an excess of gaba and other other neurochemicals when people drink alcohol   initially gaba goes way up when they drink the alcohol and they feel relaxed and disinhibited and   all that kind of stuff the alcohol wears off and all of a sudden in proportion to everything else   there’s way not enough gaba so anxiety goes way up so what we want to remember is when we’re taking   substances or engaging it well taking substances specifically they are going to impact and wear off   in a much different rate than what would happen from our body normally excreting or causing   those neurochemicals to be excreted depressant increase gaba and may increase serotonin so they   found that alcohol may increase serotonin it also increases gaba but again when it wears off you got   a problem what there are other depressants out there besides alcohol though so it’s important   to know what are your clients taking what are they using recreationally not to be judgmental you know   if you have a couple drinks in the evening it is what it is what other things are you taking are   you using including looking herbs like valerian Valerians are pretty powerful depressant so it’s   important to know what what they’re taking so they know what impact is having on their body   there are a variety of neurotransmitters that are implicated in moods sex stress and thyroid   hormones among others modulate the secretion and absorption that is modulate the availability of   these neurotransmitters so if there’s a lack or an insufficiency proportionally speaking of   norepinephrine what we want to ask is not how do we increase it but what’s causing it why is there   an imbalance in norepinephrine in this particular patient dysphoria is about having an imbalance not   necessarily too much or too little you may have too much X in relation to Y too much glutamate   in relation to GABA so talking with your clients if they start taking medications talk with them   about how they feel and whether it’s getting worse you’re getting better to help understand you know   are we targeting the right things here sleep deprivation directly contributes alterations   in hormone and neurotransmitter levels and excessive eating may be caused by high cortisol   levels because the brain thinks it needs to store energy for the long fight sex hormones impact the   availability of serotonin but oxytocin has been shown to inhibit cortisol so pet a dog get a hug   do something to promote bonding it will help with stress levels dysphoric moods are caused   by a neurotransmitter imbalance but what causes that imbalance in each person berries greatly   and they found it even berries greatly among people with PTSD so just like depression PTSD   does not have one simple cause a cascade effect can happen when any one of these systems goes   offline so if the thyroid system goes offline has a dysfunction for some reason it may negatively   impact all the other symptoms because it’s going to change the balance and the ratios   of all the other hormones and chemicals involved in those feedback loops so final thoughts chronic   stress impairs sleep which causes imbalances and hormones and neurotransmitters involved   in eating sleeping mood attention motivation and sex disruptions in nutrition can fail to   provide the building blocks for the hormones and neurotransmitters so it could be something as   simple as you know eating junk food every day sleep impairment is associated with decreases   in thyroid hormones and increases in cortisol and dysregulation of eating so if somebody’s hungry   all the time but they’ve got a low mood and you know they present with depressive symptoms we   may want to look at what’s going on and could it is a factor contributing to this is sleep   um but any of these things could also contribute to problems with sleep estrogen and testosterone, imbalances can cause depression or anxiety like symptoms and thyroid hormone imbalances can also   cause depression and anxiety-like symptoms so the the take-home message is this stuff is stinkin   complicated but what we know is everything is intimately interconnected so we don’t   want to just start by saying well it sounds like you’ve got this and try to pigeonhole everybody   into one particular causation we need to understand what’s going on with them and since   we can’t measure brain neurochemicals to figure out exactly which one’s out of whack that’s where   the part art comes into psychology as part art and part science okay so are there any questions you I think you’re all probably feeling like me when after I wrote this I worked on research for about   20 hours and I was all but drooling at myself by the end I was like really I tackled a pretty   deep subject for an hour and you may need to go back and look at the presentation to kind   of make all the connections and connect the dots as it applies to your clients but let’s   see thinking about autism symptoms and these issues and body functions and hormones yeah   I mean certainly autism is correlated and I’m pretty ignorant as to the neurophysiology of   autism but I would think that there’s a strong correlation with the neurotransmitters so I   would look at other systems to see if there are something that’s going offline that may be   contributing to the neuro neurotransmitter imbalance when symptoms are exacerbated which makes me think you know again I don’t know as much I don’t know   much about autism but when a client begins stemming I’m wondering if those impulsive   behaviors mean there’s high levels of anxiety at that point so I’m   wondering what’s happening with the stress response system in the GABA feedback loop I would love after you guys kind of digest this and stuff if you have any   thoughts reactions connections I would love to hear back from you I’ll put   my email and other than that have a wonderful amazing weekend and I will see you on Tuesday if you enjoy this podcast please like and subscribe either in your podcast player or   on YouTube you can attend and participate in our live webinars with doctor Snipes by   subscribing at all CEUs comm slash counselor toolbox this episode has   been brought to you in part by all CEUs com providing 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 used coupon code consular toolbox to get a 20% discount on your order this month As found on YouTube Human Synthesys Studio It’s Never Been Easier To Create Human Spokesperson Videos. 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