The “Chemical Imbalance” in Mental Health Problems

Neurotransmitter Levels

Your Neurotransmitter Levels and Emotional Health

Your emotional health is a combination of attitudes, personality, support systems, and your brain’s neurotransmitter levels. Positive attitudes and a healthy personality help us through life’s difficulties and a good support system of family and friends is also valuable during times of trouble. Despite having these resources, there are times when coping with our experiences and life events changes our neurotransmitter status. Like an overheated automobile, we begin to have difficulty operating properly.

We are all at-risk for changes in our brain’s chemistry. Mostly commonly, we will experience depression, anxiety, or stress reactions. As our neurotransmitters change, they bring with them additional symptoms, behaviors, and sensations that add to our on-going difficulties. Recognizing these changes is an important part of treatment and returning your life to normal and reducing our stress.

This discussion is offered to explain how the neurotransmitter system in the brain can create psychiatric conditions and mental health problems. It is hoped the discussion will provide information that will be of value to those who suspect their neurotransmitter system is creating problems.

The following is a discussion of neurotransmitters and current thoughts about how these neurochemicals are involved in psychiatric illness. Four neurotransmitters, out of over fifty, are well researched and known to be related to psychiatric conditions.

Dopamine: Parkinson’s Disease and ADHD to Smoking and Paranoia

Dopamine is a neurotransmitter linked to motor/movement disorders, ADHD, addictions, paranoia, and schizophrenia. Dopamine strongly influences both motor and thinking areas of the brain.

One type of Dopamine works in the brain movement and motor system. As this level of dopamine decreases below the “normal range” we begin to experience more motor and gross-movement problems. Very low levels of Dopamine in the motor areas of the brain are known to produce Parkinson’s Disease with symptoms such as:

Dopamine in the thinking areas of the brain might be considered the neurotransmitter of focus and attending. Low levels impair our ability to focus on our environment or to “lock on” to tasks, activities, or conversations. Low levels of Dopamine make concentration and focus very difficult with low levels also associated with Attention-Deficit Hyperactivity Disorder (ADHD). On the other end of the Dopamine dipstick, as Dopamine levels in the brain begin to raise, we become excited/energized, then suspicious and paranoid, then finally hyperstimulated by our environment. With low levels of Dopamine, we can’t focus while with high levels of Dopamine our focus becomes narrowed and intense to the point of focusing on everything in our environment as though it were directly related to our situation.

Mild elevations in Dopamine are associated with addictions. Nicotine, cocaine, and other substances produce a feeling of excited euphoria by increasing Dopamine levels in the brain. Too much of these chemicals/substances and we feel “wired” as moderate levels of Dopamine make us hyperstimulated – paying too much attention to our environment due to being overstimulated and unable to separate what’s important and what is not.

In an ADHD child, low levels of Dopamine don’t allow the child to focus or attend to anything in the environment, looking very physically hyperactive when running about the room or switching from activity-to-activity due to their lack of focus. As Dopamine levels increase above the normal range, our ability to focus increases to the point of being paranoid. Mild elevations make the environment overly stimulating and excited.

Moderately high Dopamine levels make us on-guard, suspicious, and prone to misinterpret experiences in the environment. Known as an “idea of reference” in psychiatry, we begin thinking unrelated experiences are suddenly directly related to us. People observed talking across the street are now talking about us. As Dopamine increases, it can become so intense that we feel the radio, television, and newspaper contain secret messages directed at us from Hollywood or elsewhere. It’s as though we are attempting to incorporate/add everything we witness into our life. Planes flying overhead are snapping pictures of us and motorists talking on cellular phones are calling in a report on us. Our mind speed increases and races in an attempt to add all we see into our life. In an attempt to make sense, we may become extremely religious, paranoid, or feel we are a very important person. Increased Dopamine also increases the perception of our senses, as though turning up the volume in all our senses – hearing, vision, taste, smell, and touch.

As Dopamine levels increase, the noises we heard loudly suddenly become auditory hallucinations. Our inner thoughts are now being heard outside our body. These “voices” begin talking to us, known to take different forms such as derogatory (putting you down), religious topics, command (telling you to do something), or sexual content. Hallucinations (experiencing something that is not truly there in reality) will soon develop in all our senses. We may begin seeing faces in clouds, carpets, or patterns. We may sense the touch of spirits or movements inside our body. We may experience unusual smells or tastes.

High levels of Dopamine in the brain often cause us to lose our contact with reality. As though living in a science-fiction movie, we begin to develop unusual if not bizarre ideas about what is happening to us. With our paranoia, we may experience delusions (false beliefs) of persecution or may think we have super powers (delusions of grandiosity) and can predict the future or read minds. High levels of Dopamine are found in Schizophrenia, drug intoxication, and other psychotic conditions where the ability to distinguish the inner world from the real world is impaired.

Treatment for psychiatric/medical conditions associated with Dopamine imbalance, as you might expect, involves increasing or decreasing Dopamine levels in the brain. Low-Dopamine disorders are treated with medications that increase Dopamine in the brain. For Parkinson’s Disease – L Dopa is prescribed and for ADHD, medications that are psychostimulants. Amphetamines and medications with similar action actually slow down the hyperactive (ADHD) children by increasing Dopamine – boasting their level into the normal range, allowing them to now focus and attend.

Mildly elevations in Dopamine are associated with addictions such as narcotics, speed, and nicotine/smoking.Thus, medications used in the treatment of addictions actually block or lower Dopamine production. If a medication blocks dopamine, it also blocks the effects of the addicted substance as well as blocking the craving sensation. The medication to help smokers, Zyban, is actually the antidepressant Wellbutrin that is known to block Dopamine.

Moderate to high levels of Dopamine, associated with severe psychiatric conditions such as Paranoia and Schizophrenia, are treated with medications that block or lower Dopamine in the brain. These medications, called antipsychotics, have been available for many years. Early antipsychotic medications however, lowered Dopamine throughout the brain, including the Dopamine located in the motor/movement areas. For that reason, older antipsychotic medications produced motor/movement problems that looked like Parkinson’s Disease – short-step gait, fixed facial expression, tremors, poor balance, etc. Newer medications have fewer side effects in motor areas, as they are able to specifically target one type of Dopamine.

Dopamine levels typically change very slowly. Patients who develop Paranoia and/or Schizophrenia often experience a gradual increase in Dopamine levels over several years – also experiencing an increase in the severity of symptoms over those years. A typical high school or college student may develop a sense of being on-edge or unusual feelings, gradually becoming suspicious and feeling alienated, moving into auditory hallucinations, and finally developing bizarre false beliefs (delusions) of persecution or exaggerated self-importance over the next several years. Stress can often rapidly increase Dopamine, but it still rarely happens overnight.

When an individual becomes psychotic, paranoid, and hallucinates in only a few days, we must strongly suspect medication/drug intoxication or neurological events – something that could increase Dopamine levels dramatically and almost instantly. The prolonged use of amphetamines (speed) or steroids can produce a loss of reality and sudden paranoia. As it might happen, a construction worker taking “street” speed to increase his work productivity finds his hand or foot talking to him (auditory hallucinations) and decides to cut it off. The sudden presence of psychosis (hallucinations, delusions, paranoia, etc.) in an individual with a history of prior normal adjustment would suggest the need for intensive medical and neurological workup.

Serotonin: From Bliss to Despair

Serotonin, first isolated in 1933, is the neurotransmitter that has been identified in multiple psychiatric disorders including depression, obsessive-compulsive disorder, anorexia, bulimia, body dysmorphic disorder (nose doesn’t look perfect after ten surgeries), social anxiety, phobias, etc. Serotonin is a major regulator and is involved in bodily processes such as sleep, libido (sexual interest), body temperature, and other areas.

Perhaps the best way to think of Serotonin is again with an automobile example. Most automobiles in the United States are made to cruise at 70 miles per hour, perfect for interstate highways and that summer vacation. If we place that same automobile on a racetrack and drive day-after-day at 130 mph, two things would happen. Parts would fail and we would run the engine so hot as to evaporate or burnout the oil. Serotonin is the brain’s “oil”.

Like a normal automobile on a race track, when we find ourselves living in a high stress situation for a prolonged period of time, we use more Serotonin than is normally replaced. Imagine a list of your pressures, responsibilities, difficulties and environmental issues (difficult job, bad marriage, poor housing, rough neighborhood, etc.). Prolonged exposure to such a high level of stress gradually lowers our Serotonin level. As we continue to “hang on” we develop symptoms of a severe stress-produced depression.

An automobile can be one, two or three quarts low in oil. Using the automobile as an example, imagine that brain Serotonin can have similar stages, being low (one quart low), moderately low (two quarts low), and severely low (three quarts low). The less Serotonin available in the brain, the more severe our depression and related symptoms.

When Serotonin is low, we experience problems with concentration and attention. We become scatterbrained and poorly organized. Routine responsibilities now seem overwhelming.It takes longer to do things because of poor planning. We lose our car keys and put odd things in the refrigerator. We call people and forget why we called or go to the grocery and forget what we needed. We tell people the same thing two or three times.

As stress continues and our Serotonin level continues to drop, we become more depressed. At this point, moderately low or “two quarts” low, major changes occur in those bodily functions regulated by Serotonin. When Serotonin is moderately low, we have the following symptoms and behaviors:

Individuals can live many years moderately depressed. They develop compensations for the sleep and other symptoms, using sleeping medication or alcohol to get some sleep. While chronically unhappy and pessimistic, they explain their situation with “It’s just my life!” They may not fully recognize the depressive component.

Very low levels of Serotonin typically bring people to the attention of their family physician, their employer, or other sources of help. Severe Serotonin loss produces symptoms that are difficult to ignore. Not only are severe symptoms present, but also the brain’s ideation/thinking becomes very uncomfortable and even torturing. When Serotonin is severely low, you will experience some if not all of the following:

Clinical Depression is perhaps the most common mental health problem encountered in practice. One in four adults will experience clinical depression within their lifetime. Depression is the “common cold” of mental health practice – very common and much easier to treat today than in the past.

Treatment for depression, as might be expected, involves increasing levels of Serotonin in the brain. Since the mid-eighties, medications have been available that attempt to specifically target and increase Serotonin. Known as Selective Serotonin Reuptake Inhibitors (SSRI’s), these medications such as Prozac, Zoloft, and Paxil are felt to work by making more Serotonin available in the brain.

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

Likely to occur by accident by combining two Serotonin-increasing medications or substances, Serotonin Syndrome (SS) produces violent trembling, profuse sweating, insomnia, nausea, teeth chattering, chilling, shivering, aggressiveness, over-confidence, agitation, and malignant hyperthermia. Emergency medical treatment is required, utilizing medications that neutralize or block the action of Serotonin as the treatment for Serotonin Syndrome (SS).

Like Dopamine, Serotonin can be accidentally increased or decreased by substances. One method of birth control is known to produce severe depression as it lowers Serotonin levels. A specific medication for acne has also been linked with depression and suicidal ideation. For this reason, always inform your physicians if you are taking any medication for depression. Also avoid combining antidepressants with any herbal substances reported to be of help in Depression such as St. John’s Wort.

[ Introduction ] [ Neurotransmitter Levels ]
[ Norepinephrine: Arousal to Panic ] [ Medication ]

Written by Joseph M. Carver, Ph.D.,Clinical Psychologist Please visit Dr. Carver's website for more articles.