The Chemical Imbalance in Mental Health Problems by Joseph M. Carver, Ph.D.

, Clinical Psychologist

This article has been developed and ritten !or "se as a patient hando"t. It may be reprod"ced#copied to provide patient in!ormation. Introd"ction $ver the years, advances in ne"rology and research have simpli!ied the ay psychologists, psychiatrists, and others diagnosis and treat mental health problems. In over one h"ndred years o! mental health treatment, the symptoms and behaviors associated ith certain mental health conditions have remained the same. Psychotic disorders, here the individ"al o!ten can%t disting"ish bet een reality and their !antasies, still have a"ditory hall"cinations. Depressed individ"als still can%t sleep and remain preocc"pied ith the past. Hyperactive children &'ttention(De!icit Hyperactivity Disorder or 'DHD) still e*hibit "ncontrollable restlessness. +hen patients !irst began reclining on the co"ches o! psychoanalytic psychiatrists, the depressed !ol,s tal,ed abo"t their past. This led the !o"nders o! psychology and psychiatry to believe that iss"es that began in childhood ca"sed many mental health problems. -"t ."estions ere still not ans ered. +hy o"ld a bad relationship ith yo"r mother create the appetite loss !o"nd in depression, especially hen eating problems only started several months prior to the session/ -y hat strange mechanism o"ld a childhood iss"e create an a"ditory hall"cination, o!ten years a!ter the reported tra"matic event/ Many people had di!!ic"lt childhoods, b"t they didn%t hall"cinate and have a great appetite. It became clear that many mental health problems also had a physical component that involved changes in concentration, sleep, appetite, speech pattern, energy level, perceptions &hall"cinations), and motivation. 0t"dies began to determine the connection, i! indeed one as present, bet een the condition o! the patient and the physical signs#symptoms that ere also present. The pict"re became easier to "nderstand hen chemicals in the brain called ne"rotransmitters ere discovered. The brain consists o! billions o! ne"rons or cells that m"st comm"nicate ith each other. The comm"nication bet een ne"rons maintains all body !"nctions, in!orms "s hen a !ly lands on o"r hand, or hen e have pain. The comm"nication bet een ne"rons is controlled by the brain%s type and level o! ne"rotransmitters. 1e"rotransmitters are chemical s"bstances that control and create signals in the brain both bet een and ithin ne"rons. +itho"t ne"rotransmitters, there o"ld be no comm"nication bet een ne"rons. The heart o"ldn%t get a signal to beat, arms and legs o"ldn%t ,no to move, etc.

's e discovered more abo"t ne"rotransmitters, e began to identi!y hich ne"rotransmitters controlled certain bodily !"nctions or hich ere related to certain emotional#psychiatric di!!ic"lties. 0erotonin, a ne"rotransmitter, as !o"nd to be related to body temperat"re and the onset o! sleep. 2esearch also identi!ied 0erotonin as related to depression and later to a variety o! mental health conditions s"ch as anore*ia and obsessive(comp"lsive disorder. 's research in ne"rotransmitters contin"ed, st"dies bet een ne"rotransmitters and mental conditions revealed a strong connection bet een amo"nts o! certain ne"rotransmitters in the brain and the presence o! speci!ic psychiatric conditions. 3sing an everyday e*ample, o"r a"tomobile operates by "sing a variety o! !l"ids s"ch as engine oil, transmission !l"id, bra,e !l"id, and coolant &anti(!ree4e). 5very a"tomobile has a ay to meas"re the levels or amo"nts o! each o! these needed li."ids s"ch as the dipstic, !or oil and transmission !l"id and mar,ed indicators !or anti(!ree4e and bra,e(!l"id levels. 3sing o"r dipstic, to meas"re engine oil, !or an e*ample, e can !ind o"r engine to be !o"nd one, t o, or even three ."arts lo . '!ter a recent oil change, the dipstic, may also tell "s that e have e*cessive oil in the engine. To or, properly, all !l"id levels m"st be in the normal range as indicated by the dipstic,. +hen e receive a blood test, val"es o! certain blood components are given ith the normal range also provided, indicating i! a blood chemical is belo or above the average range. 1e"rological research has identi!ied over !i!ty &67) ne"rotransmitters in the brain. 2esearch also tells "s that several ne"rotransmitters are related to mental health problems 8 Dopamine, 0erotonin, 1orepinephrine, and 9'-' &9amma 'minob"tyric 'cid). Too m"ch or too little o! these ne"rotransmitters are no !elt to prod"ce psychiatric conditions s"ch as schi4ophrenia, depression, bi(polar disorder, obsessive(comp"lsive disorder, and 'DHD. 3n!ort"nately, the body doesn%t have a b"ilt(in dipstic, !or ne"rotransmitters, at least one that%s ine*pensive eno"gh !or comm"nity mental health practice. There are advanced imaging techni."es s"ch as Positron 5mission Tomography &P5T 0cans) that are being "tili4ed in research and in the development o! medications that directly in!l"ence changes in speci!ic ne"rotransmitters. :ac,ing a P5T 0canner, most pro!essionals eval"ate ne"rotransmitter levels by loo,ing !or indicators in tho"ght, behavior, mood, perception, and#or speech that are considered related to levels o! certain ne"rotransmitters. This is perhaps best ill"strated in individ"als ith depressed mood. The mental health pro!essional is o!ten re."ired to separate those ho o"ld bene!it !rom co"nseling and those ho may re."ire co"nseling and an antidepressant medication. The ,ey is loo,ing !or those symptoms that are ,no n to be related to chemical changes in the brain. ;or e*ample, sit"ational depression o!ten prod"ces sad e*pressions, orry, pessimistic attit"de and other !eat"res b"t does not create prolonged changes in the physical symptoms s"ch as changes in

se*"al interest, appetite, or sleep. The contin"ed presence o! physical symptoms tells "s that the brain%s ne"rotransmitter levels have changed. The technical aspects o! ne"rotransmitter levels, the psychiatric symptoms they prod"ce, and ho medications have been developed to raise or lo er the brain levels o! these ne"rotransmitters can be very complicated. ;or this reason, the same proced"re o! e*plaining other medical conditions here medication brings symptoms bac, to the normal range is o!ten "sed. Medical patients ith high blood press"re, high blood s"gar, or high cholesterol are in!ormed that their body chemistry is too high, or in some cases, too lo and m"st be corrected ith medication. ;or many years, mental health pro!essionals have "sed the term chemical imbalance to e*plain the need !or medications that are "sed to treat mental health conditions. This simple and commonly "sed e*planation recogni4es that the condition is a medical problem and that it can be treated ith medication. The chemical imbalance e*planation also re!lects the overall theme o! treatment 8 identi!ying hat ne"rotransmitters are involved in the clinical symptom pict"re and ith medication, attempting to ret"rn that ne"rotransmitter level bac, to the normal range. <o"r 1e"rotransmitter :evels and 5motional Health <o"r emotional health is a combination o! attit"des, personality, s"pport systems, and yo"r brain%s ne"rotransmitter levels. Positive attit"des and a healthy personality help "s thro"gh li!e%s di!!ic"lties and a good s"pport system o! !amily and !riends is also val"able d"ring times o! tro"ble. Despite having these reso"rces, there are times hen coping ith o"r e*periences and li!e events changes o"r ne"rotransmitter stat"s. :i,e an overheated a"tomobile, e begin to have di!!ic"lty operating properly. +e are all at(ris, !or changes in o"r brain%s chemistry. Mostly commonly, e ill e*perience depression, an*iety, or stress reactions. 's o"r ne"rotransmitters change, they bring ith them additional symptoms, behaviors, and sensations that add to o"r on(going di!!ic"lties. 2ecogni4ing these changes is an important part o! treatment and ret"rning yo"r li!e to normal and red"cing o"r stress. This disc"ssion is o!!ered to e*plain ho the ne"rotransmitter system in the brain can create psychiatric conditions and mental health problems. It is hoped the disc"ssion ill provide in!ormation that ill be o! val"e to those ho s"spect their ne"rotransmitter system is creating problems. Components of the Chemical Imbalance Approach

'll bodily and brain processes have a normal and healthy range o! !"nctioning. There is a standard range !or normal blood press"re, normal ins"lin levels, normal body temperat"re, etc. -ody and brain processes operating in the normal range prod"ce no signi!icant symptoms. 1ormal body temperat"re has no symptoms !or e*ample. +hen the normal range o! !"nctioning becomes ="st reg"lated, signi!icant symptoms can develop that ill re."ire treatment. The ma=ority o! psychiatric symptoms are associated ith a dysreg"lation in the brain>s ne"rotransmitters. In treatment, i! psychiatric symptoms are created by lo levels o! the ne"rotransmitter, treatment involves increasing these levels. I! psychiatric symptoms are created by high levels o! a ne"rotransmitter, treatment involves decreasing the availability o! this ne"rotransmitter. ' ret"rn to the ?normal range? decreases and#or eliminate psychiatric symptoms.

What is the Evidence for This Model? Psychiatric disorders are displayed consistently. +hen several symptoms o! a disorder are present, e can e*pect to !ind additional symptoms o! that disorder "pon e*amination. Psychiatric disorders have the same symptoms across all c"lt"res, races, ethnic gro"ps, and gender. Individ"als ith paranoia are s"spicio"s o! their co"ntry>s ?secret police?. +hile hall"cinations and del"sions may di!!er in content, they do not di!!er in the ay the hall"cinations#del"sions are e*hibited or treated. Despite the bac,gro"nd o! an individ"al ith Post(Tra"matic 0tress Disorder, !or e*ample, the symptoms and behaviors are identical. The symptoms o! diabetes or high blood press"re are consistent across all c"lt"res !or e*ample. Psychiatric diagnosis is based on the mechanism and symptoms, not the content o! the depressive tho"ghts, hall"cinations, !ears, or del"sions. 'll individ"als ith schi4ophrenia, !or e*ample, e*hibit !lat a!!ect. The ma=ority o! psychiatric conditions can be e*actly d"plicated by the ingestion o! certain chemical s"bstances. 0peci!ic symptoms o! paranoia, psychosis, an*iety, depression, etc. can be created in a healthy individ"al "sing certain dr"gs and s"bstances. 3nintentional psychiatric symptoms can be prod"ced by non(psychiatric medications d"e to their in!l"ence on ne"rotransmitters associated ith psychiatric disorders. Psychiatric symptoms decrease ith correct medications and increase ith the rong medications. 0topping psychiatric medications ill prod"ce a ret"rn o! symptoms.

The !ollo ing is a disc"ssion o! ne"rotransmitters and c"rrent tho"ghts abo"t ho these ne"rochemicals are involved in psychiatric illness. ;o"r ne"rotransmitters, o"t o! over !i!ty, are ell researched and ,no n to be related to psychiatric conditions. Dopamine@ Par,inson%s Disease and 'DHD to 0mo,ing and Paranoia Dopamine is a ne"rotransmitter lin,ed to motor#movement disorders, 'DHD, addictions, paranoia, and schi4ophrenia. Dopamine strongly in!l"ences both motor and thin,ing areas o! the brain. $ne type o! Dopamine or,s in the brain movement and motor system. 's this level o! dopamine decreases belo the normal range e begin to e*perience more motor and gross(movement problems. Aery lo levels o! Dopamine in the motor areas o! the brain are ,no n to prod"ce Par,inson%s Disease ith symptoms s"ch as@ M"scle rigidity and sti!!ness 0tooped#"nstable post"re :oss o! balance and coordination 9ait & al,ing pattern) dist"rbance 0lo movements and di!!ic"lty ith vol"ntary movements 0mall(step gait# al,ing 'ches in m"scles Tremors and sha,ing ;i*ed, mas,(li,e !acial e*pression 0lo , monotone speech Impairment o! !ine(motor s,ills ;alling hen al,ing Impairment in cognitive#intellect"al ability Dopamine in the thin,ing areas o! the brain might be considered the ne"rotransmitter o! !oc"s and attending. :o levels impair o"r ability to !oc"s on o"r environment or to loc, on to tas,s, activities, or conversations. :o levels o! Dopamine ma,e concentration and !oc"s very di!!ic"lt ith lo levels also associated ith 'ttention(De!icit Hyperactivity Disorder &'DHD). $n the other end o! the Dopamine dipstic,, as Dopamine levels in the brain begin to raise, e become e*cited#energi4ed, then s"spicio"s and paranoid, then !inally hyperstim"lated by o"r environment. +ith lo levels o! Dopamine, e can%t !oc"s hile ith high levels o! Dopamine o"r !oc"s becomes narro ed and intense to the point o! !oc"sing on everything in o"r environment as tho"gh it ere directly related to o"r sit"ation. Mild elevations in Dopamine are associated ith addictions. 1icotine, cocaine, and other s"bstances prod"ce a !eeling o! e*cited e"phoria by increasing Dopamine levels in the brain. Too m"ch o! these chemicals#s"bstances and e

!eel ired as moderate levels o! Dopamine ma,e "s hyperstim"lated 8 paying too m"ch attention to o"r environment d"e to being overstim"lated and "nable to separate hat%s important and hat is not. In an 'DHD child, lo levels o! Dopamine don%t allo the child to !oc"s or attend to anything in the environment, loo,ing very physically hyperactive hen r"nning abo"t the room or s itching !rom activity(to(activity d"e to their lac, o! !oc"s. 's Dopamine levels increase above the normal range, o"r ability to !oc"s increases to the point o! being paranoid. Mild elevations ma,e the environment overly stim"lating and e*cited. Moderately high Dopamine levels ma,e "s on(g"ard, s"spicio"s, and prone to misinterpret e*periences in the environment. Bno n as an idea o! re!erence in psychiatry, e begin thin,ing "nrelated e*periences are s"ddenly directly related to "s. People observed tal,ing across the street are no tal,ing abo"t "s. 's Dopamine increases, it can become so intense that e !eel the radio, television, and ne spaper contain secret messages directed at "s !rom Holly ood or else here. It%s as tho"gh e are attempting to incorporate#add everything e itness into o"r li!e. Planes !lying overhead are snapping pict"res o! "s and motorists tal,ing on cell"lar phones are calling in a report on "s. $"r mind speed increases and races in an attempt to add all e see into o"r li!e. In an attempt to ma,e sense, e may become e*tremely religio"s, paranoid, or !eel e are a very important person. Increased Dopamine also increases the perception o! o"r senses, as tho"gh t"rning "p the vol"me in all o"r senses 8 hearing, vision, taste, smell, and to"ch. 's Dopamine levels increase, the noises e heard lo"dly s"ddenly become a"ditory hall"cinations. $"r inner tho"ghts are no being heard o"tside o"r body. These voices begin tal,ing to "s, ,no n to ta,e di!!erent !orms s"ch as derogatory &p"tting yo" do n), religio"s topics, command &telling yo" to do something), or se*"al content. Hall"cinations &e*periencing something that is not tr"ly there in reality) ill soon develop in all o"r senses. +e may begin seeing !aces in clo"ds, carpets, or patterns. +e may sense the to"ch o! spirits or movements inside o"r body. +e may e*perience "n"s"al smells or tastes. High levels o! Dopamine in the brain o!ten ca"se "s to lose o"r contact ith reality. 's tho"gh living in a science(!iction movie, e begin to develop "n"s"al i! not bi4arre ideas abo"t hat is happening to "s. +ith o"r paranoia, e may e*perience del"sions &!alse belie!s) o! persec"tion or may thin, e have s"per po ers &del"sions o! grandiosity) and can predict the !"t"re or read minds. High levels o! Dopamine are !o"nd in 0chi4ophrenia, dr"g into*ication, and other psychotic conditions here the ability to disting"ish the inner orld !rom the real orld is impaired. Treatment !or psychiatric#medical conditions associated ith Dopamine imbalance, as yo" might e*pect, involves increasing or decreasing Dopamine

levels in the brain. :o (Dopamine disorders are treated ith medications that increase Dopamine in the brain. ;or Par,inson%s Disease 8 : Dopa is prescribed and !or 'DHD, medications that are psychostim"lants. 'mphetamines and medications ith similar action act"ally slo do n the hyperactive &'DHD) children by increasing Dopamine 8 boasting their level into the normal range, allo ing them to no !oc"s and attend. Mildly elevations in Dopamine are associated ith addictions s"ch as narcotics, speed, and nicotine#smo,ing. Th"s, medications "sed in the treatment o! these addictions o!ten create a manageable mild elevation in Dopamine, th"s bloc,ing the craving sensation. The medication to help smo,ers, Cyban, is act"ally the antidepressant +ellb"trin that is ,no n to bloc, the re"pta,e o! Dopamine &mildly increasing Dopamine) and th"s bloc, the craving !or cigarettes. Moderate to high levels o! Dopamine, associated ith severe psychiatric conditions s"ch as Paranoia and 0chi4ophrenia, are treated ith medications that bloc, or lo er Dopamine in the brain. These medications, called antipsychotics, have been available !or many years. 5arly antipsychotic medications ho ever, lo ered Dopamine thro"gho"t the brain, incl"ding the Dopamine located in the motor#movement areas. ;or that reason, older antipsychotic medications prod"ced motor#movement problems that loo,ed li,e Par,inson%s Disease 8 short(step gait, !i*ed !acial e*pression, tremors, poor balance, etc. 1e er medications have !e er side e!!ects in motor areas, as they are able to speci!ically target one type o! Dopamine. Dopamine levels typically change very slo ly. Patients ho develop Paranoia and#or 0chi4ophrenia o!ten e*perience a grad"al increase in Dopamine levels over several years 8 also e*periencing an increase in the severity o! symptoms over those years. ' typical high school or college st"dent may develop a sense o! being on(edge or "n"s"al !eelings, grad"ally becoming s"spicio"s and !eeling alienated, moving into a"ditory hall"cinations, and !inally developing bi4arre !alse belie!s &del"sions) o! persec"tion or e*aggerated sel!(importance over the ne*t several years. 0tress can o!ten rapidly increase Dopamine, b"t it still rarely happens overnight. +hen an individ"al becomes psychotic, paranoid, and hall"cinates in only a !e days, e m"st strongly s"spect medication#dr"g into*ication or ne"rological events 8 something that co"ld increase Dopamine levels dramatically and almost instantly. The prolonged "se o! amphetamines &speed) or steroids can prod"ce a loss o! reality and s"dden paranoia. 's it might happen, a constr"ction or,er ta,ing street speed to increase his or, prod"ctivity !inds his hand or !oot tal,ing to him &a"ditory hall"cinations) and decides to c"t it o!!. The s"dden presence o! psychosis &hall"cinations, del"sions, paranoia, etc.) in an individ"al ith a history o! prior normal ad="stment o"ld s"ggest the need !or intensive medical and ne"rological or,"p.

0erotonin@ ;rom -liss to Despair 0erotonin, !irst isolated in DEFF, is the ne"rotransmitter that has been identi!ied in m"ltiple psychiatric disorders incl"ding depression, obsessive(comp"lsive disorder, anore*ia, b"limia, body dysmorphic disorder &nose doesn%t loo, per!ect a!ter ten s"rgeries), social an*iety, phobias, etc. 0erotonin is a ma=or reg"lator and is involved in bodily processes s"ch as sleep, libido &se*"al interest), body temperat"re, and other areas. Perhaps the best ay to thin, o! 0erotonin is again ith an a"tomobile e*ample. Most a"tomobiles in the 3nited 0tates are made to cr"ise at G7 miles per ho"r, per!ect !or interstate high ays and that s"mmer vacation. I! e place that same a"tomobile on a racetrac, and drive day(a!ter(day at DF7 mph, t o things o"ld happen. Parts o"ld !ail and e o"ld r"n the engine so hot as to evaporate or b"rno"t the oil. 0erotonin is the brain%s oil. :i,e a normal a"tomobile on a race trac,, hen e !ind o"rselves living in a high stress sit"ation !or a prolonged period o! time, e "se more 0erotonin than is normally replaced. Imagine a list o! yo"r press"res, responsibilities, di!!ic"lties and environmental iss"es &di!!ic"lt =ob, bad marriage, poor ho"sing, ro"gh neighborhood, etc.). Prolonged e*pos"re to s"ch a high level o! stress grad"ally lo ers o"r 0erotonin level. 's e contin"e to hang on e develop symptoms o! a severe stress(prod"ced depression. 'n a"tomobile can be one, t o or three ."arts lo in oil. 3sing the a"tomobile as an e*ample, imagine that brain 0erotonin can have similar stages, being lo &one ."art lo ), moderately lo &t o ."arts lo ), and severely lo &three ."arts lo ). The less 0erotonin available in the brain, the more severe o"r depression and related symptoms. +hen 0erotonin is lo , e e*perience problems ith concentration and attention. +e become scatterbrained and poorly organi4ed. 2o"tine responsibilities no seem over helming. It ta,es longer to do things beca"se o! poor planning. +e lose o"r car ,eys and p"t odd things in the re!rigerator. +e call people and !orget hy e called or go to the grocery and !orget hat e needed. +e tell people the same thing t o or three times. 's stress contin"es and o"r 0erotonin level contin"es to drop, e become more depressed. 't this point, moderately lo or t o ."arts lo , ma=or changes occ"r in those bodily !"nctions reg"lated by 0erotonin. +hen 0erotonin is moderately lo , e have the !ollo ing symptoms and behaviors@ Chronic !atig"e. Despite sleeping e*tra ho"rs and naps, e remain tired. There is a sense o! being orn o"t 0leep dist"rbance, typically e can%t go to sleep at night as o"r mind#tho"ght is racing. Patients describe this as My mind on%t

sh"t "pH 5arly(morning a a,ening is also common, typically at I@77 am, at hich point ret"rning to sleep is di!!ic"lt, again d"e to the racing tho"ghts. 'ppetite dist"rbance is present, "s"ally in t o types. +e e*perience a loss o! appetite and s"bse."ent eight loss or a craving !or s eets and carbohydrates hen the brain is trying to ma,e more 0erotonin. Total loss o! se*"al interest is present. In !act, there is loss o! interest in everything, incl"ding those activities and interests that have been en=oyed in the past. 0ocial ithdra al is common 8 not ans ering the phone, rarely leaving the ho"se#apartment, e stop calling !riends and !amily, and e ithdra !rom social events. 5motional sadness and !re."ent crying spells are common. 0el!(esteem and sel!(con!idence are lo . -ody sensations, d"e to 0erotonin%s role as a body reg"lator, incl"de hot !l"shes and temperat"re changes, headaches, and stomach distress. :oss o! personality 8 a sense that o"r sense o! h"mor has le!t and o"r personality has changed. +e begin to ta,e everything very personally. Comments, glances, and sit"ations are vie ed personally and negatively. I! someone spea,s to yo", it irritates yo". I! they don%t spea,, yo" become angry and !eel ignored. <o"r !amily ill have the sense that yo" have !aded a ay. <o" tal, less, smile less, and sit !or ho"rs itho"t noticing anyone. <o"r behavior becomes odd. ;amily members may !ind yo" sitting in the dar, in the ,itchen at I@77 am.

Individ"als can live many years moderately depressed. They develop compensations !or the sleep and other symptoms, "sing sleeping medication or alcohol to get some sleep. +hile chronically "nhappy and pessimistic, they e*plain their sit"ation ith It%s ="st my li!eH They may not !"lly recogni4e the depressive component. Aery lo levels o! 0erotonin typically bring people to the attention o! their !amily physician, their employer, or other so"rces o! help. 0evere 0erotonin loss prod"ces symptoms that are di!!ic"lt to ignore. 1ot only are severe symptoms present, b"t also the brain%s ideation#thin,ing becomes very "ncom!ortable and even tort"ring. +hen 0erotonin is severely lo , yo" ill e*perience some i! not all o! the !ollo ing@ Thin,ing speed ill increase. <o" ill have di!!ic"lty controlling yo"r o n tho"ghts. The brain ill !oc"s on tort"ring memories and

yo"%ll !ind it di!!ic"lt to stop thin,ing abo"t these "ncom!ortable memories or images. <o"%ll become emotionally n"mbH <o" o"ldn%t ,no ho yo" !eel abo"t yo"r li!e, marriage, =ob, !amily, !"t"re, signi!icant other, etc. It%s as tho"gh all !eelings have been t"rned o!!. 's,ed by others ho yo" !eel 8 yo"r response might be I don%t ,no H $"tb"rsts ill begin, typically t o types. Crying o"tb"rsts ill s"r!ace, s"ddenly crying itho"t m"ch arning. -ehavioral o"tb"rsts ill also s"r!ace. I! yo" brea, the lead in a pencil, yo" thro the pencil across the room. Temper tantr"ms may s"r!ace. <o" may storm o"t o! o!!ices or p"blic places. 5scape !antasies ill begin. The most common 8 Hit the 2oadH The brain ill s"ggest pac,ing "p yo"r personal e!!ects and leaving the !amily and comm"nity. Memory tort"re ill begin. <o"r brain, thin,ing at D77 miles an ho"r, ill search yo"r memories !or yo"r most tra"matic or "npleasant e*periences. <o" ill s"ddenly become preocc"pied ith horrible e*periences that may have happened ten, t enty, or even thirty years ago. <o" ill relive the death o! loved ones, divorce, childhood ab"se 8 hatever the brain can !ind to tort"re yo" ith 8 yo"%ll !eel li,e it happened yesterday. <o"%ll have 5vil Tho"ghts. 1e mothers may have tho"ghts abo"t smothering their in!ants. Tho"ghts o! harming or ,illing others may appear. <o" may be tort"red by images#pict"res in yo"r memory. It%s as tho"gh the brain !inds yo"r most "ncom!ortable ea, spot, then terrori4es yo" ith it. +ith 0erotonin a ma=or bodily reg"lator, hen 0erotonin is this lo yo"r body becomes "nreg"lated. <o"%ll e*perience changes in body temperat"re, aches#pains, m"scle cramps, bo el#bladder problems, smothering sensations, etc. The 5vil Tho"ghts then tell yo" those symptoms are d"e to a terminal disease. Depressed !ol,s never have gas 8 it%s colon cancer. ' br"ise is le",emia. <o"%ll develop a 1eed(!or(Change Panic. <o"%ll begin thin,ing a change in li!estyle &Midli!e CrisisH), a divorce, an e*tramarital a!!air, a ne =ob, or a Corvette ill change yo"r mood. 'bo"t G7 percent o! =obs are lost at this time as depressed individ"als grad"ally !ade a ay !rom their li!e. Most e*tramarital a!!airs occ"r at this time. 's lo 0erotonin levels are related to obsessive(comp"lsive disorders, yo" may !ind yo"rsel! starting to co"nt things, become preocc"pied ith germs#disease, e*cessively orry that appliances are t"rned o!! or doors loc,ed, orry that televisions m"st be t"rned o!! on an even(n"mbered channel, etc. <o" may develop rit"als involving sa!ety and co"nting. $ne a"to assembly plant or,er began believing his or, o"ld c"rse a"tomobiles i! their

serial n"mber, hen each n"mber as added, didn%t e."al an even n"mber. +hatever normal personality traits, ."ir,s, or attit"des yo" have, they ill s"ddenly be increased three(!old. ' per!ectionist ill s"ddenly become an*io"sly over helmed by the messiness o! their environment or distra"ght over leaves that !all each min"te to land on the la n. Penny(pinchers ill s"ddenly become preocc"pied ith the electric and ater cons"mption in the home. ' trigger event may prod"ce bi4arre behavior. 'lready moderately lo in 0erotonin, an animal bite or scratch may ma,e yo" s"ddenly preocc"pied ith rabies. ' media story abo"t the harm!"l e!!ects o! radiation may ma,e yo" remember a teenage to"r o! the local n"clear po er plant 8 s"ddenly !eeling all yo"r symptoms are no the res"lt o! e*pos"re to radiation. +hen yo" reach the bottom o! severely lo 0erotonin, the garbage tr"c, ill arrive. 5veryone ith severely lo 0erotonin is told the same thing. <o" ill be told D) <o"%re a bad spo"se, parent, child, employee, etc., J) <o" are a b"rden to those ho love or depend on yo", F) <o" are orsening the lives o! those aro"nd yo", I) Those ho care abo"t yo" o"ld be better i! yo" eren%t there, 6) <o" o"ld be better i! yo" eren%t aro"nd, and K) <o" and those aro"nd yo" o"ld be better o!! i! yo" ere totally o"t o! the pict"re. 't that point, yo" develop s"icidal tho"ghts.

Clinical Depression is perhaps the most common mental health problem enco"ntered in practice. $ne in !o"r ad"lts ill e*perience clinical depression ithin their li!etime. Depression is the common cold o! mental health practice 8 very common and m"ch easier to treat today than in the past. Treatment !or depression, as might be e*pected, involves increasing levels o! 0erotonin in the brain. 0ince the mid(eighties, medications have been available that attempt to speci!ically target and increase 0erotonin. Bno n as 0elective 0erotonin 2e"pta,e Inhibitors &002I%s), these medications s"ch as Pro4ac, Colo!t, Pa*il, and Cele*a are !elt to or, by ma,ing more 0erotonin available in the brain. :i,e all ne"rotransmitters, e can have too m"ch 0erotonin. +hile elevated levels o! 0erotonin prod"ce a sense o! ell(being, bliss, and oneness ith the "niverse 8 too m"ch 0erotonin can prod"ce a li!e(threatening condition ,no n as 0erotonin 0yndrome &00). :i,ely to occ"r by accident by combining t o 0erotonin(increasing medications or s"bstances, 0erotonin 0yndrome &00) prod"ces violent trembling, pro!"se s eating, insomnia, na"sea, teeth chattering, chilling, shivering, aggressiveness, over(con!idence, agitation, and malignant hyperthermia. 5mergency medical

treatment is re."ired, "tili4ing medications that ne"trali4e or bloc, the action o! 0erotonin as the treatment !or 0erotonin 0yndrome &00). :i,e Dopamine, 0erotonin can be accidentally increased or decreased by s"bstances. $ne method o! birth control is ,no n to prod"ce severe depression as it lo ers 0erotonin levels. ' speci!ic medication !or acne has also been lin,ed ith depression and s"icidal ideation. ;or this reason, al ays in!orm yo"r physicians i! yo" are ta,ing any medication !or depression. 'lso avoid combining antidepressants ith any herbal s"bstances reported to be o! help in Depression s"ch as 0t. John%s +ort. 1orepinephrine@ ;rom 'ro"sal to Panic 1orepinephrine &15) is the ne"rotransmitter o!ten associated ith the !ight or !light response to stress. 0trongly lin,ed to physical responses and reactions, it can increase heart rate and blood press"re as ell as create a sense o! panic and over helming !ear#dread. This ne"rotransmitter is similar to adrenaline and is !elt to set threshold levels to stim"lation and aro"sal. 5motionally, an*iety and depression are related to norepinephrine levels in the brain, as this ne"rotransmitter seems to maintain the balance bet een agitation and depression. :o levels o! norepinephrine are associated ith a loss o! alertness, poor memory, and depression. 1orepinephrine appears to be the ne"rotransmitter o! aro"sal and !or that reason, lo er(than(normal levels o! this ne"rotransmitter prod"ce belo (average levels o! aro"sal and interest, a symptom !o"nd in several psychiatric conditions incl"ding depression and 'DHD. It is !or this reason that medications !or depression and 'DHD o!ten target both dopamine and norepinephrine in an attempt to restore both to normal level. Mild elevations in o"r norepinephrine levels prod"ce heightened aro"sal, something ,no n to be prod"ced by stim"lants. This aro"sal is considered pleas"rable and several street dr"gs s"ch as cocaine and amphetamines or, by increasing the brains level o! norepinephrine. This increased sense o! aro"sal is pleas"rable, lin,ing these s"bstances to their potential !or addiction. 2esearch tells "s that some individ"als "sing antidepressants develop a state o! hypomania or emotional elation and physical aro"sal in this same manner. ;or that reason, individ"als "sing modern antidepressants are o!ten ca"tioned to noti!y their treating physician#psychiatrist i! they become too happy. Moderately high levels o! norepinephrine create a sense o! aro"sal that becomes "ncom!ortable. 2emembering that this ne"rotransmitter is strongly involved in creating physical reactions, moderate increases create orry, an*iety, increased startle re!le*, ="mpiness, !ears o! cro ds L tight places, impaired concentration, restless sleep, and physical changes. The physical symptoms may incl"de rapid

!atig"e, m"scle tension#cramps, irritability, and a sense o! being on edge. 'lmost all an*iety disorders involve norepinephrine elevations. 0evere and s"dden increases in norepinephrine are associated ith panic attac,s. Perhaps the best ay to vis"ali4e a panic attac, is to remember the association ith the !light or !ight response. The !light or !ight response is a chemical reaction to a dramatic and threatening sit"ation in hich the brain prod"ces e*cessive amo"nts o! norepinephrine and adrenaline 8 giving "s e*tra strength, increased energy#aro"sal, m"scle tightness &!or !ighting or r"nning), and a desperate sense that e m"st do something immediately. This animal response as activated in early man hen a bear sho ed "p at his cave or hen !aced ith a tiger in the oods. In modern times, imagine yo"r reaction i! hile calmly atching television, someone or something started trying to ,noc, yo"r !ront door in to attac, yo". In the !light or !ight reaction, yo"r brain and body chemistry prepare yo" to either r"n !rom the sit"ation or !ight to the deathH ' panic attac, is the activation o! the !light or !ight chemical reaction itho"t a bear at the door. It%s as tho"gh the sel!(protection animal response is ,ic,ing(o!! accidentally, hen no real li!e(threatening sit"ation is present. Bno n no as panic attac,s, they can s"r!ace at the grocery, at ch"rch, or hen yo" least e*pect it. 's norepinephrine is a !ast(acting ne"rotransmitter, the panic attac, may last less than ten min"tes &!eels li,e ho"rs ho everH) b"t yo"%ll be rattled#sha,en !or several ho"rs. Panic attac,s are strong physical and chemical events and incl"de the !ollo ing symptoms@ Palpitations, po"nding heart or rapid heart rate 0 eating and body temperat"re changes Trembling or sha,ing 0hortness o! breath o! smothering sensations Cho,ing sensations Chest pain and discom!ort 1a"sea or stomach distress Di44iness, lightheadedness, or !eeling !aint 0ense o! "nreality, as tho"gh yo" are o"tside yo"rsel! ;ear o! losing control or going cra4y ;ear o! dying 1"mbness and tingling thro"gho"t the body Chills and hot !l"shes

I! e thin, abo"t the a"tomobile e*ample, a panic attac, is the e."ivalent o! yo"r dashboard arning lights coming on 8 yo"r stress level is too high. Panic attac,s, or s"rges o! norepinephrine, can also occ"r by accident as hen created by the "se o! certain medications. The medications !or certain medical conditions can ca"se a panic attac, or increase o"r level o! an*iety. Medications o!ten "sed !or asthma, !or e*ample, can create an*iety or panic attac,s.

Treating lo or elevated levels o! norepinephrine in the brain involve di!!erent approaches. :o levels o! norepinephrine are o!ten treated "sing ne er antidepressants. Many ne antidepressants, ,no n as 0erotonin( 1orepinephrine 2e"pta,e Inhibitors &012I%s) ith brand names li,e 5!!e*or and 0er4one, treat depression by increasing levels o! both serotonin and norepinephrine ne"rotransmitters. Treatment !or high levels o! norepinephrine, as !o"nd in an*iety and panic disorders, involves decreasing ne"rotransmitter levels directly or "sing medications hich increase another ne"rotransmitter that inhibits or decreases the action o! norepinephrine. $ne o! those inhibiting ne"rotransmitters is 9'-', also ,no n as 9amma('minob"tyric 'cid. 9'-'@ Mania and 0ei4"res to 2ela*ation and Imp"lse Control 9amma('minob"tyric 'cid &9'-') is a ne"rotransmitter that is inhibitory, that is, it decreases the ability o! other ne"rotransmitters to or,. 9'-' is involved in o"r level o! e*citability. 2ather than enco"raging comm"nication bet een cells s"ch as Dopamine, 0erotonin or 1orepinephrine ( 9'-' red"ces, disco"rages, and bloc,s comm"nication. This ne"rotransmitter is important in brain areas involving emotion and an*iety. +hen 9'-' is in the normal range in the brain, e are not overly aro"sed or an*io"s. 't the same time, e have appropriate reactions to sit"ations in o"r environment. 9'-' is the comm"nication speed controller, ma,ing s"re all brain comm"nications are operating at the right speed and ith the correct intensity. Too little 9'-' in the brain, the comm"nication becomes o"t o! control, overstim"lated, and chemically "nstable. Too m"ch 9'-' and e are overly rela*ed and sedated, o!ten to the point that normal reactions are impaired. :o levels o! 9'-' are associated ith -ipolar Disorder, Mania. +ith 9'-' levels belo average, the brain is too stim"lated. +e begin tal,ing rapidly, staying "p !or days at a time, and develop ild and grandiose ideas. In a Manic state, e are so high and o"t o! control that social problems are ."ic, to develop, o!ten d"e to hyperse*"ality, e*cessive spending, rec,less decisions, ris,(ta,ing behavior, and grandiose ideas. +e may !eel so good that e thin, e are a heavenly spirit, an intellect"al geni"s, or possessing e*traordinary po ers. I personally had one patient ho loc,ed himsel! in his mobile home and spent one ee, re riting the 1e Testament in hillbilly. 'nother, ith limited ed"cation, began p"rchasing boo,s on the Theory o! 2elativity by 'lbert 5instein, sensing he may be able to "se the in!ormation to invent arp drive. :o levels o! 9'-' are also associated ith problems o! poor imp"lse control, incl"ding clinical conditions s"ch as gambling, temper tantr"ms, and stealing.

+hen 9'-' is lo in the brain, imp"lsive behaviors are not inhibited &stopped) by logical or reasonable thin,ing. :o levels o! 9'-' are also associated ith epilepsy or sei4"re disorders. I! e imagine a sei4"re as a type o! electrical storm, the sei4"re begins at one location in the brain then r"shes across and thro"gh the brain li,e a s"dden storm. :o levels o! 9'-' ma,e it easy !or the brain to develop sei4"res hich is hy sei4"res are part o! the ithdra al syndrome !or many s"bstances that or, ith 9'-' s"ch as alcohol and tran."ili4ers &ben4odia4epines 8 Mana*, 'tivan, :ibri"m, Aali"m, etc.). 0"bstances that arti!icially maintain a high level o! 9'-', hen stopped, create a dramatic drop in 9'-' levels, th"s creating the ris, !or ithdra al sei4"res d"e to the chemical instability that is created. High levels o! 9'-' prod"ce more control, rela*ation, and even sedation. 'lcohol or,s by increasing 9'-' levels, hich is hy all body systems are rela*ed at !irst 8 then sedated to the point o! sl"rred speech, "nsteady gait, and !oggy thin,ing. 'lcohol ithdra al, or the s"dden severe drop o! high 9'-' levels, prod"ce a lo 9'-' level and the possibility o! sei4"res. +ithdra al !rom ben4odia4epines is ,no n to !ollo the same pattern. Ta,ing !orty milligrams o! Aali"m !or t o years, s"ddenly stopping all medication, ill li,ely prod"ce a sei4"re. Medications !or an*iety create rela*ation and a decrease in an*iety by increasing 9'-' levels in the brain. 'lcoholic beverages or, in the same mannerN the alcohol increasing 9'-' levels to prod"ce mild e"phoria, loss o! social an*iety, and other symptoms o! into*ication. 5*cessive inta,e o! ben4odia4epines and#or alcohol is e*tremely dangero"s as the high 9'-' level act"ally smothers the comm"nication bet een brain ne"rons 8 sometimes to the point o! a total lac, o! comm"nication bet een ne"rons 8 also ,no n as death. Medications !or sei4"res, imp"lse control problems, and -ipolar Disorder, Mania all or, by increasing the 9'-' levels itho"t accompanying e"phoria. :ithi"m and anti(sei4"re medications all increase 9'-' into the normal range, th"s lo ering the possibility o! sei4"res and prod"cing brain chemical stability. 's 9'-' is the ne"rotransmitter policeman, changes in 9'-' can in!l"ence all ne"rotransmitters b"t especially norepinephrine. Medication Treatment o! the Chemical Imbalance 3nderstanding these !o"r ne"rotransmitters provides a indo to "nderstanding the ma=ority o! psychiatric conditions, ranging !rom depression to schi4ophrenia. Mental health pro!essionals "se psychological testing, intervie s, ."estionnaires, and patient history to determine !irst, i! a change in the ne"rotransmitter system is present, then second, hat ne"rotransmitters are involved. ' proper clinical diagnosis then leads to proper medication treatment.

Medications are prescribed in an e!!ort to ret"rn the brain%s ne"rotransmitter stat"s to normal. M"ch li,e a physician may prescribe a medication to lo er yo"r cholesterol or increase another body chemical, mental health pro!essionals are concerned ith ret"rning yo"r ne"rotransmitter levels to normal. Medications !or mental health conditions or, in several ays@ 0ome imitate the ne"rotransmitter, triggering a response as tho"gh the original ne"rotransmitter ere present 0ome bloc, the ne"rotransmitter !rom being absorbed by the s"rro"nding ne"rons, ,no n as bloc,ing the re"pta,e. 2e"pta,e inhibitors bloc, the reabsorption#re"pta,e o! 0erotonin or 1orepinephrine and th"s ma,e more ne"rotransmitter available 0ome !orce the release o! the ne"rotransmitter, ca"sing an e*aggerated e!!ect. Cocaine does this to 1orepinephrine and Dopamine hile MDM' &5cstasy 8 a cl"b dr"g) does this to 0erotonin. 0ome increase ne"rotransmitters ,no n to slo do n or red"ce the prod"ction o! other ne"rotransmitters. 0ome bloc, the release o! ne"rotransmitters completely 0ome inter!ere ith the storage o! ne"rotransmitters, allo ing them to come o"t o! storage and lose potency

-ased on the ne"rotransmitter theory o! psychiatric illness, e can plot clinical conditions and see ho mental health pro!essionals determine medication treatment by recogni4ing hich ne"rotransmitters are involved@ Diagnosis@ 1e"rotransmitter@ Medication@ Diagnosis@ 1e"rotransmitter@ Medication@ Diagnosis@ 1e"rotransmitter@ Medication@ Diagnosis@ 1e"rotransmitter@ 0tress(Prod"ced Depression :o 0erotonin 0elective 0erotonin 2e"pta,e Inhibitor &002I) 'gitated#'n*io"s Depression :o 0erotonin 5levated 1orepinephrine 002I and 'ntian*iety Medication or 0erotonin 1orepinephrine 2e"pta,e Inhibitor &012I) Ma=or Depression ith Psychosis &0evere depression ith hall"cinations#paranoia) 5levated Dopamine :o 0erotonin 'ntipsychotic medication 002I -ipolar Disorder, Mania :o 9'-'

Medication@ Diagnosis@ 1e"rotransmitter@

'nticonv"lsant or :ithi"m

-ipolar Disorder, Depressed :o 9'-' :o 0erotonin Medication@ 'nticonv"lsant or :ithi"m 002I Interesting Medications and Their Side Effects Aiagra, "sed !or the treatment o! erectile dys!"nction, at higher doses can create a bl"e tint in the vis"al !ield. Medications "sed !or restless leg syndrome, beca"se they prod"ce a mild elevation in Dopamine, can prod"ce comp"lsive behavior and a craving to gamble. 1altre*one, an anti(addiction medication, can ret"rn to red"ce the "rge to steal in ,leptomania.

Medications "sed !or m"ltiple medical conditions may have psychiatric side e!!ects. ;or this reason, hile e sho"ld al ays in!orm all physicians abo"t all medications, it is also important to monitor o"r mental health hen any medication is changed, added, or deleted. 'ny change in o"r mood, attit"de, or behavior is important to bring to yo"r physician>s attention. ;inal Tho"ghts ' variety o! conditions and circ"mstances enco"ntered in li!e can prod"ce changes in o"r brain chemistry. These changes can then create mental health problems. +e have ,no n !or years that chemicals and s"bstances in the body can become "nreg"lated as in high blood press"re, high cholesterol, lo #high blood s"gar, etc. There is no stigma associated ith "sing medications to ret"rn these body chemicals#s"bstances bac, to their normal levels. It is the hope o! mental health pro!essionals that the p"blic can "nderstand the medical and ne"rochemical nat"re o! vario"s emotional and psychiatric conditions, th"s eliminating the stigma o!ten associated ith treatment. Modern treatment is very e!!ective and can eliminate years o! emotional s"!!ering ith very little in the ay o! intervention or treatment. Mental health treatment is available in every co"nty in the 3nited 0tates. This article is presented as a p"blic service by Joseph M. Carver, Ph.D., a Clinical Psychologist. 2evised@ '"g"st J7DJ