Updated: Jul 31, 2021
I work with a lot of people who have challenges with mood, memory and focus. Many have tried or are currently using Rx medications to improve these symptoms.
Conventional psychology and psychiatry use terms like "anxiety" and "depression" and give prescription medications based on those criteria. Sometimes they give great relief, other times they fail to help, and sometimes they backfire. There are a lot of reasons for this, but one of them is that these drugs target specific neurotransmitters and the neurotransmitters targeted are not always the ones that need support.
One issue I often see is that "anxiety" can have several different neurotransmitter pictures. An anxious person might have recycling thoughts that manifest as "catastrophizing", another anxious person might be experiencing "fight or flight", yet another might feel sensory overwhelm, and another might have OCD manifestations. Each of these scenarios would be classified as "anxiety", but each of these has a completely different neurotransmitter pattern and therefore needs a different treatment approach.
The same is true for depression. There is a version of depression that has recycling negative thoughts, another version where people feel a lack of joy, motivation, energy and emptiness. Again, these two scenarios result from deficiencies in different neurotransmitters and require different support.
When trying to figure out what natural substances might help ease someone's emotional suffering, or help with their brain function, I find it more helpful to isolate what neurotransmitter pathways are out of balance than to rely on general terms like "anxiety" or "depression".
There are a couple of ways to test neurotransmitter levels in the body. One is to do a blood test for neurotransmitters. The other is a urine test. You may ask: If these tests exist, why are they not done by doctors before prescribing medications for mood issues? There are actually a few reasons for this. First, we have neurotransmitters throughout our whole body. For instance, 90% or more of the serotonin in our body is produced in our digestive system. There are a series of membranes surrounding the brain called the Blood Brain Barrier (BBB). This barrier is designed to keep most large molecules in the body from entering the brain (and vice versa). Surprisingly, the serotonin made in your gut does not go into the brain. Likewise, the amount of serotonin in your body and blood does not necessarily reflect the levels in your brain. Because of this, doctors do not generally rely on blood tests to tell them what is happening in the brain.
The urine tests are actually looking for molecules being eliminated by the body after neurotransmitters are broken down. Whatever is in the urine is something the body was getting rid of. If you find very high levels of a neurotransmitter (or its breakdown product) in the urine, you don't really know if it is because the body has a huge amount, or if the body is getting rid of too much. Likewise if levels on a urine test are very low, we don't know if it is because the body has very low amounts, or if the body is failing to break down and eliminate the neurotransmitter (low urine levels, leaving high levels in the body). All you know with urine tests is what the body eliminated. Again, it is not clear if we can reliably extrapolate brain levels of neurotransmitters from these tests.
Though these tests are not precise, they can be useful when matched up how someone is feeling and what exact symptoms they are experiencing. I consider them suggestions, but certainly not diagnostic.
Unique Neurotransmitter Symptoms
Did you know that it is possible to approximate which neurotransmitters are out of balance just by asking specific questions? Each neurotransmitter has a unique signature. Each neurotransmitter keeps a very specific part of our mental - emotional system in balance. Each has very specific symptoms when they are out of balance.
When I am working with someone that has symptoms that have been labeled "anxiety" or "depression", my first goal is to figure out exactly which neurotransmitters are out of balance.
I do this by asking targeted questions about their specific symptoms. Here are the symptoms that are unique to each neurotransmitter:
Low serotonin manifests as invasive, recycling, negative thoughts. Sometimes described as "thought loops" or ruminating.
People may find that they re-live unhappy memories, not know what made them remember that particular thing, and not be able to stop replaying it in their head.
Others worry about unlikely "catastrophic" future scenarios, and they can't stop worrying that those things might happen.
The key thing with these negative thought loops is that they are out of context (there does not need to be an obvious trigger for these thoughts), they repeat over and over, and they are difficult or impossible to stop.
Low GABA manifests as "monkey mind". The brain is very active, with random thoughts, wandering from topic to topic. It is very, very difficult to get the mind to be quiet or still.
I sometimes compare this to "snow on the TV screen". There is no content or "story" playing, but you can't turn the TV off.
There are many other possible symptoms of low GABA, but "monkey mind" is the only one that is unique to GABA.
If I say the word "fingernails on a chalkboard" you can feel your neck muscles tense and your brain curling up away from that sensation.
That is what I call "brain cringe"
High levels of glutamate often manifest as "brain cringe" in response to sensory stimulation. Light, sound, color, touch, crowds or any other form of stimulation makes you cringe away and want to hide in a dark, quiet room.
Low dopamine often manifests as a lack of motivation, a lack of joy or satisfaction, and an inability to focus due to this apathy.
Some ADD is related to low dopamine.
High dopamine can manifest as OCD-like symptoms. People can become very particular and rigidly attached to schedules, plans, processes. In more severe cases they can develop rituals like counting, washing hands, checking locks or the stove, etc.
Epinephrine is essentially the same thing as adrenaline.
Too much epinephrine = fight or flight.
This can show up as a panic attack or as a constant feeling of tension and fear.
Common symptoms are pounding heart, heart palpitations, tight chest, feeling shaky, butterflies in stomach. Sleep is difficult or impossible for many when they are in fight or flight.
Neurotransmitters are each made from specific amino acids. Amino acids are the building blocks of protein. These molecules are converted from protein into brain chemicals by enzymes. Neurotransmitters are also broken down by enzymes. Each enzyme has specific vitamins and minerals that it needs to function. Once you map out which neurotransmitters are out of balance, it is possible to use targeted nutrients to help the body make more of the ones that are low and increase the elimination of the ones that are too high. If someone is low in serotonin, it is possible to give the raw material used to build serotonin (5HTP or Tryptophan) plus the nutrients needed by the enzyme that converts 5HTP to Serotonin (magnesium and vitamin B6). Extreme caution needs to be taken when a person is on a prescription drug that also affects the serotonin pathway. While this process seems relatively simple, I do not recommend trying to do this without the support and advice of a seasoned practitioner.
Treat the cause of anxiety and depression
OK, I know some of my very smart colleagues are probably rolling their eyes at this post. We now know that neurotransmitters do not "spontaneously" go out of balance. There are usually triggers. The most common triggers are things that cause micro-inflammation in the brain.
There are a wide variety of things that can cause this micro-inflammation: food sensitivities (especially gluten), exposure to mold or toxic chemicals, hormone imbalances (especially estrogen excess, or estrogenic chemicals). Low mitochondrial function in the brain is another common trigger. Mitochondria are little organs in our cells that make energy. The brain uses a LOT of energy, so anything that slows down the mitochondria has a big (negative) impact on the brain. In addition to the toxic exposures listed above, old head injuries, hypoxia (from mouth breathing or sleep apnea), nutrient deficiencies and either severe or chronic illness can all have a negative effect on mitochondria. Another common contributor to neurotransmitter imbalance is genomics. Somewhere between one third and one half of the population has genes that make it easier for their neurotransmitters to fall out of balance.
Most holistic and functional practitioners focus on identifying and lessening these triggers, and rightfully so, as they are the true underlying cause of the imbalance. Because of this, amino acid therapy to balance neurotransmitters has fallen out of fashion, and is even scorned by some.
I mostly agree with my very smart colleagues. Treating the symptoms of neurotransmitter imbalance by giving the nutrient raw materials to either build more neurotransmitters or help clear out excess neurotransmitters can be a short term fix. If one of the issues listed above is the cause of the neurotransmitter imbalance, a permanent return to health is not likely to be achieved by just addressing the immediate deficiencies.
Here's the thing: many of the issues listed above can take weeks, months or even years to correct. When someone is struggling with anxiety or depression they are REALLY suffering. Often silently, with little way to find comfort or escape. Deep depression or being in constant "fight or flight" is every bit as bad as being in chronic physical pain.
Correcting neurotransmitter levels with nutrients can give almost immediate relief to many people who are suffering and struggling with these symptoms. In some cases the correct nutrients given at the correct doses can bring relief in as little as 15 minutes. Over time, these nutrients can be used to re-balance neurotransmitter levels. If the underlying causes are not addressed, these imbalances can certainly come back, but providing short term relief makes it much easier for people to do the work of addressing the other, deeper causes.
Addressing underlying causes for anxiety, depression or other mood issues is like climbing a mountain. Doing intensive psychotherapy, changing your diet, or doing intensive detox work are all very energy intensive. They require a fair amount of bandwidth for planning and processing. If you try to do those things while you are paralyzed by low serotonin, low dopamine and high adrenaline, it is like trying to climb up the face of a cliff by your fingernails in a thunderstorm. You might be able to do it, but it will be really, really hard. If you are able to balance your neurotransmitters with nutrients while you do this work, it is still an uphill climb, but it is more like hiking up a sloping, mulchy path. It is still an uphill climb, and you still have to get to the top of the mountain, but it is so, so much easier.
If you, or someone you love struggles with mood or focus issues, please know that relief and healing are possible.