Tuesday, July 18, 2017

Hormone Imbalance, Poor Neurotransmitter Activity Linked to Mental Illnesses

Poor Neurotransmitter activity?

My sociology instructor in college, either from a binge
or bugged about social changes at the time liked to say.
"Your mind is only mushed as the corn field you live in."
For the time my instructor was talking about the lack of
environmental stimulus, relating to living out in the back woods.
Simple life, simple minded. Retardation by deprivation?
True and the point is to ask why! Why? So it can be changed!!!!

Is it a non educated environment where education is not valued,
and gets passed on to family members. Somewhat true but
it's also that they could never afford their education in the first place.
Being it's like building credit to poor people. It takes money to
have credit as you have to buy something.

But no money to keep your mind busy is no problem.
Just do something! It does not have to cost a lot!
There are things you can do the point is try!

Poor Neurotransmitter activity from something that is in and out of people's hands.

~~~~~Poor Neurotransmitter Activity Linked to Mental Illnesses
Understanding the way neurotransmitters function in the brain could lead to better treatments for mental disorders. Normally, nerve impulses move along the brain through axons , long cellular structures – until they land at a presynaptic membrane. These membranes house the neurotransmitters that will be sent out into free spaces, or synaptic clefts, so that they can be collected by receptors of another neuron. The neuron that collects the neurotransmitter then internalizes it and the nerve impulse can keep moving forward with the message.

If serotonin or norepinephrine movement is interrupted, depression or anxiety disorders can result, as these hormones (also called neurotransmitters) regulate things like mood, appetite and concentration. For patients with depression, the neurotransmitters may return to their original location (the presynaptic membrane) instead of sending the right message produced by the serotonin to a neuron. Medications for depression can help stop these hormones from returning to their original location, a process called reuptake. The result is that broken signals are repaired; there is more serotonin activity; and reduced symptoms for depression.

Dopamine is another neurotransmitter linked to mental illness, such as  schizophrenia, characterized in part by emotional disturbances, but certain medications can help reduce the symptoms. Attention-deficit/hyperactivity disorder (ADHD) is also believed to be a result of interrupted passages of dopamine or norepinephrine. Tiredness, high levels of stress and poor motivation are also linked to low dopamine.

Additional mental illnesses, such as personality disorders and social disorders, are believed to be caused by the interrupted transfer of neurotransmitter messages. In patients with drug or alcohol addictions, the gamma-aminobutyric acid, or GABA, receptor may be affected. This neurotransmitter slows the speed of nerve impulses and causes muscles to relax.

Interestingly, people with vitamin deficiencies may be more likely to experience disrupted, lacking or ineffective neurotransmitters. Amino acids are the building blocks of neurotransmitter production, but amino acids can’t be generated without first taking in a broad range of vitamins and minerals. Diets that are too low in protein may also contribute to impaired neurotransmitter function. A combination of good nutrition, prescription medications or antidepressants, exercise and psychotherapy are recommended to increase neurotransmitter production and encourage a smooth flow of these critical chemicals in the brain.

~~~~~Hormone Imbalance, Not Bipolar Disorder
I now have a sufficient database to report that a significant subset of BP patients are not BP at all but have gonadal hormone problems. Correct identification and treatment of these imbalances stabilize the patients and refute the purported BP (although I do not know how to get the incorrect diagnoses out of insurance records and undo the damage to these peoples lives). This occurs in men and women.

Ladies first:  There are two subgroups here; really, really bad PMS and really, really bad PMS in conjunction with Stein-Leventhal Syndrome (PCOS-PolyCystic Ovarian Syndrome).

Most of these women are diagnosed at relatively early ages, but after menarche. Indeed they have florid mood swings, affective dysregulation, depression, impulsivity, suicidal gestures...the whole gamut. True psychotic symptoms are rare. And yes, they come to me on one of the cocktails du jour. Many do meet criteria for ADHD and PLMD (Periodic Limb Movement Disorder) but these have always been subordinate to the horrible, Rapid Cycling BP.

Careful history, often with input from parents, partners or spouses reveals--here’s the surprise--that the patient’s cycling correlates closely with her menstrual cycle. In fact, that’s when her BP is harder to control. My impression then becomes, Hmm...

I won’t go into a discussion of hormone cycling, enzymes and neurotransmitters now, but will put some references at the end. In short, after careful evaluation and consideration I detoxify these women from their toxic cocktails. It is difficult and often frightening. But once SSRIs and and dopamine blocking agents are gone, the super-sensitization of the dopamine pathways have cooled-off a tailored titration onto a pulse pattern of Wellbutrin controls the PMS and BP disappears. Imagine that!

No, every woman diagnosed with BP who has PMS does not fit this paradigm, just many of them. Something to consider.

The women with PCOS and BP often haven’t been diagnosed with PCOS yet. Some have. PCOS is characterized by irregular, painful menses, elevated testosterones, masculinization, hirsutism, weight gain and many other features in varying degree. Insulin resistance and Diabetes Mellitus is common. In the patients they may have significant internal hormone fluctuations without the manifestations of a period--menses. Thus it is necessary to get long and careful histories, keep calendars, get hormone assays at “different” times and then decide about treatment. By the bye, most medications for BP cause weight gain and some directly increase blood glucose and all of this is quite bad for a patient with PCOS.

In selected cases the BP meds are withdrawn. The metabolic issues must be addressed; control and suppress androgens to normal female levels, control blood glucose and insulin. Then address the PMS. AS noted above this usually can be accomplished with Wellbutrin, but is some cases wherein the fluctuations are so erratic and unpredictable that a pulse pattern cannot be established effectively Monoamine Oxidase Inhibitors (MAOIs) are used because it is the surge in MAO that occurs abruptly when a woman’s estrogen drops (and the MAO is the enzyme that degrades all biogenic amines--dopamine, serotonin, noradrenalin, et. al.) and induces the miserable moodiness and symptoms of PMS mistakenly called BP in these cases.

Now the men:  this has been more subtle and took longer to clarify. Men have estrogen just as women have testosterone. Testosterone is metabolized into estrogen! I posited years ago that a subset of men are exceedingly rapid metabolizers of testosterone into estrogen (and also some may over-produce it intrinsically). A recent article in the “New England Journal of Medicine” confirmed my supposition.

Anyhow, I figured this one out backwards. After seeing a series of men with putative BP, on all of the usual drugs, I discerned a pattern of diminished libido, sexual dysfunction, subtle feminization and often new and strange sexual thoughts and fantasies. This was always called a medication side effect. However evaluation of hormone levels revealed relative to absolute hypogonadism. I do not attribute the finding to the psychiatric drugs because I have also seen several men who presented with first depressive episodes and no prior treatment with the same features. And their estrogens were usually high normal or abnormal.

But let’s stick with the BP. Finally off psych meds and on testosterone replacement some interesting things happened. Their moodiness, irritability, insomnia, and other symptoms resolved as they were re-masculinized and estrogen levels fell. Some of the time.

A sub-group that has been most fascinating are the super fast metabolizers. When give transdermal testosterone daily the were feminized by immediate conversion to estrogen. This was not considered a good result by the men and their wives. Use of injectable long-acting, slow-release testosterone worked, but not in the traditional 200 mg in the tush every two weeks. After a sufficient duration of treatment (in testosterone replacement therapy blood levels can rise swiftly in a few weeks but clinical response can take three months or more) they began to cycle again, often worse. This has been called ‘roid rage’ from excessive testosterone but in fact the trouble occurred as the testosterone wore off and the estrogen rose dramatically. A sort of male PMS. At first we addressed this by increasing frequency of injection, usually with a lower dose (100 mg or each time). The result would be an individualized but predicable cycle; 3-6 good days followed by the crash. Yet testosterone levels were pretty even. The estrogen levels were cycling down after an injection and skyrocketed with the crash! Eureka.

~~~~~Poverty harms brain?
The General conclusion, which can be done here, looks like this: from the neurobiological point of view, poverty is not a lifelong stigma, inherited from ancestors, with whom nothing can be done and which we can only hope for some kind of a successful mutation. But while poverty can ruin the life not only in terms of material well-being, but also literally changing the brain and therefore the psyche. In other words, to obtain a healthy society, need to care not about that, that was not rich, and about how to not be poor.

~~~~~Have You Stopped Enjoying Life? Could Be Low Dopamine
Some people feel so bad they want to die, but don’t follow through because they actually lack motivation. There is no pleasure. That must sound doesn’t it, but it holds true for many. Why bother with anything, nothing brings you pleasure… this kind of depression is related to dopamine imbalances. Does it sound like you?

You’ve been trained to equate depression with serotonin deficiency, not dopamine, but in fact people with serotonin-related depression don’t usually wish to die. They feel blue, they have no motivation, sometimes poor self esteem, but they don’t want to really die. They are commonly put on drugs such as Prozac, a very good one if you’re aiming to raise serotonin temporarily. But

Prozac might backfire, I’ll tell you why in a minute. It has to do with fluoride and iodine. My point right now is depression is NOT a Prozac deficiency (or Celexa, or Cymbalta, or Lexapro, or any of them). They may be helpful, and you may rely on them but the point here is depression results from something other than a medication deficiency. There’s an important distinction I want to make, one that could potentially save your life, or someone you love.

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