DOPAMINE

Dopamineinthethinkingareasofthebrainmightbeconsideredtheneurotransmitterof
focusandattending.Lowlevelsimpairourabilitytofocusonourenvironmentorto
lockontotasks,activities,orconversations.LowlevelsofDopaminemake
concentrationandfocusverydifficultwithlowlevelsalsoassociatedwithAttention
DeficitHyperactivityDisorder(ADHD).OntheotherendoftheDopaminedipstick,as
Dopaminelevelsinthebrainbegintoraise,webecomeexcited/energized,then
suspiciousandparanoid,thenfinallyhyperstimulatedbyourenvironment.Withlow
levelsofDopamine,wecantfocuswhilewithhighlevelsofDopamineourfocus
becomesnarrowedandintensetothepointoffocusingoneverythinginourenvironment
asthoughitweredirectlyrelatedtooursituation.
ModeratelyhighDopaminelevelsmakeusonguard,suspicious,andproneto
misinterpretexperiencesintheenvironment.Knownasanideaofreferencein
psychiatry,webeginthinkingunrelatedexperiencesaresuddenlydirectlyrelatedtous.
Peopleobservedtalkingacrossthestreetarenowtalkingaboutus.AsDopamine
increases,itcanbecomesointensethatwefeeltheradio,television,andnewspaper
containsecretmessagesdirectedatusfromHollywoodorelsewhere.Itsasthoughwe
areattemptingtoincorporate/addeverythingwewitnessintoourlife.Planesflying
overheadaresnappingpicturesofusandmotoriststalkingoncellularphonesarecalling
inareportonus.Ourmindspeedincreasesandracesinanattempttoaddallweseeinto
ourlife.Inanattempttomakesense,wemaybecomeextremelyreligious,paranoid,or
feelweareaveryimportantperson.IncreasedDopaminealsoincreasestheperceptionof
oursenses,asthoughturningupthevolumeinalloursenseshearing,vision,taste,
smell,andtouch.
AsDopaminelevelsincrease,thenoisesweheardloudlysuddenlybecomeauditory
hallucinations.Ourinnerthoughtsarenowbeingheardoutsideourbody.Thesevoices
begintalkingtous,knowntotakedifferentformssuchasderogatory(puttingyoudown),
religioustopics,command(tellingyoutodosomething),orsexualcontent.
Hallucinations(experiencingsomethingthatisnottrulythereinreality)willsoon
developinalloursenses.Wemaybeginseeingfacesinclouds,carpets,orpatterns.We
maysensethetouchofspiritsormovementsinsideourbody.Wemayexperience
unusualsmellsortastes.
HighlevelsofDopamineinthebrainoftencauseustoloseourcontactwithreality.As
thoughlivinginasciencefictionmovie,webegintodevelopunusualifnotbizarreideas
aboutwhatishappeningtous.Withourparanoia,wemayexperiencedelusions(false
beliefs)ofpersecutionormaythinkwehavesuperpowers(delusionsofgrandiosity)and
canpredictthefutureorreadminds.HighlevelsofDopaminearefoundin
Schizophrenia,drugintoxication,andotherpsychoticconditionswheretheabilityto
distinguishtheinnerworldfromtherealworldisimpaired.

Dopaminelevelstypicallychangeveryslowly.PatientswhodevelopParanoiaand/or
SchizophreniaoftenexperienceagradualincreaseinDopaminelevelsoverseveralyears
alsoexperiencinganincreaseintheseverityofsymptomsoverthoseyears.Atypical
highschoolorcollegestudentmaydevelopasenseofbeingonedgeorunusualfeelings,
graduallybecomingsuspiciousandfeelingalienated,movingintoauditory
hallucinations,andfinallydevelopingbizarrefalsebeliefs(delusions)ofpersecutionor
exaggeratedselfimportanceoverthenextseveralyears.Stresscanoftenrapidlyincrease
Dopamine,butitstillrarelyhappensovernight.
Whenanindividualbecomespsychotic,paranoid,andhallucinatesinonlyafewdays,we
muststronglysuspectmedication/drugintoxicationorneurologicaleventssomething
thatcouldincreaseDopaminelevelsdramaticallyandalmostinstantly.Theprolongeduse
ofamphetamines(speed)orsteroidscanproducealossofrealityandsuddenparanoia.
Asitmighthappen,aconstructionworkertakingstreetspeedtoincreasehiswork
productivityfindshishandorfoottalkingtohim(auditoryhallucinations)anddecidesto
cutitoff.Thesuddenpresenceofpsychosis(hallucinations,delusions,paranoia,etc.)in
anindividualwithahistoryofpriornormaladjustmentwouldsuggesttheneedfor
intensivemedicalandneurologicalworkup.
Serotonin:FromBlisstoDespair
Serotonin,firstisolatedin1933,istheneurotransmitterthathasbeenidentifiedin
multiplepsychiatricdisordersincludingdepression,obsessivecompulsivedisorder,
anorexia,bulimia,bodydysmorphicdisorder(nosedoesntlookperfectafterten
surgeries),socialanxiety,phobias,etc.Serotoninisamajorregulatorandisinvolvedin
bodilyprocessessuchassleep,libido(sexualinterest),bodytemperature,andotherareas.
PerhapsthebestwaytothinkofSerotoninisagainwithanautomobileexample.Most
automobilesintheUnitedStatesaremadetocruiseat70milesperhour,perfectfor
interstatehighwaysandthatsummervacation.Ifweplacethatsameautomobileona
racetrackanddrivedayafterdayat130mph,twothingswouldhappen.Partswouldfail
andwewouldruntheenginesohotastoevaporateorburnouttheoil.Serotoninisthe
brainsoil.
Likeanormalautomobileonaracetrack,whenwefindourselveslivinginahighstress
situationforaprolongedperiodoftime,weusemoreSerotoninthanisnormally
replaced.Imaginealistofyourpressures,responsibilities,difficultiesandenvironmental
issues(difficultjob,badmarriage,poorhousing,roughneighborhood,etc.).Prolonged
exposuretosuchahighlevelofstressgraduallylowersourSerotoninlevel.Aswe
continuetohangonwedevelopsymptomsofaseverestressproduceddepression.

Anautomobilecanbeone,twoorthreequartslowinoil.Usingtheautomobileasan
example,imaginethatbrainSerotonincanhavesimilarstages,beinglow(onequartlow),
moderatelylow(twoquartslow),andseverelylow(threequartslow).ThelessSerotonin
availableinthebrain,themoresevereourdepressionandrelatedsymptoms.
WhenSerotoninislow,weexperienceproblemswithconcentrationandattention.We
becomescatterbrainedandpoorlyorganized.Routineresponsibilitiesnowseem
overwhelming.Ittakeslongertodothingsbecauseofpoorplanning.Weloseourcar
keysandputoddthingsintherefrigerator.Wecallpeopleandforgetwhywecalledorgo
tothegroceryandforgetwhatweneeded.Wetellpeoplethesamethingtwoorthree
times.
AsstresscontinuesandourSerotoninlevelcontinuestodrop,webecomemore
depressed.Atthispoint,moderatelylowortwoquartslow,majorchangesoccurin
thosebodilyfunctionsregulatedbySerotonin.WhenSerotoninismoderatelylow,we
havethefollowingsymptomsandbehaviors:
Chronicfatigue.Despitesleepingextrahoursandnaps,weremaintired.Thereisa
senseofbeingwornout
Sleepdisturbance,typicallywecantgotosleepatnightasourmind/thoughtisracing.
PatientsdescribethisasMymindwontshutup!Earlymorningawakeningisalso
common,typicallyat4:00am,atwhichpointreturningtosleepisdifficult,againdueto
theracingthoughts.
Appetitedisturbanceispresent,usuallyintwotypes.Weexperiencealossofappetite
andsubsequentweightlossoracravingforsweetsandcarbohydrateswhenthebrainis
tryingtomakemoreSerotonin.
Totallossofsexualinterestispresent.Infact,thereislossofinterestineverything,
includingthoseactivitiesandintereststhathavebeenenjoyedinthepast.
Socialwithdrawaliscommonnotansweringthephone,rarelyleavingthe
house/apartment,westopcallingfriendsandfamily,andwewithdrawfromsocialevents.
Emotionalsadnessandfrequentcryingspellsarecommon.
Selfesteemandselfconfidencearelow.
Bodysensations,duetoSerotoninsroleasabodyregulator,includehotflushesand
temperaturechanges,headaches,andstomachdistress.
Lossofpersonalityasensethatoursenseofhumorhasleftandourpersonalityhas
changed.

Webegintotakeeverythingverypersonally.Comments,glances,andsituationsare
viewedpersonallyandnegatively.Ifsomeonespeakstoyou,itirritatesyou.Iftheydont
speak,youbecomeangryandfeelignored.
Yourfamilywillhavethesensethatyouhavefadedaway.Youtalkless,smileless,
andsitforhourswithoutnoticinganyone.
Yourbehaviorbecomesodd.Familymembersmayfindyousittinginthedarkinthe
kitchenat4:00am.
Individualscanlivemanyyearsmoderatelydepressed.Theydevelopcompensationsfor
thesleepandothersymptoms,usingsleepingmedicationoralcoholtogetsomesleep.
Whilechronicallyunhappyandpessimistic,theyexplaintheirsituationwithItsjustmy
life!Theymaynotfullyrecognizethedepressivecomponent.
VerylowlevelsofSerotonintypicallybringpeopletotheattentionoftheirfamily
physician,theiremployer,orothersourcesofhelp.SevereSerotoninlossproduces
symptomsthataredifficulttoignore.Notonlyareseveresymptomspresent,butalsothe
brainsideation/thinkingbecomesveryuncomfortableandeventorturing.When
Serotoninisseverelylow,youwillexperiencesomeifnotallofthefollowing:
Thinkingspeedwillincrease.Youwillhavedifficultycontrollingyourownthoughts.
Thebrainwillfocusontorturingmemoriesandyoullfinditdifficulttostopthinking
abouttheseuncomfortablememoriesorimages.
Youllbecomeemotionallynumb!Youwouldntknowhowyoufeelaboutyourlife,
marriage,job,family,future,significantother,etc.Itsasthoughallfeelingshavebeen
turnedoff.AskedbyothershowyoufeelyourresponsemightbeIdontknow!
Outburstswillbegin,typicallytwotypes.Cryingoutburstswillsurface,suddenlycrying
withoutmuchwarning.Behavioraloutburstswillalsosurface.Ifyoubreaktheleadina
pencil,youthrowthepencilacrosstheroom.Tempertantrumsmaysurface.Youmay
stormoutofofficesorpublicplaces.
Escapefantasieswillbegin.ThemostcommonHittheRoad!Thebrainwillsuggest
packingupyourpersonaleffectsandleavingthefamilyandcommunity.
Memorytorturewillbegin.Yourbrain,thinkingat100milesanhour,willsearchyour
memoriesforyourmosttraumaticorunpleasantexperiences.Youwillsuddenlybecome
preoccupiedwithhorribleexperiencesthatmayhavehappenedten,twenty,oreventhirty
yearsago.Youwillrelivethedeathoflovedones,divorce,childhoodabusewhatever
thebraincanfindtotortureyouwithyoullfeellikeithappenedyesterday.
YoullhaveEvilThoughts.Newmothersmayhavethoughtsaboutsmotheringtheir
infants.Thoughtsofharmingorkillingothersmayappear.Youmaybetorturedby

images/picturesinyourmemory.Itsasthoughthebrainfindsyourmostuncomfortable
weakspot,thenterrorizesyouwithit.
WithSerotoninamajorbodilyregulator,whenSerotoninisthislowyourbodybecomes
unregulated.Youllexperiencechangesinbodytemperature,aches/pains,muscle
cramps,bowel/bladderproblems,smotheringsensations,etc.TheEvilThoughtsthen
tellyouthosesymptomsareduetoaterminaldisease.Depressedfolksneverhavegas
itscoloncancer.Abruiseisleukemia.
YoulldevelopaNeedforChangePanic.Youllbeginthinkingachangeinlifestyle
(MidlifeCrisis!),adivorce,anextramaritalaffair,anewjob,oraCorvettewillchange
yourmood.About70percentofjobsarelostatthistimeasdepressedindividuals
graduallyfadeawayfromtheirlife.Mostextramaritalaffairsoccuratthistime.
AslowSerotoninlevelsarerelatedtoobsessivecompulsivedisorders,youmayfind
yourselfstartingtocountthings,becomepreoccupiedwithgerms/disease,excessively
worrythatappliancesareturnedoffordoorslocked,worrythattelevisionsmustbe
turnedoffonanevennumberedchannel,etc.Youmaydevelopritualsinvolvingsafety
andcounting.Oneautoassemblyplantworkerbeganbelievinghisworkwouldcurse
automobilesiftheirserialnumber,wheneachnumberwasadded,didntequalaneven
number.
Whatevernormalpersonalitytraits,quirks,orattitudesyouhave,theywillsuddenlybe
increasedthreefold.Aperfectionistwillsuddenlybecomeanxiouslyoverwhelmedby
themessinessoftheirenvironmentordistraughtoverleavesthatfalleachminutetoland
onthelawn.Pennypincherswillsuddenlybecomepreoccupiedwiththeelectricand
waterconsumptioninthehome.
Atriggereventmayproducebizarrebehavior.AlreadymoderatelylowinSerotonin,
ananimalbiteorscratchmaymakeyousuddenlypreoccupiedwithrabies.Amediastory
abouttheharmfuleffectsofradiationmaymakeyourememberateenagetourofthelocal
nuclearpowerplantsuddenlyfeelingallyoursymptomsarenowtheresultofexposure
toradiation.
WhenyoureachthebottomofseverelylowSerotonin,thegarbagetruckwill
arrive.EveryonewithseverelylowSerotoninistoldthesamething.Youwillbetold1)
Youreabadspouse,parent,child,employee,etc.,2)Youareaburdentothosewholove
ordependonyou,3)Youareworseningthelivesofthosearoundyou,4)Thosewhocare
aboutyouwouldbebetterifyouwerentthere,5)Youwouldbebetterifyouwerent
around,and6)Youandthosearoundyouwouldbebetteroffifyouweretotallyoutof
thepicture.Atthatpoint,youdevelopsuicidalthoughts.
ClinicalDepressionisperhapsthemostcommonmentalhealthproblemencounteredin
practice.Oneinfouradultswillexperienceclinicaldepressionwithintheirlifetime.

Depressionisthecommoncoldofmentalhealthpracticeverycommonandmuch
easiertotreattodaythaninthepast.
Treatmentfordepression,asmightbeexpected,involvesincreasinglevelsofSerotonin
inthebrain.Sincethemideighties,medicationshavebeenavailablethatattemptto
specificallytargetandincreaseSerotonin.KnownasSelectiveSerotoninReuptake
Inhibitors(SSRIs),thesemedicationssuchasProzac,Zoloft,andPaxilarefelttowork
bymakingmoreSerotoninavailableinthebrain.
Likeallneurotransmitters,wecanhavetoomuchSerotonin.Whileelevatedlevelsof
Serotoninproduceasenseofwellbeing,bliss,andonenesswiththeuniversetoo
muchSerotonincanproducealifethreateningconditionknownasSerotoninSyndrome
(SS).
LikelytooccurbyaccidentbycombiningtwoSerotoninincreasingmedicationsor
substances,SerotoninSyndrome(SS)producesviolenttrembling,profusesweating,
insomnia,nausea,teethchattering,chilling,shivering,aggressiveness,overconfidence,
agitation,andmalignanthyperthermia.Emergencymedicaltreatmentisrequired,
utilizingmedicationsthatneutralizeorblocktheactionofSerotoninasthetreatmentfor
SerotoninSyndrome(SS).
LikeDopamine,Serotonincanbeaccidentallyincreasedordecreasedbysubstances.One
methodofbirthcontrolisknowntoproduceseveredepressionasitlowersSerotonin
levels.Aspecificmedicationforacnehasalsobeenlinkedwithdepressionandsuicidal
ideation.Forthisreason,alwaysinformyourphysiciansifyouaretakinganymedication
fordepression.Alsoavoidcombiningantidepressantswithanyherbalsubstances
reportedtobeofhelpinDepressionsuchasSt.JohnsWort.