About 12 yrs ago, I had what I call my "crashed and burned" period. It was a horrible time in my life. Something I wouldn't wish on my worst enemy. It was before difficult child came along, and I had zero knowledge of mental health issues.
I was an over-achiever, and so many things changed for me. My short and long-term memory vanished, I lost my organizational skills, I was sad for no apparent reason, wanted to be alone all the time, I developed severe Obsessive Compulsive Disorder (OCD) behaviors, developed severe anxiety, I couldn't make simple decisions, etc. I even lost my sense of direction.
At the same time, my body started to medically break down. I lost a lot of weight, had seemingly constant headaches, slept very little, my left arm would suddenly go numb, dizzyness, lots of female type problems cropped up, forcing myself to concentrate would literally make my brain feel like it was burning and more. Emotionally, I was dead. I couldn't function at work or in my private life. I felt like I was dying.
I went from doctor to doctor to doctor to no avail -- at least 5 or 6.
The last doctor I went to said, "Life is too short. Get rid of whatever is bothering you." (How's that for a treatment plan?) So I did. I didn't really know what was bothering me. I totally changed my life -- making major life-changing decisions when I should have been hospitalized. I took a leave of absense from a job I'd had for nearly 20 years, left my ex, and moved out-of-town.
All of this was so very out-of-character for me, I just couldn't understand.... I obsessed on finding out what had happened to me, but it was many years later before that happened. I knew it had to be stress related, because 2 or 3 years down the road from my "crash and burn," when I was under a lot of stress, I could feel myself slipping back to that bad time.
When difficult child was in counseling, I asked his psychologist about it. In 3 minutes or less, she said, "You depleted your natural resources." It took some more time before I came to understand that, too. The excerpt below explains it.
The short version is that I had a very high-pressure job that after nearly 20 years of working with very little time off, the mind just couldn't go anymore no matter how hard I pushed it. And it really wasn't sudden. Looking back, about +/5 years prior, the red flags started to present. Long-term stress does a number on mind and body.
Not one doctor I saw ever suggested that I go to a psychologist or psychiatrist and I was ignorant.
If you even think you might need help, be proactive -- see a good mental health provider.
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:
Chronic fatigue. Despite sleeping extra hours and naps, we remain tired. There is a sense of being "worn out"
Sleep disturbance, typically we can't go to sleep at night as our mind/thought is racing. Patients describe this as "My mind won't shut up!" Early-morning awakening is also common, typically at 4:00 am, at which point returning to sleep is difficult, again due to the racing thoughts.
Appetite disturbance is present, usually in two types. We experience a loss of appetite and subsequent weight loss or a craving for sweets and carbohydrates when the brain is trying to make more Serotonin.
Total loss of sexual interest is present. In fact, there is loss of interest in everything, including those activities and interests that have been enjoyed in the past.
Social withdrawal is common not answering the phone, rarely leaving the house/apartment, we stop calling friends and family, and we withdraw from social events.
Emotional sadness and frequent crying spells are common.
Self-esteem and self-confidence are low.
Body sensations, due to Serotonin's role as a body regulator, include hot flushes and temperature changes, headaches, and stomach distress.
Loss of personality a sense that our sense of humor has left and our personality has changed.
We begin to take everything very personally. Comments, glances, and situations are viewed personally and negatively. If someone speaks to you, it irritates you. If they don't speak, you become angry and feel ignored.
Your family will have the sense that you have "faded away". You talk less, smile less, and sit for hours without noticing anyone.
Your behavior becomes odd. Family members may find you sitting in the dark in the kitchen at 4:00 am.
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:
Thinking speed will increase. You will have difficulty controlling your own thoughts. The brain will focus on torturing memories and you'll find it difficult to stop thinking about these uncomfortable memories or images.
You'll become emotionally numb! You wouldn't know how you feel about your life, marriage, job, family, future, significant other, etc. It's as though all feelings have been turned off. Asked by others how you feel your response might be "I don't know!"
Outbursts will begin, typically two types. Crying outbursts will surface, suddenly crying without much warning. Behavioral outbursts will also surface. If you break the lead in a pencil, you throw the pencil across the room. Temper tantrums may surface. You may storm out of offices or public places.
Escape fantasies will begin. The most common Hit the Road! The brain will suggest packing up your personal effects and leaving the family and community.
Memory torture will begin. Your brain, thinking at 100 miles an hour, will search your memories for your most traumatic or unpleasant experiences. You will suddenly become preoccupied with horrible experiences that may have happened ten, twenty, or even thirty years ago. You will relive the death of loved ones, divorce, childhood abuse whatever the brain can find to torture you with you'll feel like it happened yesterday.
You'll have Evil Thoughts. New mothers may have thoughts about smothering their infants. Thoughts of harming or killing others may appear. You may be tortured by images/pictures in your memory. It's as though the brain finds your most uncomfortable weak spot, then terrorizes you with it.
With Serotonin a major bodily regulator, when Serotonin is this low your body becomes unregulated. You'll experience changes in body temperature, aches/pains, muscle cramps, bowel/bladder problems, smothering sensations, etc. The "Evil Thoughts" then tell you those symptoms are due to a terminal disease. Depressed folks never have gas it's colon cancer. A bruise is leukemia.
You'll develop a Need-for-Change Panic. You'll begin thinking a change in lifestyle (Midlife Crisis!), a divorce, an extramarital affair, a new job, or a Corvette will change your mood. About 70 percent of jobs are lost at this time as depressed individuals gradually fade away from their life. Most extramarital affairs occur at this time.
As low Serotonin levels are related to obsessive-compulsive disorders, you may find yourself starting to count things, become preoccupied with germs/disease, excessively worry that appliances are turned off or doors locked, worry that televisions must be turned off on an even-numbered channel, etc. You may develop rituals involving safety and counting. One auto assembly plant worker began believing his work would curse automobiles if their serial number, when each number was added, didn't equal an even number.
Whatever normal personality traits, quirks, or attitudes you have, they will suddenly be increased three-fold. A perfectionist will suddenly become anxiously overwhelmed by the messiness of their environment or distraught over leaves that fall each minute to land on the lawn. Penny-pinchers will suddenly become preoccupied with the electric and water consumption in the home.
A "trigger" event may produce bizarre behavior. Already moderately low in Serotonin, an animal bite or scratch may make you suddenly preoccupied with rabies. A media story about the harmful effects of radiation may make you remember a teenage tour of the local nuclear power plant suddenly feeling all your symptoms are now the result of exposure to radiation.
When you reach the bottom of "severely low" Serotonin, the "garbage truck" will arrive.
Everyone with severely low Serotonin is told the same thing. You will be told
1) You're a bad spouse, parent, child, employee, etc.,
2) You are a burden to those who love or depend on you,
3) You are worsening the lives of those around you,
4) Those who care about you would be better if you weren't there,
5) You would be better if you weren't around, and
6) You and those around you would be better off if you were totally out of the picture. At that point, you develop suicidal thoughts.
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.
Norepinephrine: From Arousal to Panic
Norepinephrine (NE) is the neurotransmitter often associated with the "fight or flight" response to stress. Strongly linked to physical responses and reactions, it can increase heart rate and blood pressure as well as create a sense of panic and overwhelming fear/dread. This neurotransmitter is similar to adrenaline and is felt to set threshold levels to stimulation and arousal. Emotionally, anxiety and depression are related to norepinephrine levels in the brain, as this neurotransmitter seems to maintain the balance between agitation and depression.
Low levels of norepinephrine are associated with a loss of alertness, poor memory, and depression. Norepinephrine appears to be the neurotransmitter of "arousal" and for that reason, lower-than-normal levels of this neurotransmitter produce below-average levels of arousal and interest, a symptom found in several psychiatric conditions including depression and ADHD. It is for this reason that medications for depression and ADHD often target both dopamine and norepinephrine in an attempt to restore both to normal level.
Mild elevations in our norepinephrine levels produce heightened arousal, something known to be produced by stimulants. This arousal is considered pleasurable and several "street drugs" such as cocaine and amphetamines work by increasing the brains level of norepinephrine. This increased sense of arousal is pleasurable, linking these substances to their potential for addiction. Research tells us that some individuals using antidepressants develop a state of "hypomania" or emotional elation and physical arousal in this same manner. For that reason, individuals using modern antidepressants are often cautioned to notify their treating physician/psychiatrist if they become "too happy".
Moderately high levels of norepinephrine create a sense of arousal that becomes uncomfortable. Remembering that this neurotransmitter is strongly involved in creating physical reactions, moderate increases create worry, anxiety, increased startle reflex, jumpiness, fears of crowds & tight places, impaired concentration, restless sleep, and physical changes. The physical symptoms may include rapid fatigue, muscle tension/cramps, irritability, and a sense of being on edge. Almost all anxiety disorders involve norepinephrine elevations.
Severe and sudden increases in norepinephrine are associated with panic attacks. Perhaps the best way to visualize a panic attack is to remember the association with the "flight or fight" response. The "flight or fight" response is a chemical reaction to a dramatic and threatening situation in which the brain produces excessive amounts of norepinephrine and adrenaline giving us extra strength, increased energy/arousal, muscle tightness (for fighting or running), and a desperate sense that we must do something immediately. This animal response was activated in early man when a bear showed up at his cave or when faced with a tiger in the woods. In modern times, imagine your reaction if while calmly watching television, someone or something started trying to knock your front door in to attack you. In the "flight or fight" reaction, your brain and body chemistry prepare you to either run from the situation or fight to the death!
A panic attack is the activation of the "flight or fight" chemical reaction without a bear at the door. It's as though the self-protection animal response is kicking-off accidentally, when no real life-threatening situation is present. Known now as panic attacks, they can surface at the grocery, at church, or when you least expect it. As norepinephrine is a fast-acting neurotransmitter, the panic attack may last less than ten minutes (feels like hours however!) but you'll be rattled/shaken for several hours. Panic attacks are strong physical and chemical events and include the following symptoms:
Palpitations, pounding heart or rapid heart rate
Sweating and body temperature changes
Trembling or shaking
Shortness of breath of smothering sensations
Choking sensations
Chest pain and discomfort
Nausea or stomach distress
Dizziness, lightheadedness, or feeling faint
Sense of unreality, as though you are outside yourself
Fear of losing control or going crazy
Fear of dying
Numbness and tingling throughout the body
Chills and hot flushes
If we think about the automobile example, a panic attack is the equivalent of your dashboard warning lights coming on your stress level is too high. Panic attacks, or surges of norepinephrine, can also occur by accident as when created by the use of certain medications. The medications for certain medical conditions can cause a panic attack or increase our level of anxiety. Medications often used for asthma, for example, can create anxiety or panic attacks.
Treating low or elevated levels of norepinephrine in the brain involve different approaches. Low levels of norepinephrine are often treated using newer antidepressants. Many new antidepressants, known as Serotonin-Norepinephrine Reuptake Inhibitors (SNRI's) with brand names like Effexor and Serzone, treat depression by increasing levels of both serotonin and norepinephrine neurotransmitters.
Treatment for high levels of norepinephrine, as found in anxiety and panic disorders, involves decreasing neurotransmitter levels directly or using medications which increase another neurotransmitter that inhibits or decreases the action of norepinephrine. One of those inhibiting neurotransmitters is GABA, also known as Gamma-Aminobutyric Acid.
