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Neurotransmitters are chemicals that are used to relay, amplify and modulate the brain. They are the molecules that are used to communicate a transmitting nerve cell to a receiving nerve cell.  The 3 most common neurotransmitters are Serotonin, Dopamine and Norepinephrine.  But there are many others.  When a person has a mental illness, usually the cause is an imbalance of one or more of the neurotransmitters.  Your doctor will attempt to determine which chemical you are either lacking or have an excess of, as it is extremely hard to diagnose the actual chemical that is at an imbalance in a person’s brain.  It’s a hit and miss science.  Because of this mental illness is very hard to administer to.  Understand from the beginning is very important.  You are treating your symptoms with medication, altering the makeup of your brain chemicals.  You will have ups and downs, just be honest with your psychiatrist as to what the medications are doing to you, this would be a good time to start keeping a journal if you don’t already. 

So you may have much difficulty in your diagnosis.  But don’t be afraid to commit to treatment because of this.  It will take trial and error to find a treatment for your illness as even professionals quite frequently misunderstand mental illness. Please be careful about taking too many medications as well.

If you think of them as different kinds of fruit it might be clearer.  For example, a neurotransmitter molecule could be an apple, an orange, or a banana.  An apple transmitter can only capture apples, and an orange can only capture an orange and so on and so forth.  If one tries to capture a different kind this causes an imbalance, as they are not doing their designated jobs.  Each one has their own phone line these are the nerves.  They work together to form a team.  But none are alike, much the same as human beings.   

Serotonin is believed to play an important role in aggression and anger. It is also believed to regulate body temperature, mood, sleep, vomiting, sexuality and appetite.  Serotonin is synthesized extensively in the human gastrointestinal tract (about 95%) and the major storage place is platelets in the bloodstream.  It is synthesized from the amino acid tryptophan also known as TPH, as well as the amino acid decarboxylase also known as DDC.  The TPH mediated reaction is the rate-limiting step in the pathway.  There is evidence those genetic polymorphisms in both influence susceptibility to anxiety and depression.  There is also evidence that ovarian hormones can affect the expression of TPH in humans. The gut secretes over 95% of the body’s Serotonin.  

Dopamine receptors are a class of metabotropic G-protein (a subtype receptor) that are prominent in the central nervous system.  Dopamine plays a key role in many processes, such as motivation, learning and fine motor skills.  The Dopamine receptors are common neurological drug targets, which can be the cause of drug addiction. 

Norepinephrine mediates chemical communication in the sympathetic nervous system, a branch of the autonomic nervous system.  It is released at a synaptic nerve ending to transmit the signal from one nerve cell to other cells.  It is released into the bloodstream from the adrenal medulla under sympathetic activation. The sympathetic nervous system functions in response to short-term stress.  Therefore it increases the heart rate and blood pressure.  Other actions of Norepinephrine include increased glycogen as converted to glucose in the liver and the conversion of fatty acids, which relaxes of the body’s resources in order to meet stressful challenges.

There are other types of neurotransmitters, but to keep it simple for the reader, I will only focus on the three main neurotransmitters.  This will help you gain a better understanding of mental illness that you may be experiencing and/or yours.

I cannot stress enough the importance of proper medical care.  Most Psychiatrist are well informed in Bipolar Disorder, however it may be difficult to determine you and yours needs when it comes to psychiatric attention.  Because it is a practice of trial and error, you may find yourself and those around you going through some very bad behaviors.  It may be a bumpy road, but such is the illness of Bipolar Disorder in and of itself. 

Many diseases are the result of a chemical imbalance.  Depression is one, Parkinson’s disease and Alzheimer disease, are a couple more.  A chemical imbalance can be very disruptive to a person’s life.  A chemical imbalance can bring on symptoms that make you behave in a manner, which is not acceptable in society today.  Like being prone to anxiety, being prone to depression, acting promiscuous, and having financial difficulties.

As neurotransmitters are chemicals that allow movement of information from one neuron to another, this can cause and electrical reaction in the brain that facilitates the release of the neurotransmitter in a gap, which in turn causes an imbalance. The transmission of information hits a roadblock when there is a gap in the chemical makeup.  Neurotransmitters are manufactured in a region of a neuron known as the cell body.  From there, they are transported to the terminal end of the neuron, where they are enclosed in small membrane-bound bags called vesicles (the sole exception is nitric oxide, which is not contained inside a vesicle, but is released from the neuron soon after being made).  In response to an action potential signal, the neurotransmitters are released from the terminal area when the vesicle membrane fuses with the neuron membrane.  The neurotransmitter chemical then diffuses across the synapses.

At the other side of the synapses, neurotransmitters encounter receptors.  An individual receptor is a trans-membrane protein, meaning part of the protein projects from both the inside and outside surfaces of the neuron membrane, with the rest of the protein spanning the membrane.  A receptor may be capable of binding to a neurotransmitter, similar to the way a key fits into a lock.  Not all neurotransmitters can bind to all receptors; there is selectivity within the binding process.

When a receptor site recognizes a neurotransmitter, the site is described as becoming activated. When there is a gap, this causes and imbalance.  This can result in depolarization or hyper polarization, which acts directly on the affected neurons, or the activation of another molecule (second messenger) that eventually alters the flow of information between neurons. Depolarization stimulates the release of the neurotransmitter from the terminal end of the neuron.  Hyper polarization makes it less likely that this release will occur. 

This dual mechanism provides a means of control over when and how quickly information can pass from neuron to neuron.  The binding of a neurotransmitter to a receptor triggers a biological effect. However, once the recognition process is complete, its ability to stimulate the biological effect is lost. The receptor is then ready to bind to another transmitter.  This causes confusion in the brain.

Neurotransmitters can also be inactivated by degradation by a specific enzyme called acetycholinesterase.  Cells known as astroctes can remove neurotransmitters from their receptor area. Finally, some neurotransmitters can be reabsorbed into the terminal region of the neuron by taking medication containing the neurotransmitters.

These neurotransmitters are simply signaling mechanisms that tell our brains how to respond to certain stimuli, which may include our own internal thought patterns or circumstanced in the environment around us.  When we respond, or take action, to situations around us, the neurotransmitters are the catalyst for those responses.  Essentially neurotransmitters are responsible for the feelings we experience, such as happiness, sadness, anxiety and fear.

Though it is not clearly understood by researchers exactly how neurotransmitters affect our feelings, clinical studies show that proper balance of neurotransmitters is critical to overall emotional well-being.  Emotional disorders have been linked to chemical imbalance of specific neurotransmitters.   To understand how neurotransmitters worked and why prescription medications are sometimes prescribed to help relieve the symptoms it is important to understand the process of reuptake.

Reuptake or uptake is a chemical process that occurs in the brain. It is defined, as the re-absorption of a neurotransmitter after it has performed its function of transmitting a neural impulse.  In effect, what happens is that the neurotransmitter, once reabsorbed, is no longer available to the active synapses of the brain.  Problems arise when neurons reabsorb neurotransmitters before they’ve had a chance to serve their function.  A lack of availability of Serotonin for example, is believed to be responsible for feelings of anxiousness. 

Modern medications work by inhibiting, or restricting the reuptake of these neurotransmitters in the synapses of the brain.  Taking synthetic reuptake or natural inhibitors, people often report feeling better over a period of 1 week to 3 months.

When patients first begin reclining on the couches of psychoanalytical psychiatrists, the depressed people talk about their past.  This led many psychiatric professionals to believe that the issues began in childhood caused by mental health problems.  But the questions were still not answered. Why would a bad relationship with your mother cause an appetite loss found in depression?  Especially when the problem only began several months prior to the session? But what strange mechanism would a childhood issue create an auditory hallucination, often years after the reported traumatic event?  Many people have had difficult childhoods. But they didn’t hallucinate and have a great appetite.  It became clear that many mental health problems also had a physical component that involved changes in concentration, sleep, speech pattern, energy level, perceptions (hallucinations), and motivations.  Studies began to determine the connection between the condition of the patient and the physical symptoms that were also present.

The brain consists of billions of neurons or cells that must communicate with each other. 

Without neurotransmitters, there would be no communication between and within neurons. The heart wouldn’t get a signal to beat, arms and legs wouldn’t know to move and so on and so forth.

As researchers discovered more about neurotransmitters, they began to identify which neurotransmitters controlled certain bodily functions or which were related to certain emotional/psychiatric difficulties.  As research in neurotransmitters continued, studies between neurotransmitters and mental conditions revealed a strong connection between amounts of certain neurotransmitters in the brain and the presence of specific psychiatric conditions.  Using an everyday example, an automobile operates by using a variety of fluids such as engine oil, and transmission fluid, and marked indicators for anti-freeze and brake-fluid levels.   Using a dipstick to measure engine oil, for an example, they found the engine to be 1, 2, or even 3 quarts low.  After a recent oil change, the dipstick may also tell them that they have excesses of oil in the engine.  To work properly, all fluid levels must be in the "normal range” as indicated by the dipstick.  When we receive blood tests, values of certain blood components are given with the "normal range” also provided, including if a blood chemical is below or above the average range.  Neurological research has identified over 50 neurotransmitters in the brain.  Research also tells that several neurotransmitters are related to mental health problems. 

Unfortunately, the body doesn’t have a dipstick for its neurotransmitters, as least one that’s inexpensive enough for community mental health practice.  There are advanced imaging techniques such as a Positron Emission Tomography (PET scan) that is being utilized in research and in the development of medications that directly influence change in specific neurotransmitters.  Lacking a PET scanner, most professionals evaluate neurotransmitter levels by looking for indicators in through behavior, mood, perception, and/or speech that are considered related to levels of certain neurotransmitters.

This illustrates the lack of tools in the medical profession with respect to mood disorders.  The mental health professionals are often required to separate those who would benefit from counseling and those who may require counseling and an antidepressant medication for depression. The key is looking for those symptoms that are known to be related to chemical changes in the brain.  For example, situational depression often produces sad expressions, worry, pessimistic attitude, and other features but does not create prolonged changes in the physical symptoms such as changes in sexual interest, loss of appetite, or changes in sleep patterns the continued presence of physical symptoms tells the professionals that the brain’s neurotransmitter levels have changed,

The technical aspects of neurotransmitter levels, the psychiatric symptoms they produce, and how medications have been developed to raise or lower the brain levels of these neurotransmitters can be very complicated as you can see.  For this reason, the same procedure of explaining other medical conditions where medication brings symptoms back to the "normal range” is often used.  Medical patients with high blood pressure, high blood sugar or high cholesterol are informed that their body chemistry is too high, or in some cases, too low and must be corrected with medication.  It is the same as with Bipolar Disorder.

For many years mental health professionals have used the term "chemical imbalance” to explain the need for medications that are used to treat mental health conditions for insurance purposes.  This simple and commonly used explanation recognizes that the condition is a medical problem and that it can be treated with medication.  The "chemical imbalance” explanation also reflects the overall theme of treatment, identifying what neurotransmitters are involved in the clinical symptom picture, and attempting to bring the neurotransmitters back to a "normal range”.

Your emotional health is a combination of attitudes, personality, support systems and your brains neurotransmitter levels.  Positive attitudes and healthy personality help bring life’s difficulties into perspective and a healthy support system of family and friends is also valuable during times of trouble.  Despite having these resources, there are still times when coping with our experience and life events change our neurotransmitter status.  Like an overheated automobile, we begin to have a difficulty operating properly. 

We are all at risk for changes in our brain’s chemistry.  Most commonly, we will experience depression, anxiety or stress reactions.  As our neurotransmitters change, they bring with them additional symptoms, behaviors, and sensations that add to our ongoing difficulties.  Recognizing these changes is an important part of treatment and returning you to a regular life again and reducing your stress.

By Andrea McKinney

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