Neurotransmitters Made Easy: Chemistry and

Brad Lander PhD, LICDC Clinical Director / Psychologist

Talbot Hall - Addiction Medicine at The Ohio State University Wexner Medical Center

Brain’s switching station Key Point #1 Converts short-term Integrates messages to long-term memory

Thinking and mood are Vigilance, fear, directs attention, controlled by fight-flight-fright response

chemicals Executive functioning (neurotransmitters)

Regulates functions (, thirst, sex, sleep, body temperature)

•1 Two Functions

•Excitatory -  excitability of a nerve cell • Inhibitory – Slows down activity

Key Point #2

We are born with genetically determined sensitivity

Taken from Fred Von Stieff, MD, 2012. Brain in Balance, Ghost River Images

•2 5-hydroxytryptamine (5-HT)

• Well-being • Calm mood •Self-regulation – Sleep, appetite, libido • Social bonding •Empathy

Glutamate

• Excites other • Opposed by GABA • Associative learning

• Associative memory

•3 GABA gamma-aminobutyric acid

• Slows activity of other neurons • Opposes glutamate • Allows calming from fear created in the

Norepinephrine/ (DA) noradrenaline -(NE)

•Pleasure • Warning/vigilance – Food, water, sex •Alarm • • Fight – flight – fright • • Decreases nerve pain

•4 (Ach)

• Sympathetic •  acetylcholine, noradrenalin, & dopamine levels and, at higher doses  serotonin & • Memory (rote) levels • Attention • Increases alertness and energy • Speeds nerve transmission “volume control” • Peripheral nerves, Internal organs, and muscle/nerve • Profile changes from to connection /pain killer with increasing dosages

Endocannabinoid Opiate

• Movement • Analgesia • Cognition •Sedation •Memory • Decrease rate of body functions •Pain perception • Appetite

Endorphin & Factors Affecting Neurotransmitter Systems

•Diet • Endogenous • Body states (fatigue, hunger, illness) • Reduce pain •Events • & well-being • Thoughts • Transmission of pain impulses • Drugs/medicines •

•5 Key Point #2

We are born with genetically determined receptor sensitivity

(Temperament vs. Personality)

Mood Thought Reinforcement Attention Movement

Creative, High-energy Depression

Mood Thought Reinforcement Attention Movement Mood Thought Reinforcement Attention Movement

Schizophrenia ADD

Mood Thought Reinforcement Attention Movement Mood Thought Reinforcement Attention Movement

•6 Parkinson’s Disease Eight Neurotransmitter Systems

Mood Thought Reinforcement Attention Movement

29 primary subtypes 83 variations

Associated Mental Disorders 83 variations Serotonin Depression GABA Anxiety disorder Glutamate OCD/PTSD Dopamine Acetylcholine Alzheimer’s disease Endocannabinoid Amotivational syndrome Opiate Chronic pain disorder

•7 Predisposition for Addiction Alcoholic Family Tree 1

• Serotonin deficiency • B57 rats

Alcoholic Family Tree 2 Drugs Affecting Serotonin

Well-being •Ecstasy Calm mood •MDMA Self-regulation •LSD Sleep, appetite, • libido Social bonding Empathy

Drugs Affecting GABA Drugs Affecting Glutamate

Slows activity of • Excites other • other neurons neurons (PCP) • Opposes Opposed by • • glutamate GABA • Dextromethorphan Allows calming Associative (DMT) from fear created learning in the amygdala Associative memory

•8 Drugs Affecting Dopamine Drugs Affecting

Pleasure •Cocaine Warning/vigilance •Cocaine Reinforcement • Alarm • Motor initiation • Methamphet- Fight – flight - fright Decreases nerve pain

Drugs Affecting Acetylcholine Drugs Affecting Endocannabinoid

Sympathetic • Nicotine • Movement •Tetrahydrocan- nabinol (THC) nervous system • Cognition Memory (rote) •Memory Attention • Pain control Peripheral nerves • Appetite and Internal organs

Drugs Affecting Opiate

Analgesia •Morphine A person’s drug of Sedation • choice is the one Decrease rate of • body functions • that lines up best • with the receptors • •Fentanyl •Tramadol

•9 Key Point #3

Drug use is motivated by “correcting deficits” and Feeling better

Joe

Mood Thought Reinforcement Attention Movement

•10 Joe + Meth Jane

Mood Thought Reinforcement Attention Movement Mood Thought Reinforcement Attention Movement

Jane + Meth Key Point #4

Affecting any one system affects many other systems

Mood Thought Reinforcement Attention Movement

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+

•11 + + + - + +

+ -

+ + Key Point #5 + + + Tolerance is the down- regulation of neurons trying to “right“ the drug- + - created imbalance +

•12 •13 Key Point #6 Key Point #7

Withdrawal is the up- Treatment Involves regulation process of attention to undoing tolerance neurotransmitter systems

•14 Change neurotransmitter Two Types balance

•Diet • – from food – Glutamate, GABA • Wellness (sleep, exercise, relaxation) • Environment • Biogenic – made in the brain – Dopamine, serotonin, • Thoughts norepinephrine, endorphin • Medication

Phenylalanine  fish, poultry, meat, eggs Medications for Serotonin legumes,  cheese, milk, Selective serotonin uptake L- tofu, fruits, L-Tyrosine DOPA vegetables inhibitors (SSRIs) L-DOPA  C, E • Prozac, Paxil, Celexa, Lexapro Dopamine ginseng Monoamines oxidase inhibitor  nettles (MAOI) Norepinephrine red clover dandelion • Parnate, Nardil, Marplan  peppermint

•15 Dopamine

• Abilify • Wellbutrin • Haldol • •Tramadol

Schizophrenia Haldol

DA1 DA2 DA4 5TH1 5TH2 DA1 DA2 DA4 5TH1 5TH2

•16 Seroquil

DA1 DA2 DA4 5TH1 5TH2 DA1 DA2 DA4 5TH1 5TH2

Abilify

DA1 DA2 DA4 5TH1 5TH2 DA1 DA2 DA4 5TH1 5TH2

Opiate

Partial •Buprenorphine Suboxone, Subutex Full •Methadone Antagonist •Naltrexone, ReVia, Vivitrol

•17 Points to Remember Points to Remember

1. Thinking and mood are controlled by 5. Tolerance is the down-regulation of brain chemicals neurons trying to “right “ the drug- 2. We are born with genetically created imbalance determined receptor sensitivity 6. Withdrawal is the up-regulation 3. Drug use is motivated by “correcting process of undoing tolerance deficits” 7. Treatment Involves attention to 4. Affecting any one system affects neurotransmitter systems many other systems

References

• : Drugs, the Brain, and Behavior. Jerrold S. Meyer &, Linda F. Quenzer. Sinauer Associates, 2005. • Brain In Balance: Understanding the and Behind Addiction and Sobriety. Fredrick Von Stieff M.D. Kenyon Hill Publishing, 2012. • The Secret Life of the Brain. Richard Restak, M.D. Joseph Henry Press, 2001.

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