EP 19 – Is It a Chemical Imbalance?

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Episode Transcript

Hello friends!

Welcome to episode 19. Today we’re going to continue our discussion of brain and mental health. I didn’t really set out to have a 3 part series on this topic but it is just so fascinating and so relevant right now that I can’t stop thinking about the implications. 

In the prior two episodes, we talked about the brain-body-mind connection and then went a bit deeper into the key causes of brain dysfunction that drive neurodegeneration as well as many mental health issues. 

I feel like we should take that a bit deeper today.

Let’s start off with a basic premise. We all prefer to be happy. Our most important job as an organism is to stay alive. In order to do that, we have evolved to find positive feelings when we do things that help us survive and negative emotions when we feel threatened. All mammals have these basic instincts and the wiring necessary to create environments that support this desire. 

Viewed through this lens, we are all “self-medicating” all day long. We are making decisions that are geared towards creating more happy brain chemicals than unhappy ones. These chemicals aren’t supposed to be on all the time but we are wired to remember what worked last time so that we can do it again next time. If there is a positive survival value to the behavior, our brains want to know that. We also want to know the behaviors that have negative survival value so that we can avoid those.

There have been many hypotheses and models for how our brains regulate our behavior. The model that most western medicine has been operating under for the past 70 years is called the monoamine hypothesis and it emerged out of an attempt to understand depression. 

I’m no medical historian so I’m going to just give a very oversimplified version of this but suffice it to say that as each of these brain chemicals, called neurotransmitters or neurohormones was discovered, there was an attempt to understand the specific role that that chemical played on our mood and mental state.  

The idea was that depression was the result of a low level of serotonin, dopamine, or other neurotransmitters at the synapse. If we could manipulate this chemical we could feel great all of the time.

This idea seemed to make sense and so the pharmaceutical companies began trying to figure out how to influence serotonin levels over the years they have tried several different approaches and I’ll explain the most popular approach in just a minute.

Unfortunately, this hypothesis had many blindspots and weaknesses. It might have explained some portion of the picture but not the entire picture. And although some people saw the faults from the beginning, it was such an appealing idea that it became the dominant model for decades. Only now, with more understanding from research, the limitations of this model are being more widely discussed. 

Now might be a good time to explain how nerves communicate with each other so that you can see the role of these chemical signals.

Hopefully, you’ve all seen an artist’s rendition of a nerve cell at some point. Let’s just paint a little picture in our minds though. The main part of the cell or cell body is where the nucleus is. Shooting off of this cell body is a bunch of little extensions that might look like a tree with a trunk and some smaller branches. These are called dendrites. In addition to the dendrites, there is also a larger extension called the axon. This is the long tail of the neuron that grows to reach out to connect with other neurons in the vicinity. At the end of the axon is a terminal and at that terminal, there is a bulb. Inside that bulb are small packets of neurotransmitters. When an electrical impulse moves through a neuron it goes from the dendrites at one end to the axon terminal at the other end. When that signal gets to the end, it causes a release of some of the packets of neurotransmitters into a very small space between the bulb and the neighboring dendrite of the next nerve cell. It’s like the message is sent along the nerve in electricity and then at the end of the line, it is handed to the next neuron with a chemical package.  Now the other neuron has to have a special catcher’s mitt on it to receive the chemical package. This is simply called a receptor.  If the chemical message is sent and received correctly, the message spreads. With trillions of these connections in our brains, we get a summation of activity in certain parts that do certain things and somehow, by these simple mechanisms, all of the complexity of life happens. Wild right?

So now with that basic understanding, let’s go just a bit deeper and expose a couple of the problems with the dominant model.

The first problem is that this current model is way too simple. It is true that our brains work by chemicals and electricity so if the brain isn’t working, there has to be a chemical issue at some level, but it doesn’t work clinically to just try to push one chemical up or down. We have to think more holistically.

As I’ve already mentioned, there are lots of chemicals interacting with each other in the brain. Trying to manipulate one at a time without recognizing the impact on the others reflects a lack of sophistication in our understanding of how the brain works. 

Over the past couple of episodes, I’ve already shared a more complete model that now integrates additional variables like inflammatory cytokines, activated immune cells, toxins from the gut, blood sugar, and insulin issues as well as stress hormones and nutrient deficiencies. 

This underscores another weakness. Even if we do uncover an imbalance in the level of a neurotransmitter, without knowing what caused that chemical to be low, we aren’t going to be able to solve the problem. We have to know what is at the root.

A low neurotransmitter level may be caused by a deficiency in a vitamin or mineral that lies along the pathway of production. It may be caused by a lack of nutritional building blocks called amino acids. Both of those issues will be solved with slightly different mechanisms than if the problem is due to neuroinflammation driven by immune-activated inflammation of the brain due to a leaky gut or heavy metal toxicity. You get the picture. 

The current model of treatment is simply to force a temporary state where there is more neurotransmitter available in the synapse so that we might get more docking on the receptor. The most popular class of drugs do this by blocking the reabsorption of the neurotransmitter back into the bulb. But there is a major problem with this idea. The underlying assumption is that there was a deficiency in the quantity of neurotransmitters in the first place, right? Well, the longer the neurotransmitter is sitting out in the synapse between the neurons, the more it gets degraded and damaged by enzymes. So when it does eventually get resorbed, less of it is available for the next signal. So the depletion goes from bad to worse over time. There is no real effort to help the body make more of the deficient chemical. We get a possible temporary win that opens the door to more problems down the road.

Just showing up with the right answer to the test isn’t the same as knowing all of the steps required to come up with the answer. If we don’t know the upstream causes of the problem, we’ll never solve the problem.  This is true of neurotransmitters and hormones and is one of the major exposures of the shortsighted nature of modern medicine. 

It is a very tempting idea. Don’t get me wrong. We all want the most straightforward, simple answer and I certainly don’t fault people for wishing this to be true. There are enough people who feel that their problems are all solved by this model that it has survived for 70 years. It can and often is helpful enough to get people out of a crisis but it comes at a significant cost and there are millions of people out there who go from a 9 or 10/10 down to a 6/10 and then just stay there. They are better but not good and they may have serious side effects. 

Hopefully, we’re all going to live through the transition from this monoamine hypothesis model to a functional mental health model in our lifetimes. The science is continuing to emerge and more useful treatment models are out there.  

Lastly, we have to understand that these chemicals were designed to be released in small amounts to motivate and reward specific behaviors. The brain cells should have plenty of reserves of these neurotransmitters available but there is a purpose for their orchestrated release. There seems to be an idea now that we are supposed to feel great all of the time. That’s probably not a realistic expectation or a healthy model. It often leads us to over-pathologize the normal range of human experience. 

Okay, one last idea that I want you to chew on. We know that without these neurotransmitters, we don’t function well. We don’t feel well and we don’t live a full life. But are these chemicals the cause of how we feel? Or are they the result? 

Could we shape our thoughts and actions such that we create the context where we make more of the chemicals we need? This is where humans separate themselves from the rest of the animal world. Our big fluffy frontal cortex has the ability to create meaning frames that can allow us to get out ahead of our chemistry. We can purposefully do things before we feel like doing things. We can choose an action that will predictably increase the things we know we need.  

Here is where competent mental health professionals and health coaches can really shine. Helping people learn the skills and behaviors that will nudge their physiology in the right direction will help them create new neural pathways and wire differently.

It’s a two-pronged approach. The functional physician can help to ensure that the body is able to make the right chemistry and the mental health professional can address the framing of the lived experience that is causing the brain to engage in failed strategies. Adding the support of a life and the health coach will facilitate the changes in the lifestyle that drives the production and release of the right chemistry at the right time. 

Well, I hope that this episode has you thinking about things a little differently than you did before. 

If you or a loved one is struggling, please reach out and get help. Getting to the root of these issues is the most rewarding part of the work I do. 

Okay, that’s it for today. Share this episode with your friends and family. I appreciate yoru help in reaching more people with this important information. Until next time, let’s go out and do good in the world.

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