Pharmacology of Recovery from Addictions and Mood Disorders

Pharmacology of Recovery:
Dopamine, GABA, Serotonin,
Acetylcholine
Recovery & Resilience International in partnership with AllCEUs.com Co-
Occurring Disorders Recovery Coaching Curriculum
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC, CCDC
Executive Director, AllCEUs.com

Objectives
 Review the function of the most common
neurotransmitters (Dopamine, Serotonin, GABA,
Glutamate, Norepinepherine, Acetylcholine)
 Explore how different drugs interact with brain chemistry
to produce the reward
 Learn how the brain's natural protective mechanisms
actually cause withdrawal symptoms, and what that
means
 Identify mental health issues associated with imbalances
between these neurochemicals
 Examine ways to deal with chemical imbalances
Recovery & Resilience International in partnership with AllCEUs.com
Co-Occurring Disorders Recovery Coaching Curriculum

Why I Care/How It Impacts Recovery
 Whether it existed before the addiction, or was caused by
the addiction, in early recovery, nearly every person’s
neurotransmitters are out of balance.
 This causes feelings of depression, apathy, anxiety,
exhaustion. This is part of what is referred to as Post Acute
Withdrawal Syndrome
 Understanding why you feel the way you do is the first step
 Figuring out how to help yourself feel better is the next

What are Neurotransmitters
 The human brain is composed of roughly 86 billion
neurons. (1)
 These cells communicate with each other via
chemical messengers called neurotransmitters.
 Neurotransmitters regulate
 Mood
 cravings, addictions
 Energy
 Libido
 Sleep
 Attention and concentration
 Memory
 Pain Sensitivity,

Neurotransmitters Cont…
 About 86% of Americans have suboptimal
neurotransmitter levels — our unhealthy modern
lifestyle being largely to blame. (3)
 Chronic stress, poor diet, environmental toxins,
drugs (prescription and recreational), alcohol,
nicotine, and caffeine can cause neurotransmitter
depletion.

 Mechanism of action/purpose
 Movement
 Memory
 Pleasurable reward
 Learning
 Behavior and cognition
 Attention
Dopamine

 Altered dopamine neurotransmission is implicated in
Cognitive control (racing thoughts)
Attentional control
Impulse control
Working memory
Dopamine

 Where is it found
 Precursor, L-DOPA is synthesized in brain and kidneys
 Dopamine functions in several parts of the peripheral
nervous system
In blood vessels, it inhibits norepinephrine release and acts as
a vasodilator (relaxation)
In the pancreas, it reduces insulin production
In the digestive system, it reduces gastrointestinal motility
and protects intestinal mucosa
Dopamine

 Symptoms of excess & insufficiency
 Excess of dopamine
Unnecessary movements, repetitive tics
Psychosis
Hypersexuality
Nausea
Most antipsychotic drugs are dopamine antagonists
 Note: Antipsychotic drugs are used for many things other
than schizophrenia
Dopamine antagonist drugs are also some of the most
effective anti-nausea agents
Dopamine

 Symptoms of excess & insufficiency
 Insufficient dopamine
Negative symptoms
 Reduction in emotional responsiveness
 Lack of motivation
 Diminished expressiveness (speech/socialization)
 Difficulty concentrating or poor memory
Pain
Restless legs syndrome
Attention deficit hyperactivity disorder (ADHD)
Dopamine

 Nutritional building blocks
 Eating a diet high in magnesium and tyrosine rich foods will
ensure you’ve got the basic building blocks needed for dopamine
production.
 Here’s a list of foods known to provide dopamine building blocks:
Dopamine
Chicken
Almonds
Apples
Avocado
Bananas
Beets
Chocolate
Green leafy vegetables
Green tea
Lima beans
Oatmeal
Sesame & pumpkin seeds
Turmeric
Watermelon
Wheat germ

 Sunlight
 Sunlight also affects both serotonin and dopamine
transporter binding activity.
 Medications
 Increase
Dopamine in blood is unable to cross the blood-brain barrier
to reach the brain.
Levodopa-Carbidopa combination is actually converted to
dopamine in the brain
Mirapex & Requip can increase dopamine receptor activity
Dopamine

 Medications
 Most common dopamine antagonists (positive symptoms)
Risperdone, Haldol, Zyprexa, Seroquel
Metoclopramide (Reglan) is an antiemetic and antipsychotic
Dopamine

 Anti-anxiety, Anti-convulsant
 GABA is made from glutamate
 GABA functions as an inhibitory (chillax)
neurotransmitter
 Glutamate acts as an excitatory (get up and go)
neurotransmitter
 There is always a balance of these two
neurotransmitters…
Like making a warm bath, constantly adjusting the hot
and cold
GABA

 Where they are found
 Close to 40% of the synapses in the human brain work
with GABA and therefore have GABA receptors.
GABA

 Symptoms of excess
 Excess sleepiness
 Shallow breathing
 *Increased blood pressure
 Symptoms of insufficiency
 Anxiety, feeling dread for no particular reason
 Depression
 Difficulty concentrating
 Insomnia
 Seizure disorders
 racing thoughts
 Cold hands
 Heart palpitations and shortness of breath
GABA

Fermented foods sauerkraut, yogurt
Almonds & Walnuts
Cherry Tomatoes
Banana
Brown rice
Potato
Oats
Lentils
Vitamin B6, if deficient, may impair the production of
GABA as it is a cofactor nutrient.
GABA

 Inositol (Vitamin B-8)
Wheat germ
Brown rice
Green leafy vegetables
Nuts
Navy and Lima beans
GABA

 Medications
 Drugs that increase the available amount of GABA
typically have relaxing, anti-anxiety, and anti-
convulsive effect
 Gabapentin (neurontin) is a GABA analogue used to
treat epilepsy and neurotic pain.
 Benzodiazepines and Barbiturates including GHB,
Valium, Xanax
GABA

 Helps regulate
Mood
Sleep patterns
Appetite
Pain perception
 Where is it found
 Brain
 Gut/Intestines
 Skin (Melatonin)
Serotonin

 Depression
 Apathy, Emotional flatness or dullness
 Passivity
 Insomnia and other sleep problems
 Difficulty concentrating and learning
 Poor memory; amnesia
 Difficulty making decisions and acting on them
 Sexual dysfunction
Serotonin

 Symptoms of Serotonin Syndrome (Life
Threatening)
 Shivering
 Diarrhea
 Muscle rigity
 Fever
 Seizures
 Irregular heartbeat
Serotonin

 Insufficiency
 Depression
 Anxiety
 Pain sensitivity
 Women are much more likely to experience mood disorders
and carb cravings
 Men are more likely to be impulsive, have ADHD, and drink alcohol
in excess.
 Serotonin and other hormones
 Estrogen is needed to produce serotonin and serotonin is broken
down into melatonin. (BMC Women's Health)
 Low serotonin and high testosterone levels lead to aggressive
behavior. (Isr Med Assoc J. 2003 Sep;5(9):653-8.)
 Testosterone modulates serotonergic receptor activity in a way
that directly affects aggression, fear and anxiety.
Serotonin

 Foods rich in tryptophan, an amino acid that converts
to serotonin in the brain.
Whole-wheat
Potatoes
Brown rice
Lentils
Oats
Beans
Serotonin

 Medications
 SSRIs
 SNRIs
 5-HTP
 SAM-e
 Sunlight
 The skin is actually a sort of neuroendocrine gland, as
sunshine exposure stimulates skin production of most
neurotransmitters including serotonin, a key compound
involved in cognition, regulation of feeding behavior, mood,
anxiety, aggression and pain, sexual activity, sleep, and
seasonal affective disorder or SAD. Also, melatonin, a
hormone most notably synthesized in the pineal gland and
most importantly associated in the areas of regulation and
the modulation of circadian rhythm, is produced in the skin.
Serotonin

 Their mechanism of action/purpose
 In lower amounts, ACh can act like a stimulant by
releasing norepinephrine (NE) and dopamine (DA).
 Memory
 Motivation
 Higher-order thought processes
 Sexual desire and activity
 Sleep
Acetylcholine

 Depression (all symptoms)
 Nightmares
 Mental Fatigue
 Anxiety
 Insufficiency
 Alzheimers/dementia
 Parkinsons
 Impaired cognition, attention, and arousal
 Inverse relationship between serotonin and
acetylcholine
Acetylcholine

Foods high in choline
 Meats
 Dairy
 Poultry
 Chocolate
 Peanut butter
 Wheat germ
 Brussels sprouts and broccoli
Acetylcholine

 Medications
 Anticholinergics
Atropine
Benzatropine (Cogentin)
Chlorpheniramine (Chlor-Trimeton)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl, Sominex, Advil PM, Unisom)
Hydroxyzine (Atarax, Vistaril)
Bupropion (Zyban, Wellbutrin)
Dextromethorphan - Cough suppressant
Acetylcholine

 Anticholinergic drugs are used to treat a variety
of conditions:
 Gastrointestinal disorders (e.g., gastritis, diarrhea,
diverticulitis, ulcerative colitis, nausea, and vomiting)
 Genitourinary disorders (e.g., cystitis, urethritis,
prostatitis)
 Respiratory disorders (e.g., asthma, chronic bronchitis,
and chronic obstructive pulmonary disease [COPD])
 Insomnia, although usually only on a short-term basis.
Acetylcholine

 There are a variety of different neurotransmitters
involved in addiction and mental health disorders
 It is not always about increasing a
neurotransmitter. Sometimes you need to
decrease it.
 Human brains try to maintain homeostasis and too
much or too little can be bad
 A balanced diet will provide the brain the
necessary nutrients in synergystic combinations
Summary

Apply It
 Identify 3 ways you could have used this information in
the past week.
 What was the situation?
 What did you do?
 How effective was that for you?
 Short term
 Long Term
 If you would have had this new information, what could you
have done differently?
 How would that have changed the outcome?
 How can you start integrating this knowledge into your routine

Summary
 It is impossible to get an accurate level of
different neurotransmitters in the brain
 Treatment of depression, anxiety, sleep disorders
and pain disorders is often like making a good
marinara sauce.
 Identify the symptoms and then decide what you need
more (or less) of
 As you increase certain neurotransmitters, others will
decrease
 This should only be done by a physician…BUT it is
imperative that clients understand what is going on so
they can better communicate with their doc.

Summary
 Clients may be on medications for physical
ailments that are impacting their mood
 Understanding the interaction between
medications is vital

 An overlooked connection: serotonergic mediation
of estrogen-related physiology and pathology
Leszek A RybaczykEmail author, Meredith J Bashaw,
Dorothy R Pathak, Scott M Moody, Roger M Gilders and
Donald L Holzschu. BMC Women's Health BMC series
open, inclusive and trusted 2005 5:12
 Isr Med Assoc J. 2003 Sep;5(9):653-8.
 Aggression: the testosterone-serotonin link.
 Birger M1, Swartz M, Cohen D, Alesh Y, Grishpan C,
Kotelr M.

Pharmacology of Recovery from Addictions and Mood Disorders

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