How Stress Alters Hormones, Neurotransmitters & Mental Health

Foreign like to welcome everybody to today's presentation on the neuroscience of mental health. Overview of the autonomic nervous system and associated hormones and neurotransmitters. I'm your host, Dr. Donnelly Snipes. In this relatively long presentation, you're going to learn about the Goldilocks principle, neurotransmitters and hormones and their functions. You'll learn about the hpa, hpg, HPT axes and how they impact all the major neurotransmitters and hormones, symptoms of imbalance. And finally, we'll discuss strategies for healing the nervous system and healing the HP axes in all pieces of your life. So let's start out at the very beginning, the autonomic nervous system. Now, when we start using all these big terms, people start, you know, phasing out really quickly, and I, and I don't want you to do that. The autonomic nervous system is the nervous system that helps regulate what's going on in your body. You can think about it as the automatic nervous system. It has the sympathetic nervous system. And again, you can think of this as your body having sympathy for you when there is a threat out there. The sympathetic nervous system is the stress. For version, it's the upregulator. While not a single nerve, the sympathetic trunk forms the main structural component of the sympathetic nervous system, allowing for widespread distribution of signals throughout the body, enabling the fight or flight response. So just like the vagus nerve meanders or wanders through the body, the sympathetic trunk also does the similar thing. So it's got its little projections, if you will, in all of our organs and systems and helps regulate it, helps upregulate us when we need to be upregulated. The parasympathetic nervous system is your downregulator. And the main component of the parasympathetic nervous system is the vagus nerve. Most of you have heard about the vagus nerve. This is your, if you want to think of it this way, your rest and digest nerve nerve. The vagus nerve takes in information and it tells the rest of the body, hey, the threat has passed. We can wind down now people who have been stressed for a long time, chronic stress. Whether it's physical stress or environmental stress, chronic stress can cause that sympathetic nervous system to be activated a lot. And when it's activated a lot, and, and this is grossly oversimplifying it, but when that nervous system is activated a lot, then the parasympathetic nervous system and the vagus nerve kind of get rusty and they kind of get out of shape and they don't respond as well. This gets a lot stronger because it's constantly being activated. And this one gets a lot weaker because it's not being used. Which is why when we talk about healing from trauma and healing from autonomic dysregulation, a lot of times one of the main focuses is helping to strengthen the vagus nerve response, helping the body recognize, hey, there's no threat here. We can down regulate and, well, we'll get to that. The vagus nerve makes up about 75% of your parasympathetic, parasympathetic nervous system overall, connecting to your heart, lungs, gut and other vital organs. The HP axes, and I have that little slot there because we're going to talk. There are multiple axes that are hypothalamic, pituitary, and then other axes. So the HP axes as a group are part of the endocrine system. So they're not actually part of the nervous system. They regulate the release and reuptake of neurotransmitters and hormones through hormone signaling, which isn't really important in our field to do a whole bunch of differentiation. But it is interesting to note, and that's what we're going to talk about most today, are the HP axes, those hormones and neurotransmitters, and what causes them to get out of whack and the symptoms of those axes being out of whack. The Goldilocks principle is something that we don't focus on enough and it's vital. I think I talk about it later in the presentation. But just like making a good spaghetti sauce, for example, you have to have the right balance of ingredients. Too much or too little, and you don't get the flavor you want. The same thing is true for our hormones and neurotransmitters. Too much estrogen or too little estrogen has symptoms. Too much dopamine, too little dopamine, we have symptoms. We need to be in that sweet spot of just right. You don't need to memorize these, but I created a mnemonic because, you know, I like my mnemonics to help us remember all of the different hormones and neurochemicals in the body. Snagged E represents largely your neurotransmitters. Serotonin, norepinephrine, acetylcholine, glutamate, gaba, your endorphins, dopamine, and your endocannabinoids. Cat T dope represents mainly your hormones, and this is cortisol, adrenaline, thyroid, testosterone, dhea, Oxytocin, progesterone, and estrogen. Now why do we care? Because when any one of these is insufficient or in excess, it throws the balance of the rest of them out. When we are in down regulation, when we're relaxing, certain hormones and neurotransmitters kick into gear, like GABA and endorphins and oxytocin. And when we are in stress gear, we have other hormones and neurotransmitters that kick into gear, like glutamate and norepinephrine and cortisol and adrenaline. So we need to recognize that for every feeling, for every action, there is a special recipe of the hormones and neurotransmitters that we need to have. Hormones and neurotransmitters have receptors throughout the body. Yes, you can take a blood test and identify your levels of dopamine or serotonin, but that doesn't tell you the levels of serotonin or dopamine in the brain. That also doesn't tell you how well that system is actually working. You may have perfect levels of serotonin or dopamine, but the receptors are not receptive. So no matter how much dopamine you have, it doesn't matter because those receptors are already blocked. And that's one of the things we see in medication assisted therapy. When people start taking opioid antagonists, it blocks those receptors. So if they take an opioid, it doesn't have an effect. The opioid stimulates the release of dopamine and endorphins in the, in the body. But then those dopamines and endorphins are trying to activate the receptors, and the receptors just aren't receptive because they're already blocked off. Anyhow, I want you to think about, as we go through the next two slides, which mental disorders have the symptoms of problems in these areas and what I mean by that. For example, in anxiety and ptsd, we see, we often see hyperarousal. In people with clinical depression, we often see hypoarousal. And our arousal is controlled or regulated by our levels of dopamine, norepinephrine, glutamate, testosterone, oxytocin, endorphins, and thyroxin. Now, thyroxin is a thyroid hormone, and we'll put these all together later. But I want you to think about this for a second. As we age, our levels of testosterone naturally go down. Some people who have dysfunction in their dopaminergic system, also because dopamine is low, may also have dysfunction in their oxytocin system. Some people have lower levels of oxytocin because they're not engaging in with other people. And oxytocin is released when we pet an animal, when we do nice things for others, when we receive physical contact. It doesn't have to be physical contact, but it's that feeling that helps us feel connected to somebody that's caused when oxytocin is secreted. And if you've got somebody who is largely agoraphobic, especially if they don't have any pets at home, their oxytocin may be super low, which may contribute. People who have clinical depression may have a hard time getting out of bed and so they're not encountering others, which also may trigger that low levels of oxytocin. So these are all things that we can think of. So what are you going to do? Well, there's a lot of things and again, we're going to talk about that mainly at the end. But for oxytocin, we can help people figure out what is it that you can do to help yourself feel connected to someone or something else. And it could be video chatting, it could be phone calls. Maybe they're just, they've kind of sworn off people right now. The world is just too peoplely. Are they willing or are they able to have a pet and you, yes, snakes count, even though you don't think of them as, you know, warm fuzzies. Like you think of a dog or a cat if it's something that you can pet, if it's something that you can receive input from, you know, that unconditional positive regard, it's going to trigger oxytocin receptors. And so, you know, I guess what I'm saying is it doesn't have to be a huge animal that's banned in apartments, for example, but for some of these other things, we're going to talk about resetting circadian rhythms, nutrition, etc, attention. We have attention deficit. In attention deficit disorder, we have attention issues. In anxiety, we have attention issues. In depression, we. So thinking again about those diagnoses that we give people where attention deficits may be or, or hypervigilance even may be a problem, your gonadal hormones and I put in here in Goldilocks because this is one of those if your estrogen or your testosterone is too high, they find that the person tends to be more hypervigilant or whereas when their gonadal hormones are low, they tend to have more difficulty focusing on things. Thyroid, dopamine, norepinephrine, and acetylcholine and then mood. Of course, when we're talking about mood disorders, we are talking about how somebody feels. So your anxiety, your depression. But we also have mood symptoms in, in ptsd. We also have mood symptoms in personality disorders. So we want to really be broad in looking at this when we have a feeling, an emotion, a physiological or emotional response that is driven by the release of hormones and neurotransmitters and the activity of our nervous system. So it's important to understand that people's systems have been altered when they are experiencing especially long term stress, anxiety, depression, etc. There's a saying, neurons that fire together, wire together. And what that means again is if they are chronically stressed, then that sympathetic nervous system is going to get really strong. Parasympathetic nervous system, that vagus nerve is going to kind of, it's not going to peter out, but it's not going to be nearly as strong and it's going to be hard for the person to trigger the release of some of these hormones. Now one that we haven't talked about in, well, we didn't talk about it in, in the mnemonics, but nitric oxide is also a contributor to mood. And the reason I put that in there, even though we're really not going to talk about it a lot today, is nitric oxide is really a huge nootropic that they're pushing on people right now. Take this nitric oxide and you'll have all this energy. They put it in energy drinks, they put it in health drinks. But we want to recognize that we got to focus on the Goldilocks principle too much and we may over stimulate some of our, our receptors and we need to be smart about it. Motivation. The hormones and neurotransmitters that are really involved in motivation are dopamine, norepinephrine, testosterone, oxytocin and endorphins. So oxytocin comes up again, Oxytocin comes up a whole lot more than you would think sleep is involved in, is promoted by serotonin, gaba, testosterone and estrogen. When people's gonadal hormones get out of whack, it affect affects the ability of serotonin to do its job. And serotonin we know is broken down into melatonin to help us drift off to sleep. So if our gonadal hormones, like when we age or when people start taking hormone replacement therapy or birth control pills, or when we start monkeying with those gonadal hormones, we start seeing potential changes in sleep. Patterns and even circadian rhythms. In terms of energy. Low energy is a very common symptom of depression. Feeling revved up on edge, you know, unable to sit still. The person is constantly sort of dumping energy. But our energy is regulated by. By our HPA axis in large part. And the release of insulin and which is blood sugar and. Or insulin, which helps process blood sugar and fatty acids. When we're stressed and we need energy, testosterone, estrogen, typically go up. Why? Because they are activating the release of energy. People who have high estrogen levels often report levels of anxiety. People who have high serotonin levels often report having feelings of anxiety. They've just got too much going on. Glutamate is another excitatory neur neurotransmitter and dopamine. Paying attention to these things in people who have monthly cycles. And some, some women have started taking birth control, so they don't even have monthly cycles anymore. They, you know, every three months or something they may. Which in and of itself, that's disrupting the natural circadian rhythm and can alter the ability for serotonin and dopamine to do their job effectively. Inflammation and immunity. This is not often cited as a diagnostic criteria in the DSM 5TR. However, we do recognize from the research that people with anxiety, PTSD and depression, in addition to some of your other issues, often usually have increased levels of systemic inflammation. And we'll talk about why that is in a minute. When our body is in a perpetual state of inflammation or injury, then the body's working hard to try to figure out, okay, how do I tamp down this inflammation? Which means it's not paying as much attention to the bugabuggas. When we get stressed, our immunity typically goes down. When our HPA axis and HPG axis gets out of whack, we tend to be more likely to get sick. And I think most of us can think back to high school or college when we had finals and we stayed up for a week ahead of time cramming for. For those finals and then the week after finals. You would be sick as a dog. I know I would be. And then pain tolerance again. Not one that is often registered. Yeah, go Gators. Not one that is often registered in the. DSM 5tr. However, pain tolerance is a big issue. People who have depression often feel achy. It often actually hurts to move. And what we've seen is the alteration in gonadal hormones. Serotonin, dopamine and I should have. And endorphins are common in major depressive disorder. So they actually do feel more pain. They actually do hurt more because their body is not suppressing the pain the way it would if it were healthy. In anxiety disorders and trauma related disorders, people tend to be more hypervigilant, more stressed, more tense, and that can lead to a whole host of pain issues as well as the same issues we're going to talk about with depression, where the receptors for the endorphins just quit being receptive, they become resistant or tolerant. Are there any questions so far? It. And yes, Michelle, that's, that's a great way to put it. Your body goes through physically what you're going through mentally because what you're feeling emotionally and how you're able to think you emotionally and cognitively is impacted by, by all those hormones and neurotransmitters that body factory is promoting or creating those feelings and reactions. And, and yes, there is. We will talk at the end of this today about how to reverse these effects in people with trauma, with chronic stress so they can feel, so they can be more regulated. And it's a long process. When one of the things I get very frustrated with clients in early recovery from addiction, for example, they want to feel better now. And when I tell them, well, in recovery you've got this period that we call post acute withdrawal, which can last for up to two years. And they look at me like I've got three heads and you know, okay, you know, believe what you want, but I can show the, can show the research evidence if they're interested. But it takes a while for the body to recover. It's kind of like if you've ever been a runner, going from running a full sprint and then trying to recover with a jog versus recovering by, you know, just kind of stopping and doing a really slow walk and trying to catch your breath, you recover a whole lot faster. If you can let your body, you know, get the message and focus on, on the recovery process. But as I've said many times, most people can't go sit on a beach in Tahiti for three months. So they're going to have stress in their life. What we need to do is help them identify all of the areas that they can reduce stress in their life, recognizing that just like after open heart surgery, the heart has to heal itself, the skin has to repair. You know, if they cracked your ribs open, that has to heal. There's a lot of healing that has to go on. You're not going to get up from open heart surgery and be running four miles the next week. It Takes your body time and your nervous system is no different. And I agree with you, Danielle. One of the things I always do when working with people is strongly suggest I can't require, but strongly suggest that they go to the doctor and have a full physical, including a full blood panel that looks at their hormones, their, their gonadal hormones and their thyroid hormones, as well as their vitamin D levels, their iron levels, their B12 levels. Those are the five things that are really commonly sort of out of whack in people who have mood issues or mood symptoms, whether it's a mood disorder or it's related to a trauma issue, or it may be related to something else like aging or premature, premature menopause that can really upset the apple cart and helping them recognize that once their hormones stabilize. We see the same thing in women who are postpartum. We see the same thing in people who have complete hysterectomies where their ovaries are also removed. So there are a lot of changes. And I haven't worked with somebody who is on hormone therapy who is transgender, but I would strongly guess that they may also have a whole host of symptoms that they've got to deal with as their body adapts to a recipe of hormones and neurotransmitters that it's not used to. Great question. Cortisol is your main stress hormone. And we're not going to go through each one of the hormones and neurotransmitters, but we're going to hit the highlights. Cortisol is your main stress hormone. It's also a steroid. It's anti inflammatory. It peaks in the morning and gradually declines during the day. We call this the awakening response. It's normal and it should be. It should be happening. You should wake up and have more energy and then be tired by the end of the day. That is a typical circadian rhythm. Some people, when their circadian rhythms get out of whack because of stress, because they're not sleeping well for a variety of reasons. The because I've got really poor sleep hygiene. They. They may awaken in the morning whenever they're supposed to get up and their body says, no, not doing it. And hopefully at some point along there, they do have a cortisol spike that gives them the energy to get through the day. But a lot of times people don't. People who have had chronic stress, who have cptsd, who have uncontrolled ptsd, who have anxiety disorders or depression, often don't have this awakening response. They wake up in the morning and they're, they're just like, I, I can't, I don't know if I can get out of bed. Now. Some people have the opposite where they're hypersensitive to that awakening response and when it happens, they feel like they're going to crawl out of their skin. They wake up in the morning and, and they're like, oh my gosh, I can't face the day. It feels like this, the sky is going to fall. Helping people recognize that, yes, their thoughts, their beliefs, their expectations about what is happening during the day is important. It's also important to recognize that even if you're addressing those things, if your body is wired to be hypersensitive to cortisol than in the morning, when your body naturally spikes your cortisol until that system heals it, you're going to have that morning anxiety. And help them develop tools to downregulate instead of feeling like, oh my gosh, this is going to be a horrible day. And, and so those are things that we can help people do do is help them develop skills to cope while they heal. Just like the person who breaks their femur, the big bone in your thigh, you're not getting up and walking around even with a cast on. You're going to have this big old cast. You're going to probably be in traction for a while and then in a, in a wheelchair while the bone heals. But you still gotta pee, you still got to take a shower, you've still got to cope with the pain, you've still got to deal with life. You know, the world doesn't stop just because you broke your femur. Helping people manage their stress and their frustration at not being able to do things like they think they should be able to do or like they used to be able to do is part of our job. Helping them recognize and learn those tools to tolerate that distress until their HP axes heal. Cortisol helps regulate your circadian rhythms. And as we go into the rest of the presentation and talk about how cortisol can get out of whack, you're going to see why a lot of the people we work with have circadian rhythms that are either non existent or just all over the place. So cortisol helps regulate circadian rhythms, it helps control blood sugar levels, it helps regulate metabolism, it helps reduce inflammation, it helps with memory formation, it helps with control salt and fluid balance, and control blood pressure. I bet you didn't know about the whole salt and fluid balance thing either. So when people get really stressed, they may have more difficulty controlling their salt and fluid balance. Well, what do we know happens to the body when our salt and fluid balance gets out of whack? Generally the blood pressure either goes way up or sometimes way down, but typically way up. So again, you need to have enough cortisol to regulate things, but, but not so much that you're causing excess stress on any of these systems. The other thing I do want to point out is the blood sugar. If your body is constantly stressed and you're constantly releasing cortisol, then you're constantly releasing blood glucose for the fight orf flight reaction, which also means those blood glucose receptors, those glucose receptors are constantly being bombarded. And when you have somebody that is doing that, then it's harder for them to control their blood sugar and eventually they may start developing symptoms of diabetes. Adrenaline is a stimulant that triggers the fight or flight reaction and increases in blood pressure and increases blood pressure, respiration and blood sugar. Again, we want to have adrenaline to give us energy. We want to have cortisol and glutamate to give us energy. But when that happens, the way it gives us energy is by releasing blood sugar and fatty acids, which is good in the short term, but not continuously. Thyroxine is your thyroid hormone. Thyroid hormones help regulate your metabolism and increase during normal activation of the HPA axis. So again, if the system is calibrated correctly, then when there's a stressor, your thyroid hormones kick into gear. Your adrenaline, glutamate, cortisol, all those faucets get turned on in order to give you the energy and the focus to do what you need to do to survive. Thyroxin is inversely related to cortisol under conditions of chronic or extreme acute stress. So what this means is under chronic stress, those thyroxin, the thyroxin system becomes resistant to activation. It's just like, no, not going to do it, not worth my time. I'm going to conserve my energy for when it's really needed. And then melatonin is created by breaking down serotonin. It's an anti inflammatory and an antioxidant. When people are stressed, then that throws the system out of whack. It reduces the ability of serotonin to do its job and leads to potentially an increase in systemic inflammation. Melatonin, as most of us know, assists with sleep promotion and is inversely related to cortisol. Which is why we tell people, try not to do something that's physically or emotionally stressful, like two hours before bed, because if your cortisol goes up, then your melatonin production is not going to happen or not going to be nearly as efficient. We want to allow the cortisol levels to peak in the morning, gradually decline through the day, be at their lowest in the evening, right before we're ready to go to bed. And that signals your brain to start breaking down serotonin to make melatonin, estrogen and progesterone. Chronic stress and cortisol release often reduces estrogen in the long term. Now, we're not talking the short term. In the short term, if it increases it, but in the long term, again, those receptors become resistant to activation. They become. Think of it as tired if you want to. And so estrogen and progesterone often go down, which results in amenorrhea in women and possibly postpartum depression and autoimmune issues. Remember that people of both sexes have estrogen and progesterone. The dominant gonadal hormone in females is estrogen. The dominant gonadal hormone in males is testosterone. So when those things, when estrogen gets out of whack in somebody who is female, then it's a much bigger deal. And once testosterone gets out of whack in somebody who's male, it's a much bigger deal. Now, I'm not as familiar, I'm not very familiar at all with the research on gender affirming therapy and transgender hormone therapy. My guess, and if anybody's worked with that, that group and can add some information, that'd be great. My guess is that once somebody has transitioned over, so someone who is biologically female is. Has higher levels of testosterone and has the hormone balance of the male gender, then obviously what we're looking at is which gonadal hormone is most prominent in this individual. But again, I am just speculating here based on what we see in people who are biologically male and biologically female. Testosterone increases in both genders in response to cortisol and HPA axis activation, especially during competition. We see people's testosterone levels, you know, get all amped up when they're getting ready to run a race or do something. And that's a competitive response which was developed, you know, to help us survive, to help us be the strongest one, to be the fastest one to get to the food or get away from the hungry tiger or whatever it is. Testosterone decreases under conditions of hypocortisolism or glucocorticoid resistance, which we haven't talked about quite yet, but that's under chronic stress when cortisol is released but not able to activate the receptors. We call that hypocortis. Hypocortisolism. And so when cortisol can't do its job, then testosterone doesn't get the signal, so it doesn't get released either, and testosterone levels decrease. Oxytocin, very interestingly has a positive correlation with cortisol, suggesting there may be a social support system seeking response. When people are under stress in. Under certain conditions, not all conditions. Under certain conditions, they may have an increase in oxytocin. Think about babies or small children. When they're under stress, they want caregiver. You know, they. They run to caregiver. They have this internal driving force, which is oxytocin, that says, hey, flee to safety. So we can see why, in some circumstances, oxytocin actually does increase when people are under stress. Yes, it increases when people are relaxing, too. But it. It's one of those things that we need to pay attention to or just recognize that hormones and neurotransmitters may serve different functions at different times. Changes in the hypothalamic pituitary gonadal axis. So your gonadal hormones are also implicated in cognitive decline and increased risk of neurogenerative diseases like Alzheimer's. All right, so why do we care? You may be seeing people in clinic that have. That are aging and starting to have cognitive decline. You may be. And I can speak from my own experience. I went into premature menopause, and my cognition went, you know, was not good. My motivation was low. You know, I was very sluggish, didn't really know exactly what was going on. Obviously, I was having hot flashes, so I wasn't sleeping well at night. And I just attributed everything to not sleeping well because of the hot flashes, which, when in reality, there was a lot more going on under the surface, so to speak. So recognizing that aging or anything that changes the gadal system can cause cognitive symptoms, can cause brain fog, can cause fatigue, memory problems, and helping people understand it, and then take the steps that work best for them, whether that is learning tools to cope with it or hormone replacement therapy or. I think those are about the only two options if your hormones are out of whack. But chronic stress is another thing that throws our HPG axis out of whack. Now, the hypothalamic pituitary gonadal axis typically is thought of as our reproductive axis, but when we're under stress, the body says, yeah, probably not a good time to reproduce right now. Don't know about you, but probably not a time to bring a baby in the world. So we may see alterations in the functioning of that axis. People who are under chronic stress because of unsafe conditions, because of chronic pain, because of ptsd, whatever the case is, it can be physical, emotional, or cognitive stress, but ultimately stress is stress, and it activates that HPA axis. And as you're going to learn in a minute, when that HPA axis stays activated for too long, then we start seeing systemic changes. The body says, okay, we got to conserve some resources. We can't keep running this hot for this long. So asking yourself, when you're seeing a client, regardless of their age, could their cognitive issues be partly due to thyroid or gonadal hormone imbalances? The other group that I haven't talked about that I think is important to remember is your adolescence. Oh, boy. Their hormones are all over the stinking place, and they may be low one day, high the next day. You know, we all went through high school. We know what was. What it was like. But remembering that adolescence lasts until about age 24, if you're seeing a young adult, we also want to assess their hormone levels. If you're seeing someone who is pregnant, obviously their hormone levels are changing, and they may have subsequent changes in energy, in mood, in cognition, and helping them recognize that if. If those changes started when you got pregnant, then likely they will start to abate when. After you deliver the baby or after you stop breastfeeding. However, what can we do in the meantime so you can have your highest quality of life? Another huge time for hormone changes is when breastfeeding ceases. A lot of people think of postpartum depression as those four to six weeks after giving birth. Yes, that's when we typically think of it. But the American College of Obstetrics and Gynecology has started to recognize that it's a much longer period, up to six months, and that, yes, you have your initial hormone changes and physiological changes after giving birth that, you know, because birth is stressful on the body. You're, you know, pushing an entire. An entire human or more out. Even once you've recovered from that physical trauma, the hormones themselves rebalance. But if the person is breastfeeding, then hormones stay at a different in. In a different recipe in order to support the production of milk. And then when the person quits breastfeeding, there's another hormone switch. And we don't give nearly enough attention or education or warning to people about the fact that that may happen. So that is my HPG soapbox. Are there other Questions before we get go any further, because like I said, I know this is a really dense, intense subject. And for those of you who don't know, Adriana is a registered nurse in addition to a psychologist, so she is able to provide you some information on some of the medical stuff in a much more articulate way than I am. So keep those questions coming, Chad. Unfortunately, you cannot test for neurotransmitters in the brain. There is no way to do that yet. They can do brain scans to identify the areas of the brain that are lighting up, but they. They still can't even tell how much dopamine's there. They can just tell whether the area of where the dopamine receptors are is being activated or not. But it's a great question. They can do a blood test now that looks at people's genes and does a much better job of identifying, especially with SSRIs, which SSRIs may be more helpful for somebody as opposed to the others because there are so many out there. And I know that sounds kind of like, you know, guesswork, but I have known a couple of people who've done it and they swear by it. They said that, you know, they had tried a couple others, couple other SSRIs, they just couldn't find the one that worked for them. They. They took the test. They went with the SSRI that was recommended by the test, and it worked wonders. So again, I haven't looked at the research. I'm just telling you based on reports from people that I've worked with and people who are friends of mine who have taken it. All right, let's go back to neurotransmitters. Dopamine increases in response to stress and excitement. Dopamine is actually not the pleasure chemical. It's your motivation chemical. It helps process pleasure oriented stimuli. But dopamine, when you do something that is enjoyable, like, you know, sex, drugs, rock and roll, I don't know. Dopamine is released, but it also releases endorphins. And, and endorphins are like our natural opioids. They're our natural feel good chemicals. So what we're really feeling is more the endorphins. But dopamine gives us motivation to get out of bed, to run away from the hungry lion, to pick our hand up off the hot stove. You know, it does a lot of things for us. Dopamine improves attention, vigilance, and increases survival oriented learning. Dopamine helps you figure out, yeah, I want to do that again. Or, you know, tried it once, not for me not gonna do it again. And then that's why I said dopamine helps process some of the information regarding, regarding our experiences to help the rest of the brain form schema about whether that's a good thing or a thing to run away from. Acetylcholine is positively correlated with HPA axis activation and depression. Interestingly and again, remember we've got Goldilocks here. You need some acetylcholine for this system to work. Right. But if acetylcholine goes out of its proper balance, as, as it goes out of its proper balance, serotonin starts dropping. So, so we start seeing people have more depressive symptoms. Acetylcholine is system is activated by, for example, anti nausea medications. I took Dramamine once and only once. I have not felt so bad. Yeah, probably ever. I, I think that was worse than even when I was unmedicated for depression. But the activation of the, that acetylcholine system can actually activate people's depressive symptoms if their depression is related to their serotonin system. And that's important to remember as they start taking medications. And there's a whole list of medications. If you watch the video that I did specifically on acetylcholine, I talk about them. But there are a lot of over the counter medications that actually interact with our system and promote the release of certain neurotransmitters. The diphenhydramine. No, not diphenhydramine. Dextromethorphan. The cough syrup is one that became popular about a decade ago because people realized that when you took it in excess, especially if you took it not orally, that it could trigger a high. Well, this was mainly because it was activating the serotonin system. However, some people ended up developing serotonin syndrome because they were taking too much of it or they were taking it in addition to other things like opioids or, or SSRIs that activated the serotonin system. Now the normal dosage, recommended dosage of dextromethorphan for a cough probably not going to interact with somebody who's on SSRIs. You know, it's not a huge concern. But if they start abusing it, that's important. Some people are hypersensitive though, and if they notice that they start feeling more anxious, they're, they have more difficulty controlling their body temperature when they take the dextromethorphan. And they're also on some sort of antidepressant medication. It's worth considering that they may be experiencing a hypersensitivity to the activation of those serotonin receptors. My point again, my point being that we discount the additive effect of herbs and over the counter medicines and how they may interact with our prescription medications or just with our systems in general. Norepinephrine is needed to synthesize and release melatonin by the pineal gland. Not only do we need serotonin, but we also need norepinephrine. Who thunk it? When you start looking at SSRIs and antidepressant medications, you have your selective serotonic reuptake inhibitors, your SSRIs, you have your selective norepinephrine reuptake inhibitors, your SNRIs. Then you have your selective norepinephrine dopamine reuptake inhibitors, your, your SN D R eyes. They're all anti depressants. And which is why it makes it so hard when people are being prescribed medication for depression. Because you don't know, since you can't measure the activity of, or the amount of neurotransmitters in the brain or the effectiveness of that, the functioning of those symptoms of those systems. I mean, it's difficult to know which antidepressant is going to be most helpful for people. We do know an ssri, even though it's controlling mainly serotonin, it's going by virtue of increasing the activity of the serotonin system, is going to affect all of those other hormones and neurotransmitters we talked about. To some degree, the effect is a lot greater when the medication is directly targeting it. So you're not going to impact norepinephrine as much. With an SSRI like Zoloft, you're going to have a much stronger effect on norepinephrine system. With an snri, it's easy to look these up. You go online, you type in the medication and you can ask perplexity or whatever whether what kind of antidepressant it is, if it's, if it's what kind of reuptake inhibitor, glutamate and gaba. Glutamate is our main excitatory neurotransmitter. We like glutamate, but in large quantities or for extended periods, it causes neuronal death. It's think of it sort of like hot. I think of excitatory neurochemicals as hot. And when the neurons are bathed in that hot for too long, they start getting pared down, they start, you know, dying off. We have an amazing ability in our brain called neurogenesis that allows us to regenerate neurons over time. But in order to do that, we gotta get the hot out of there. Glutamate. Now this is one of those really interesting things. Glutamate is our excitatory neurochemical. Somebody who's got complex post traumatic stress or generalized anxiety is probably going to have high levels of glutamate a lot of the time because they're stressed and they're primed for that fight orf flight. They're constantly sort of in this low level fight or flight stage. In order to make gaba, we have to break down glutamate. So if glutamate becomes low, or the glutamate system, if you want to think of it that way, stops working as effectively, then we're not going to have enough glutamate to break down to make gaba, which means we can have a GABA deficiency, which is kind of interesting. So you can have. There are a lot of reasons that you can have an imbalance in neurotransmitters, but when you're talking about GABA and glutamate, they're directly related. HPA activation increases glutamate and reduces gaba. Well, duh. We want to increase our stimulatory or excitatory neurochemicals for that fight or flight and reduce the relaxation. Remember, GABA is kind of like our natural volume, if you will. So we don't want that going on. We don't want to relax when we're being pursued by a hungry lion. Serotonin. Serotonin balance is altered in response to HPA activation. There are at least 17 different types of serotonin receptors. Okay. And each receptor has its own job. What we see when the HPA axis is activated, the 5ht1a activation goes down and 5ht2a goes up. So we get more energy when the 5ht2a is activated and when the threat is passed, then it swaps and 5ht1a goes up. It's our antidepressant. It's our feel good chemical, one of our feel good chemicals. So we want to see that balance. And we are not diagnosticians. We are not going to try to target. And I don't think that in reality we, anybody can even target and say it's your serotonin that's out of whack or, or your norepinephrine that's out of whack. We make our best guess and we go with what the symptoms are telling us. But Ultimately, for most people, if they're able to get to a place where they feel safe and empowered and can reduce excess stress, their nervous system and their HPA axis or HP axes, all of them will start to recalibrate when we start strengthening that vagal tone so the stress response, so the sympathetic branch isn't just being a big old bully all the time, and we strengthen the vagal tone so it can compete, then the person is going to naturally start having pathways rewire. Remember, the neurons that fire together wire together. If we quit sending all of our neurons firing over to the stress and we start firing or activating some of the relaxation neurons, they're going to start getting stronger and the system is going to start to get back into balance. Serotonin is broken down into melatonin when it's time to bet for bed. And high levels of cortisol will prevent the release of melatonin. I know I already said that, but it's worth restating. Helping people develop a nighttime routine to reduce their stress as much as possible is going to be important to help them get good sleep. Hormones and neurotransmitters need to move about the body factory to do their jobs. All of these systems are interconnected. The HP axes stand for the hypothalamic pituitary. And the hypothalamus and the pituitary gland are involved in all of these axes. Hypothalamic pituitary, adrenal, hypothalamic pituitary, gonadal, and hypothalamic pituitary, thyroid. The neurons and and receptors in the HP axes help transmit information sort of between departments from the hypothalamic area of the brain. They get the message and it says, okay, we need to activate the HPA axis, or, okay, we need to activate the vagus nerve. The HP axes serves as serve as different departments in the body factory. The HPA axis works in tandem with the HPT and HPG axes. So your HPA axis is your main stress response axis. That's the one we usually talk about. But when the crap hits the fan, the HPA axis kind of calls down to the HPG and HPT and says, hey, y' all, quit what you're doing. I need you over here. Another department we're not going to talk a lot about today, but it's important to recognize is the gut brain axis covered in a different video. But the vagus nerve actually connects the gut to the brain. And when we're under stress, the vagus nerve tells the gut, hey, Bring in your stress crew because we need to be making hormones and neurotransmitters to support fight or flight instead of rest and digest. The HPA axis is designed to ensure survival. It is responsible for the fight or flight res reaction and regulates many homeostatic systems in the body, including the cardiovascular system. So your heart rate, your blood pressure, the metabolic system, whether you're, you know, dumping blood sugar, how high your base metabolism is, what trim what you're doing, your immune system, ah, got you there. Remember the HPA axis, one of the most prominent hormones in it is cortisol, which is an anti inflammatory. When it's doing its job, HPA axis also helps regulate the reproductive system and the nervous system. So it's got its grimy little mitts and everything. Why? Because it needs to recruit the entire body factory to fight or flee when there's a threat. The HPA axis integrates physical and psychosocial sensory information and cognitive schema to allow effective adaptation to the environment to optimize resource utilization and survival. Which is a really flowery way of saying. The HPA axis takes in information from our senses and from our prior experiences and it combines them. It says, hey, I'm getting this in sensory information. I see a dog. I remember I've had experiences with dogs. So my senses tell me I'm in the presence of a dog. My schema tell me dogs are dangerous, therefore we're going to trigger the threat response. The HPG and HPT axes have their own jobs. You know, the thyroid regulates metabolism mainly and gonadal is mainly thought about for reproduction. But when there's a stressor and the HPA axis is activated, they essentially stop what they're doing and assist the HPA axis. I'll say this again for any of you who are neuroscientists. I know that it is grossly oversimplified, but what we're talking about here is, is basically getting you an overview, but also helping you figure out how do I explain this to clients who haven't gone through Neuropsychobiology 101? The vagus nerve also signals to the gut that there's a stressor. And the microbiome of the gut changes under stress to support the fight or flight response. Whether it's acute stress or chronic stress, that gut microbiome changes. And that's important for us to remember. And I think again, most of us have been under stress in the past and our tummy's gotten upset. Our GI system has been a little quicker to get rid of food and stuff than we would have particularly liked. And that's the body going, I don't have time to rest and digest. I need to clear out that system so I can focus on fighting or fleeing. People with anxiety often have irritable bowel and that this is part of the reason when the hormones start to get out of whack, the also the microbiome in the gut gets out of whack and the body has difficulty processing the foods that you eat. Sources of stress, physical. And I'm sure, I will say I am sure I missed some sources of stress, but these are ones that you can look at with your clients pretty easily. Nutrition. If they're not eating a good diet, then that can be a source of stress. The body register just. It doesn't have all of the building blocks it needs. Likewise, if somebody's under chronic stress, even if they're getting the building blocks like I was just talking about, they may not be being processed. They may just be putting. Be being put out because the body doesn't have the time or the ability, if you will, to process them. Which means they may be eating a great diet, but they're still nutritionally deficient. So we want to take a look at that. Are they eating healthfully, relatively, and are they absorbing the foods they eat? If they're having chronic diarrhea, then the answer is probably no. If they have IBS or Crohn's disease, then the answer's probably no. That's something that they can talk over with their physician. That's not something that we can advise them on, but. But helping them recognize because they may come to us and say, I'm eating a great diet, I'm doing what I'm supposed to do, and I still feel like crap. Well, let's, you know, talk about crap. Are you, sorry, it's Saturday, it's early. Are you actually processing the food or is it just passing through your digestive system kind of untouched? We also see the same thing in some people who have had gastric bypass surgery, that it bypasses the small intestine and so it doesn't get absorbed as easily. And if they're not a hundred percent compliant with their regimen, they may very easily become nutrient deficient. We see, we have seen cases of Wernicke Korsakoff syndrome and in people who have had bariatric surgery, not because they were drinking alcohol, but their thiamine deficiency came as a result of their body not being able to absorb enough thiamin in the foods and Stuff they were eating. Now, a lot of people who are on who've had gastric bypass have to take a special multivitamin that's high in thiamine and stuff. So most people don't experience that. That. But if they're getting a little lax on their treatment compliance, you may see this. I bring this up because there are a lot of people who've had gastric bypass. There are a lot of people who report that their mood and their demeanor and their personality almost changed after they had g gastric bypass. And sometimes it wasn't for the better. And we can look at some of the different hormones and stuff that changes if the person is when their digestive system is suddenly altered because that alters the gut microbiome significantly. Medications and irritants, and I put irritants in quotes. What I'm talking about here is things like alcohol and other things that irritate the gut. If you eat something and get salmonella, if you're drinking alcohol, you're causing inflammation in the gut. There are things that we can ingest that our body recognizes as foreign and that can be a stressor on the body. Most medications aren't overly stressful on the body. I'm not saying, you know, that anyone who takes medications ever, it's going to be a stressor. But there are medications that can cause people, as I mentioned before, to feel different because they are sensitive to it for a variety of reasons. And we need to be aware of that. I'll talk in a little. Well, yeah, in a little while about cytochrome P450. And that's an enzyme that helps your body clear medications and substances from the body. But there's only so much of it to go around. And if you're ingesting multiple medications that require the same enzyme from the Cytochrome P450 family to be broken down and clear the body, then it's going to slow the process of clearing that medication from the body. This is one of the reasons that people who are elderly tend to be much more sensitive to benzodiazepines and other medications, for example, because their liver, because it's an aged liver, slowed down like the rest of their body, slowed down a little bit. And it takes them longer to clear medications. Their Cytochrome P450 system isn't as spry as it used to be. And being sensitive to that, if they're going to a GP instead of a geriatric specialist, GPs are not always sensitive to this or even aware of it. They should be, but they're not. Both my grandmother and my grandfather, different doctors in South Florida where there's a lot of people who are older you, you'd think they would know. But both of them were actually put on benzodiazepines and my grandfather actually got to the point where they had to admit him to the hospital because he all butt overdosed taking it as prescribed. But it built up in his system because they prescribed it at a level you would prescribe for a 40 year old, not a 70 year old. Anyhow, we do want when we take our medication inventory or whatever you call it during your assessment being aware. Statins, your cholesterol medications are known to promote symptoms of depression in a lot of people. So if they just started taking a statin and they've suddenly started feeling depressed, hey might be a clue. Um, obviously we're not going to tell people to discontinue their medication, but they can talk to their doctor about options for dealing with that if they need to be on the statin for their cardiovascular health. Sleep in particular, sleep deprivation. Whether it is they're not getting enough sleep at all or they're not getting enough quality sleep because they've got something like sleep apnea, source of stress. Your body needs sleep. Adults need seven to nine hours. I'm more on the nine level. Seven to nine hours of quality sleep each night. That doesn't mean getting up six times to go to the bathroom. That doesn't mean tossing and turning. That means getting those good deep sleep cycles in there in addition to REM sleep. And as, as an aside, your antipsychotics and, and your antidepressants actually tend to suppress different aspects of sleep. Your antidepressants have been shown to suppress REM sleep in a lot of people and they think that may somehow contribute to its antidepressant qualities. Have no idea how that's true, but whatever. And antipsychotic medications actually suppress deep sleep. Deep sleep is when your body clears out the adenosine that builds up from thinking it's the trash byproducts from your brain working throughout the day, if you want to think about it that way. But people who take antipsychotics, their deep sleep is often eliminated or greatly shortened so they don't clear out all the adenosine, which is why they often feel groggy and and sleepy in the morning. By altering the dopamine levels and the other neurochemicals that are altered by your typical anti psychotics like Haldol, you're also impacting the person's ability to get that quality sleep. Now, of course, people with schizophrenia, most of them are going to choose to remain on antipsychotics because that helps them live their highest quality of life. But there are steps we can take to help people, especially if they're taking a daily dose, to help regulate their circadian rhythms. They can work with their doctor to try to figure out if there's, if there's a way they can decrease, at what level they can decrease their medication to, to minimize the disruption in their sleep. There are new medications that are constantly coming out that may, may not have that same side effect. So constant communication with doctors, even if that doesn't exist right now, it could be next month or next quarter that they release a medication that doesn't disrupt the deep sleep. But anyhow, health is a stressor or negative health is a stressor. Whether you've got cardiovascular disease, you've got a bacterial infection or a virus, the body knows something's broken down, something's wrong, and it needs to repair itself. So that's a stressor. People who have autoimmune disorders are under chronic stress, and stress increases the autoimmune disorder. So it's kind of a sticky wicket. And then finally, pain. We all know pain's a stress stressor. It's a pain in the butt to be in pain. But people who have chronic pain are regularly experiencing emotional, cognitive, as well as physical sources of stress. We can't make their pain go away. We can help them learn how to tolerate their pain. We can help them learn how to appreciate the good days. So when they're having a day where their pain is a two instead of an eight, helping them, you know, embrace that day. We can help them grieve what they can't do because they now have chronic pain. So they're not holding on to that anger and resentment that they can't do stuff or the guilt that they can't do stuff. But we need to examine when somebody has pain, how does that cause them stress physically? Probably impacts their sleep, impacts obviously their, their pain threshold and potentially their mobility. How does it impact their, their mood? How does it. And we're talking about anxiety, depression, grief, guilt, and resentment. Those are five common issues. When in people with chronic pain, how does it affect them cognitively? When people are in pain, they're in especially extreme pain, they're in a lot of pain. It's hard to think clearly. The brain is registering as a stressor, so it's in fight or flight. You can't easily be in fight or flight and think at the same time. You're not thinking while you're running away from the hungry lion. You are focusing on running away so you don't get thinking comes later. And the same thing is true when our body's in pain. It's hard to think think clearly when we're in pain. Encouraging people to recognize this is important so they don't blame themsel for having brain fog. They can understand that it may be coming from sleep disruption as well as just the body's natural response to feeling vulnerable, unhelpful thoughts. We know that causes stress, cognitive distortions, if you want to use the technical term, neurological differences. Some people with autism spectrum disorders or schizophrenia or even ADHD are neuroatypical, and they may feel either over or under stimulated by the neurotypical environment. And their body perceives that as a stressor. Just being plum overwhelmed is a stressor. You know, I'm stressed, I'm overwhelmed. A cognitive decline can also be a source of stress, especially emotionally. When people have difficulty putting words together and thinking clearly and articulating their thoughts, wants and needs, it can very often cause frustration and anger and irritability because they're not able to communicate their needs well. Anger, irritability, and frustration, those are all forms of anger. What do we know? Anger is associated with drum roll, the fight orf flight reaction. The person recognizes on some level that they're vulnerable or may feel vulnerable because they're not as spry as they used to be. And that can contribute to sources of stress and HPA axis activation. The environment, even for neurotypical people, smells, sounds, light levels can be a source of stress. If you've got that flickering light or that humming fluorescent light in your office, oh, those drive me crazy. It can be a source of stress. Now, stress is additive, so it may not be a huge big deal to you, but you add that to six other little stressors and it starts out adding up. Having people look around at what sorts of things can you mitigate in your environment? Can you have maintenance come in and change out the ballast for that for that light? Or can you bring in desk lights so you don't have to have the fluorescent lights on if the smell is overwhelming to you, Maybe the cleaners they use, what can you do? I know I'm super sensitive to paint and being around paint fumes, thankfully, that's not something that I'm around constantly, but it's not good. Paint is a systemic depressant. Paint triggers all of those Neurochemicals involved in the relaxation slash depressant response. And we do see people who are painters often have lower mood, often have lower levels of energy, especially if they're not wearing, you know, really good protective gear. And lack of safe, stable housing, that's an environmental source of stress. If you're couch surfing, if you don't know whether you're going to be able to pay your rent, that's a freaking stressor and it's going to add to any other stressors you've got going on and safe, stable housing. We can help people look into programs like HUD and Section 8 and finding affordable housing. They have. Income controlled house, low income housing here, which is not section 8 and then they have section 8 housing. So those are two different places people can look and we can help them brainstorm other ideas. If your person is a veteran, there is a program called the HUD Vash program that they can get connected with to prevent veteran homelessness. They contact their local or their nearest VA and can get hooked up with a case manager that can help them get involved with that. And then of course, relationships can be a source of stress. Are there questions? We're about halfway through class right now. And yes, Tammy, I will talk towards the end about strengthening vagal tone. But as Adriana pointed out, I do have some videos on online about strengthening vagal tone. There are lots of people that have videos on strengthening vagal tone, which is good. You know, I can focus on the mechanics and they can focus on the exercises or something I guess, but it's not as overly complicated as you might think it would. And, and Adriana does bring up a good point. Not only does intoxication with, you know, over using certain substances or abusing certain substances stress the body because the body says, oh, there's a toxin coming in or oh, we're overstimulating system. But as that toxin leaves the body, then the body goes, oh, we're out of balance again because we adjusted to having those higher levels. So withdrawal is also a stressor and typically has the opposite symptoms of intoxication. Okie dokie. I am going to take a brief little break here so I can refresh my water and stretch my legs for a second. We will start again at half past the hour, whatever hour it is for you here. It's 9:25, so we'll start again at 9:30 Central Time, 10:30 Eastern. Oh my God. What? I thought I heard something about that. Oh, that's what I didn't do. That could be part of it. No, he has giggles out there. I never turned it off. That was a great question, Sherry. And I love the fact that y' all are having me get into PubMed. That's my happy place. So awesome. Always feel free to ask questions and if I don't have the answer, I can find. I can find the answer. Most of the time I can find it in PubMed. Every once in a while I've got to actually phone a friend, but. All righty, let's see. I don't know why that's not. Not scrolling. Okie dokie. Let's get started again. Let's move on to the HPA axis and this is what I call the sciency explanation. This is one that most of our clients, if we start telling them this, they're going to look at us and their eyes are going to glaze over. But I think it's important that we start connecting the dots that we've been talking about since so far. So ultimately, stress, physical, emotional, cognitive, environmental stress, causes the HPA axis to be activated, the hypothalamic pituitary adrenal axis. This causes the secretion of cortisol, that stress hormone, adrenaline, norepinephrine, glutamate, thyroxin, testosterone and alters estrogen project pro estrogen production and serotonin and GABA levels. Cortisol causes the release of glucose for energy and as a steroid, acts as an anti inflammatory. Anti inflammatory suppressing the immune system during the acute fight or flight phase. And this is one of the things that we see in people who are stressed is they often don't feel pain until the adrenaline wears off. Well, this is part of the reason cortisol is causing the release of endorphins and anti inflammatory and is serving that anti inflammatory function to reduce the awareness of injury and pain during an immune or injury response. Pro inflammatory cytokines are released and pass through the blood brain barrier where they activate the HPA axis. Pro inflammatory cytokines are kind of like, I think of them as your little ambulance, your paramedics. And they get sent out wherever there is an injury and they notify the brain if there's an injury. They call in and they go, hey, there's a traffic crash down in the hip down here and we need some help. I know, whatever. But ultimately, pro inflammatory cytokines bring inflammation. And you might think, oh, inflammation bad, no, inflammation good. Because that brings blood and nutrients to the area to help it heal faster. Sustained inflammation or systemic generalized inflammation, yeah, that's bad. But localized Inflammation serves a purpose. Adrenaline and norepinephrine, when they're released during the stress response, tell the pituitary gland to release endorphins to blunt pain until the threat is over again. Great system. Glutamate and thyroxine stimulate the release of blood sugar and fatty acids for energy. So now we've got the drive to go. We've got the pain reduction. So, you know, we're feeling no pain, and we've got the energy to actually make it happen. Our senses receive input that are assessed by the amygdala and hypothalamus based on schema and the senses. So our body takes in information prior to the threat, and during the threat, it keeps taking in information. Is the lion still chasing me? And based on our schema, our experiences and our expectations based on past experiences, our brain takes in that sensory information and says, okay, compared to the past, I should expect that, yes, I'm safe, or no, I'm not. The hypothalamus decides whether to ignore or to respond to stimuli. If you're being chased by a hungry lion and you're running through the. Running through the forest, I don't know if they're. Yeah, whatever your hypothalamus is going to be getting input about, hey, there's a tree there, there's a rock there. There's all kinds of information. And your hypothalamus is going, yeah, we don't need to pay attention to that right now. Right now we got one thing on our mind, and that's surviving stressful stimuli trigger that HPA axis, which then recruits the hypothalamic pituitary, thyroid, and hypothalamic pituitary gonadal axis. Cortisol is released, suppresses the inflammation and initiates the release of the excitatory neurotransmitters, testosterone and endorphins. When the perception of the physical or emotional threat is gone, and I intentionally put the word perception there, our HPA axis is activated. When we perceive an actual threat, like a hungry lion or a tornado right outside our window or something, you know, that the system's working good, then we're perceiving a threat, we're reacting to it, we're good. But we can also perceive threats that aren't there. We can see and. And dogs get a bad rap. I love dogs, but some people have bad experiences with dogs. So I usually use that one because most people know somebody who's afraid of dogs. And when somebody who's had a bad experience with dogs in the past encounters a dog in the present. The sensory information, the nervous system is taking in input, saying, there's a dog there. And the schema is saying, yeah, based on prior experiences, we really want to get away from here. The perception, you know, that dog could have been totally sweet. You know, it could have been a great big old lap dog. So we don't know whether there actually was a threat, that person at that time, but their expectation, their perception or belief was that there was a threat. When the perception of the threat is gone, the system's going to stand by. That vagus nerve kicks in and says, all clear, we can all relax, regroup, go back to what you were doing. And then if the system's working well, inflammatory cytokines are released to heal anything that got broke during the stress response. It's a great system, works really well when it is only activated sometimes, you know, there has to be a give and take. It can't stay on and, you know, pedal to the metal 24 7. That's just not how we're built. So thinking about perceptions of emotional threat, when somebody's experienced, experienced trauma, when they've experienced gaslighting, when they've experienced chronic issues that made them feel unsafe and powerless, then they've started to associate a lot of stimuli with threat. This person represents a threat. People like this person represent a threat. This environment had bad experiences in this vi environment. So this environment represents a threat and all environments like it. Some people have what we call religious trauma. So they may perceive the church, not only the church where they experience trauma, but all churches bring up that memory. The, the senses take in the information. Hey, that's a church. The schema says, oh, heck to the no, you. Yeah, I'm not going in there. Same thing is true about schools for some people. So we need to recognize that reducing stress involves also retraining the or reassessing, not retraining, reassessing the person's schema to identify whether there's a threat based on the facts in this context at this time. Is this church threatening to you? Now, it may just bring back so many of those memories and traumas that you haven't processed that. Yeah, you know, that's just. It's overwhelming. It activates too many schema that I tried to forget. Okay, so that's still stressful, but encouraging people to evaluate. Again, I use the mnemonic fit cat facts in this context at this time, where things go wrong. If the initial message, the initial message that regularly triggers the threat response, if the person regularly is getting the message that they're not safe. And they're. They're actually not safe because they are in a chaotic environment, an abusive environment, they're homeless, they're whatever the case may be. Then, yeah, that HPA axis is going to stay activated a lot. And then we could start seeing the receptors for those excitatory hormones and neurotransmitters start to become unresponsive or tolerant to activation. So we do have chronic stress, chronic, real threat stress soldiers. They have a persistent actual lack of safety. So I'm not saying it's all in your head. There could be something that's constantly going on. Okay, so assuming that, you know, setting that one aside, then there's other people who may have a lack of feeling safe. They are actually safe in this moment, but they have a lot of traumas that they haven't processed. So they have never started to feel safe and empowered again. People who don't feel safe have often developed cognitive distortions like overgeneralization and magnification and mind reading that may contribute to them perceiving the current environment based on their prior schema as being unsafe. And we want to recognize that those beliefs developed out of a desire to stay safe. You know, if I started believing that all people who represent this group are unsafe, then that's the way my body has responded. My brain has responded to try to help me stay safe. Because we can't just look at somebody and go, yeah, you're safe. You're not. You're safe. You're not, you're not, you're not. We can't do that. I wish we could. We don't want to shame people for their cognitive distortions. However, we want to help them recognize that sometimes their cognitive beliefs may not be accurate. In this context. They were accurate last week, five years ago, whatever. We see people with spiders, for example, we'll switch from dogs to spiders. Some people are terrified of spiders. Just even thinking about them triggers their stress response. And they're just like, ah. They. The thought of having a spider crawling on them is almost overwhelming or maybe even is overwhelming. That's the brain reacting. Go back to your cognitive behavioral therapy. Your the activating event, spider on you consequence. You start to get stressed or you get really stressed. Between the activating event and the consequence, you had all these automatic beliefs that came from scratch schema. They came from your prior learning about spiders. And if your prior learning about spiders was that they're poisonous and they're dangerous and everything else, then yeah, you're gonna get stressed out. So in systematic desensitization we help people work with spiders or whatever their phobic stressor is and first they start learning about spiders. They educate themselves about, you know, are all spiders actually bad. They start looking for the facts for and their belief for and against their beliefs about spiders. So first we just educate. We're not going to even talk about thinking about spiders or anything. Once they have more knowledge then we can start the graded exposure to the spiders and helping people develop a the ability to downregulate, to activate that vagus nerve to downregulate and respond to the stressor in context. When they're down downregulating they're activating that vagus nerve by slowing their breathing, by addressing their cognitive distortions. If they're thinking about being in danger because there's a spider on them, reminding themselves about all the facts that tell them, you know, you're not in danger right now, not just saying no, I'm not in danger but providing themselves facts re educating their brain, adding to the schema. They have to make it more accurate based on current knowledge and, and we gradually move to the point where, you know, not everybody wants to ever hold a spider. They're just not something they want to do. But they'd like to be able to be in a house and see a spider at 2 in the morning and not lose their stuffing. And so we can work to that point. And yeah, there are some great big old ugly spiders out there. No doubt most of them are pretty harmless. So helping people and actually mobile devices Google and Google Lens has come in really helpful, come in handy for a lot of people because they can take a picture of a spider and ask Google if it's dangerous or not. Now do you want to bet your life on Google's response? No, because Google makes mistakes but at least it can give you a, you know, probably pretty likely it's safe now based on your other knowledge, you can go look it up. So anyway, we need to help people address their cognitive beliefs or their beliefs, I guess that's redundant about their safety or unsafeness in any particular situation based on the current facts and context based on who they are now and where they are now. Perceptual disturbances can cause people to feel unsafe. I think we've all been laying in bed during a thunderstorm or something and the wind's blowing just so and the moon shining just so and it looks like there's you know, some big creepy monster outside of our window or whatever. I know When I was little, I used to see, you know, the monsters outside the window. It can be a perceptual disturbance. We may see or hear something that triggered the stress response, but we don't. It may not be an accurate perception. If people have a lot of anxiety, if they don't feel safe in their home, for example, then every time the floor creaks, every time there's a storm and the wind blows, every time something changes in what they're seeing, hearing, or smelling, it can trigger the stress response because they may expect that it's something wrong. I've shared this with you before. I'll do it again. I was driving down the street with my dad one day, and I always, you know, say a prayer for a little animal if we pass it, if it's been hit on the road and it's dead, you know, whatever. That's just what I do it. I feel bad for the animal. It helps me feel better, whatever. But we were driving down the road and I said a prayer for what I thought was this little animal. I thought, oh, poor thing. You know, it's not a huge stress reaction, but it's a little stress reaction. And, you know, I said my prayer, whatever. We got a little closer and drove past it turns out it was a rug that somebody had, you know, either thrown out or lost off the back of their truck. So it's just road trash. Did I get mildly upset for no reason? Yes, but whatever. Encouraging people to just be aware of those things, triggers for prior trauma or grief. If you've been in a war zone, if you've been around when somebody has been shot, then fireworks may be extremely triggering for you. If you grew up in an environment where there was somebody who was verbally or physically abusive and you hear someone in the present that sounds just like them, it could trigger those schema, it can trigger those memories. And so you may feel like you're back in that situation where you were unsafe. You. Which is why it's important to help people acknowledge the feeling. You know, this is my body's way of trying to warn me that there might be a threat. Just like my smoke alarm warns me that there might be a fire. And I need to evaluate the content facts in this context at this time. Too often we over simply, well, we oversimplify things. I've said six times today that I'm oversimplifying things. But not having enough serotonin causing depression is grossly oversimplified. There can be a lot of reasons that people's serotonin system or dopamine system or norepinephrine system are not correctly calibrated, if you will. So the person may have insufficient amounts of neurotransmitters or hormones to secrete. Their body may not be able to make it. We need a lot of vitamins and minerals and stuff in order to break down tryptophan to make 5ht, to make serotonin and then eventually to make melatonin. And if we don't have a healthy diet, we can't do it. We just, we can't do it. So it's trying, it's like trying to put a car together without an engine. It ain't going to drive. So nutritional deficits can lead to insufficient amounts of neurotransmitters or hormones. And that also includes, like we talked about before, lack of absorption. Even if they're eating a healthy diet, if they ain't absorbing it, might as well not even count it. Genetics. Some people are born, you know, we know that there's a strong genetic component to a lot of mental health issues. Age, as I've mentioned multiple times in puberty, people's hormones are all over the place, which naturally impacts as their godadal hormones go. Isn't that a great clinical term? As they're. As their godal hormones are all over the place, it brings along with them all of the neurotransmitters, you know, they all are. It's a group and the whole group gets altered if one gets altered. So we see problems in mood in adolescence, we see impulsivity in adolescence. We also see changes in mood and cognition in people as they age because the body naturally quits making as much of most of the gonadal hormones. And then anything else that causes a significant disruption in or alteration in hormone levels like pregnancy, breastfeeding, postpartum birth control pills, etc, substances can also cause problems. When people use substances, it hyperactivates the dopaminergic system, it hyperactivates the endorphin system, it hyperactivates other sis, other neurotransmitters depending on the kind of drug that people are using, which means that those neuro th. Those receptors for those neurotransmitters are getting bombarded, just like totally overworked and getting exhausted and then chronic stress. We've already talked sort of ad nauseam about chronic stress. But when people are under chronic stress, they may, as I mentioned earlier, just be pouring out that glutamate because the HPA axis is on. And then when it's time to relax when it's time to downregulate. There's no glutamate to break down to make gaba. They're just. They're. They're out of. Out of gas, so to speak. Okay, so there could be insufficient amounts of the neurotransmitter or hormones. The initial electrical signal may not be strong enough to secrete enough neurotransmitters into the cleft. When we communicate in this system, the nerve on this end gets triggered by an electrical signal and spits out some neurotransmitters into the space between the two nerves. And you have your set receptors. Over here. It's the neurotransmitter sits in that sense synaptic cleft or that synaptic space, and waits to be absorbed or invited in by the receptors. What we do with SSRIs is make sure that that neurotransmitter hangs out in that cleft for longer. So it gives the receptors a longer time to kind of wake up and be receptive. So we can have the initial electrical signal not strong enough to secrete enough neurotransmitters, and if not enough is put in there, then potentially making it hang around longer can get the job done because more of more of it is actually absorbed. Neurotransmitters, once they've been in that cleft for a while and an enzyme is secreted and. And the neurotransmitter is broken down and reabsorbed. So the SSRIs prevent that breakdown. And if the neurotransmitter is reabsorbed too quickly, then it doesn't have time to activate the receptors. If it. If it's reabsorbed too slowly, then it may over activate the receptors, or the receptors are just unresponsive or dead. And I know that sounds morbid, but we do know that there is pruning of receptors in people who, for example, have experienced chronic stress, uncontrolled PTSD, and addiction. @ a certain point, the brain says, no, no, we can't. We can't do this much. So some of those receptors are paired back because the brain says, we're getting plenty going through to the other side with 600 receptors. We don't need 1200. So we're just going to prune them back. When receptors are continuously bombarded and overwhelmed by neurotransmitters, the brain recognizes the imbalance and takes corrective action by reducing the responsiveness of the receptors or pruning them back. This is Called tolerance or resistance. So now the brain is used to. And I'm going to use typical measurements that we use, not measurements you actually use in the brain. But, for example, the brain is used to 5 gallons of dopamine stuff coming through the system at a time, and that's. That's a normal amount. But then somebody starts using methamphetamines, and all of a sudden 20 gallons are getting pushed through at any one time. And the brain goes, whoa, don't need that much dopamine coming through. Too excited. We're running too hot. The system can't maintain that. So in order to prevent all of those receptors from getting activated and the. Everything downstream from getting overloaded, it starts pruning it back. So the. So now, even though 15 or 20 gallons of dopamine is coming through, we only have half the receptors that are active. Okay, well, that sounds good, but what happens when the person stops using. Oh, gosh, now the. Because we only have half of the receptors, the amount of dopamine in that synaptic cleft and the length of time that dopamine stays in that synaptic cleft is not enough to actually fully activate the system. And yes, this is where the high comes from. When the brain is completely hypersaturated with dopamine and endorphins and feel good chemicals. So, like alcohol leads to the development of tolerance in nervous system receptors. Overexposure of receptors to any substance will lead to tolerance and resistance. Now, alcohol, we're not actually becoming tolerant to alcohol. We're becoming tolerant to the neurotransmitters that it supercharges. Okay. And these typically are your dopamine, gaba, glutamate, endorphins. And. And that's what the person who is addicted to a substance or an activity tends to start becoming tolerant to. So it takes more. A stronger release of. Or a. A stronger electrical charge, if you will, to release more dopamine to release more endorphins and in order to actually activate that system. So we see people in addiction become tolerant to dopamine and again, all of his buddies. So when they start to detox, the. The body's actually not getting enough dopamine anymore because rearranged itself to expect that 20 gallons, and now it's back to only getting 5 gallons. And it's like, I. I can't function on just five gallons. So. And then the person starts having cravings. Endorphins are the same. Endorphins stimulate our moo. Opioid receptors. Same Thing that's stimulated by opioids. And so when people start taking opioids, for example, that is hundreds of times more powerful than our natural endorphins. So the system's being flooded again and it says, okay, number one, we're going to quit making our own endorphins because we don't need to. You're just, you're supplying them. We don't need any extra. We're overloaded as it is. That's problem number one. Problem number two is it's still overloading the system. So then they start pruning back those receptors again. Insulin. We hear people develop, developing insulin resistance. And what we see is in people who are regularly having high surges of blood sugar because they're eating a lot of crap, because their pancreas isn't working right, or because they're under chronic stress and just constantly dumping blood sugar, they can develop metabolic disturbances and insulin resistance. Those insulin receptors become less active, less receptive. And cortisol. Now we talked about this a little bit earlier. People can become resistant or tolerant to cortisol over time. The brain says, you know what? Nah, I don't. I ain't got it in me. You're crazy if you think I got it in me right now. It's going to take a whole lot more to get me off the couch right now to answer the door than it used to. So if cortisol is not able to stimulate the cortisol receptors, then it cannot serve its function. It cannot serve as an anti inflammatory, it cannot activate the system like it needs to. Under conditions of chronic physical, emotional or environmental stress, we see people develop what is called either hypocortisolism or glucocorticoid resistance, which is what I just talked about. It's the brain saying that amount of cortisol isn't going to, isn't going to start the system anymore. You need more. When that happens, cortisol is unable to suppress inflammation. So we start seeing systemic inflammation which is perceived by the body as a stressor, which further activates the HPA axis, causes more cortisol to be dumped and it's this negative spiral. When gonadal or thyroid hormones are out of balance, it alters the functioning of the HPA axis. The brain goes, whoa, we're out of whack, we're out of balance. Gotta figure out what's going on here and get back to homeostasis. Homeostasis is the balance for that person's body, whatever that is for them. HPA axis dysfunction can alter the thyroid and the go not gonadal axis functioning. So people who have diabetes have. Often have insulin resistance. People who have PCOS or polycystic ovarian syndrome, and we're going to talk about that in a. And hypothyroid in a few minutes. But they often have resistance to a lot of the gonadal hormones, which alters the. The functioning in PCOS and hypothyroid. A resistance to activation of the thyroid hormone or the. The thyroid receptors. Autoimmune issues when the body is regularly inflamed, then the system perceives it as a threat, activates the HPA axis. Cortisol's released. Cortisol is released enough because of the inflammation, it loses the. Loses its ability to suppress inflammation. So again, we're just increasing the inflammation in the system and further ramping up that HPA axis. So it gets to be a very challenging problem to. To address. Okay, so here's the part you might try. If it makes sense to you, it makes sense to me. But here's the part you might try using to explain the system to your clients. So the receptors in your brain are like homeowners. The Amazon driver knocks on the door and the person opens it and responds appropriately, hey, thanks for the package. You know, I'll bring it on in and pass it along if I need to send it to a. Send it to a relative or something. But system works well. A while later, the mar mail carrier comes. Same thing happens. The person gets up, hey, thanks for the bills. See you later. No problem. This is a normal day. Activation, Close the door. Deactivation. Activation, Close the door. Deactivation. Not a problem. When people engage in addictive behaviors or are regularly physically or emotionally stressed, the brain responds to protect the homeowners or the receptors from overload. So now we're going to talk about being under stress. Imagine it's holiday season, which everybody's stressed during the holidays. Instead, you've got a really big family, and instead of one or two packages a day, this the Amazon and. And the other package delivery places, they're just constantly at the door. 10, 15 times a day. Every time I start doing something, somebody's knocking at the door, trying to give me a package. It's exhausting. I can't get anything done because I'm constantly trying to open the door for those packages. I'm an exhausted homeowner. I'm like, you know what? I just. I can't open the door for everybody. So I decide that I'm not going to Answer the door. I'm not going to be responsive to somebody knocking on the door unless it's an emergency or a signature is required. So unless they're, you know, ringing the bell and bang, bang, bang, bang, bang. You know, like somebody's doing if they're being chased by a hungry lion. I'm not answering the door. Just leave it on the stoop and I'll get it later. And that's what we see, intolerance. We see the receptors saying, I need more of an emergency. I need more stimulation or a more intense stimulation in order to get me up off the couch to get me to be responsive. Now, if the drivers want to get the homeowner to answer the door, they need to knock louder and longer. Bom, bom. You know, you really banging on the door and being a. Being annoying. And that's sort of the akin to increasing the amount of substances. So as people develop tolerance to alcohol, used to be they could get a buzz off of a beer and, you know, then they start developing tolerance. Then it takes a six pack, and before long, they've moved on to hard liquor because a beer is just not doing it anymore. They can't drink enough beer in an hour in order to get the high that they're wanting. And we call that chasing the high. But that's what we see as the brain starts pruning back those receptors and becoming less responsive to the substance or the neurotransmitter. Many drivers, you know, back to the analogy, many package delivery people are not going to stand there and beat on the door. So the homeowner doesn't get all of their packages they were supposed to, you know, so it's holiday season's over. The package gets delivered, and the driver's like, okay, I knocked. They didn't answer. Whatever. I'm going to take it back with me because it needs a signature. All right. So the homeowner doesn't get the package. The homeowner's still unmotivated and exhausted from answering the door so much. And they're just like, if somebody knocks, just, you know, let them leave the package if they've got it. Over time. Once the delivery drivers quit showing up, you know, every 30 minutes over time, the. The homeowner starts to recover and recoup, and they don't dread seeing the delivery vans coming down the street anymore, and they start answering the door again. And that's what we see in the recovery process. It takes time. After the holidays, we all know this. After the holidays, we just kind of Want to vegetate from, you know, January 1st until sometime after Valentine's Day in my case, just want to vegetate and try to recuperate from all of the activity and constant stimulation of the holidays. Once the receptors become less responsive, it means all of the necessary packages are not getting through. And this is what we see is in withdrawal. We see people, they're supposed to be getting 15 packages a day, but only six may make it through. And that's not what they need to keep everything going down the line. Cravings for junk food or addictive behaviors are often seen as the body tries to compensate for the imbalance in the number of feel good chemical packages coming through the system. When not enough packages of serotonin, dopamine, thyroxin, etc are available to activate the NER nervous system, the person often feels apathy, depression and dysregulation. In many cases of depression, the person was first stressed either physically or psychologically in some way. A lot of times in people with major depressive disorder, what we're seeing is the flat and the apathy that we see in people with glucocorticoid resistance. They've stimulated those cortisol receptors and adrenaline receptors so much for so long now they're to that point of those receptors just it's going to take a lot to get them to turn on. Which is why the person with depression often feels apathetic, often has low levels of energy. Remember these are the things that adrenaline, cortisol, serotonin, norepinephrine are, are involved in the continuous or excessive exposure of the receptors to cortisol, glutamate, dopamine and their buddies caused the brain to adapt and become resistant to activation by cortisol, which was designed to protect the brain and prevent neuronal death and excitotoxicity. Remember I said when especially glutamate is bathing the neurons in your brain for too long, they start dying back. That's it becomes an excitotoxic environment. It gets too excited and, and the brain doesn't want to die. So it says okay, in order to prevent having cortisol, having glutamate just bathing us constantly, we're not going to, we're going to turn up the dial. So the, the HPA axis receptors, the cortisol receptors are much less sensitive. It's going to take a whole lot to require them to get activated. Glucocorticoid tolerance or hypersensitivity can also be seen in per people who emotionally disregulate, People who Are tolerant. We've talked about this in a lot of other videos. Flat to furious or flat to frantic. Because those receptors requires so much prodding to get them to actually activate the person most of the time is flat. Those feel good receptors just aren't even getting activated. But when they do, when there's a stimulus that's potent enough to activate those receptors, then there's just a tsunami of stress neurochemicals coming through the system and hyper activating the, the stress response. So we see somebody going from flat to furious or flat to frantic. And along with that, because the, the activation took so much energy, just like a tsunami is a wave with a whole lot of energy. Because that tsunami use up so much energy, it takes the person longer to get back to baseline. That is a neurochemical response. Their brain and their body, their whole nervous system is having to down regulate from a much more powerful stimulus than someone who doesn't dysregulate. Hypersensitivity is seen in some cases. Most of the time this is before tolerance develops, but sometimes it can develop afterwards. But the research has clearly indicated that some people, especially with ptsd, may actually be hypersensitive or have evidence of too much cortisol in their system. And, and the debate goes on about whether they just haven't hit tolerance yet or if this is a rebound effect. But either way, in this case, a little bit of cortisol triggers a tsunami of all of the hormones and neurotransmitters in the system. So the receptors, instead of being apathetic, they're on guard and when they get activated, they just fly into action. And it's a very similar sort of response to both of these result in dysregulation. But the dysregulation may be due to, you know, slightly different reasons. The biggest thing to remember when we're working with people who dysregulate is to educate them about the fact that it's not all in your head. Yes, it's exhausting. Yes, it takes you longer to regular down regulate back to baseline because you had a much more powerful stimulus and, or stimulus response than the other person. And the analogy I, I used last week and I usually use is you, the person whose system is working appropriately. It's like taking a glass of water and pouring it on the floor and then having to clean it up. It takes a little while. It takes a minute for the floor to dry, but you know, it's not a huge big deal. But for the person who dysregulates, it Wasn't a glass of water. They dumped a big old five gallon bucket of water and that's going to take a lot longer to clean up. It's just the way it is. We already talked about common causes of neurotransmitter imbalances and stressors. So let's look at a couple examples of physical issues that are caused by HPA axis dysregulation, which often are seen co occurring with depression and, or anxiety. But usually depression. PCOS is, I'd have to look up the numbers again, but it's something like 60% more common in women who have experienced trauma than in women who haven't. And one of the reasons they hypothesize is chronic stress leading to HPA axis disregulation. So how can stress cause your cause polycystic ovarian syndrome. How can stress cause your ovaries to go on the fritz? Well, let's think. HPA axis dysregulation leads to increased cortisol production. They're stressed. They're stressed all the time. They're stressed a lot. So that cortisol is just coursing through the system. Eventually there's an impaired negative feedback. So the vagus nerve isn't jumping in to say, hey, all clear. And so there's more stress and the person's just, they're hyper vigilant, they're looking for stress, they're not feeling safe, they're, they're in pain. Maybe there's a lot of reasons they may be stressed. But eventually when that happens, remember, cortisol loses its ability to suppress inflammation. So we start seeing systemic inflammation which triggers more cortisol production. So the negative feedback loop, the, the loop that's supposed to say, okay, dangers past, all clear. It just kind of drifts into the, into the background. We also see altered circadian rhythms when the HPA axis is dysregulated. Remember, cortisol is inversely related to melatonin. And so we start seeing the sleep schedule get out of whack. We start seeing alterations in the amount of deep slow wave sleep and REM sleep. So then we start having stress in the body. Then we start seeing HPG axis disruption. The elevated cortisol levels inhibit gatotropin releasing hormone, which impairs lutein, luteinizing hormone and follicle stimulating hormone secretion from the pituitary gland. So what normally happens in a healthy ovary isn't happening anymore because of the elevated cortisol levels. We have probably known people or have experienced it ourselves. If we were under extreme stress, we may have skipped a menstrual cycle. And that is due to those gonadal. Gonadal hormones getting out of whack in result in response to elevated cortisol. Cortisol directly impacts the ovaries. It's just, this is the way it is. If it starts altering all of these hormones, then we're not going to see proper ovulation. Some people start developing uterine fibroids, but that's not what we're talking about right now. Right now we're sticking with polycystic ovarian syndrome. So now we've got an HPA axis that's lost its ability to really function effectively and it's just on most of the time. And we have a disruption of the gonadal axis. So we're not seeing ovulation, we're seeing alterations in levels of estrogen and progesterone and testosterone. Testosterone levels tend to rise in people with pcos. We know that low estrogen is associated with depression. We know that people with PCOS tend to have problems with acne, problems with facial hair, problems with weight gain, especially around the midriff, problems with insulin sensitivity. So these alterations in the HPA and HPG axes lead to pcos. Polycystic ovarian syndrome by causing or lead to the symptoms. Insulin resistance is a key feature of pcos. So eventually, when the body is dumping blood sugar all the time, the insulin receptors are going to start becoming resistant, they're going to start becoming less responsive to the insulin in the system. HPA axis dysregulation can lead to increased adrenal androgen production. One of your main adrenal androgen hormones is dhea, which is a precursor to estrogen and testosterone. So we start seeing these adrenal androgens being increased. Disrupted gonadotropin secretion interferes with ovulation. Pcos, as we've talked about, now we see the whole system starting to go wonky. We have systemic inflammation, we have impaired negative feedback, we have cortisol, increased cortisol production, but lack of responsiveness because the receptors have become less responsive. We, we have all these other things and the body recognizes that as a stressor. So pcos, once the person has the sy symptoms of the syndrome, it exacerbates or worsens HPA axis dysfunction. The person may have increased stress related symptoms that perpetuate HPA axis activation. Well, let's think about it. If you're losing your hair, if you've got acne, if you can't sleep very well if you're not ovulating. If your gonadal hormones are out of whack, which is throwing your neurotransmitters out of whack. If you're gaining weight, can't seem to lose it. Oh, and our hypothyroid. Yeah, yeah, I can see where you might be a little bit stressed. And this is where people start getting stuck. And a person with moderate levels of pcos, you can pretty much see the signs. In women, one of the most obvious signs is thinning hair and facial hair, but also weight gain. Hypothyroid is one of another, one of the hallmark symptoms. Because of that HPA axis dysregulation, not only did the other receptors start to become resistant, but the thyroid hormones or the thyroid receptors started to become resistant. It can even in some cases trigger autoimmune thyroiditis or autoimmune inflammation of the thyroid. Insulin resistance also impacts cortisol metabolism. So we have an inability of the body to actually metabolize the cortisol that is being pumped into the system. So you can see how PCOS can become a major issue really, really quickly. And it affects every system in the body. It affects sleep, it affects circadian rhythms, it affects your gonadal hormones, your thyroid, your weight, your energy levels, your mood, your neurotransmitters, blah, blah, blah. And we don't want to rule that out. If you've got a person and you can go online and find different screening tools for pcos, if you've got a person who you think may have pcos, it's imperative that they see their physician and or endocrinologist in order to get that assessed and addressed because there's only so much talk therapy that you can do when their gonadal hormones are completely out of whack. Now, if the cause of their pcos, if they're. If the root cause of their HPA axis dysregulation is stress related to trauma, whether it be a trauma or complex trauma, doesn't matter, then our job is to help them re establish a sense of feeling safe and empowered in the present moment and to learn tools to basically manually activate the vagus nerve and down regulate when there's not a current present, present threat. Hypothyroid. I'm going to go through this a little faster because it's much the same. Chronic stress causes HPA axis dysregulation, leading to increased cortisol production, impaired negative feedback and cellular tolerance. So when that HPA axis is Constantly, you know, knocking on the door of the thyroid hormone going, hey, you and your buddies need to come help. Eventually the thyroid receptors say, yeah, no, no, we're tired, got other things to do. So we start to see cellular tolerance and the thyroid becomes less, starts secreting less thyroxin or starts breaking down T4 into active T3 less frequently or has more reverse T3, which is the inactivated form of T3. So there are a lot of ways that the thyroid, the person can experience symptoms of hypothyroid, but thyroid function is a vital step. Hyperthyroid can produce symptoms of anxiety, agitation and restlessness. So again, thyroid, get it checked. It's easy to do for a doctor. The dysregulated HPA axis affects thyroid function because chronic stress and elevated cortisol increase decreases the thyroid stimulating hormone. That's the hormone that says, hey, secrete some thyroid inhibits the conversion of inactive T4 to active T3. I think I just said that. And it lowers circulating levels of T3. Stress upregulates the conversion of T4 to reverse T3, which is inactive. So again, I said there's multiple ways that the thyroid hormones can be inadequate, if you will. Chronic stress may lead to resistance to the thyroid hormones and stress promotes the release of inflammatory cytokines. Elevated cortisol promo production promotes insulin resistance, which again impairs thyroid function. Who knew that insulin resistance could impair thyroid function? Another thing to bring up about pregnant people is about 20% of women develop hypothyroid either during pregnancy or postpartum. And, and, and this is related to, but not exclusive of gestational diabetes. So we do need to be aware that people who never had hypothyroid before postpartum actually can develop hypothyroid. And if we see somebody who's postpartum, that's one of those areas we do benefit from testing because, you know. Yeah, because that's something that a doctor can actually address. Both HPA axis dysfunction and hypothyroidism can contribute to weight gain and fatigue. And hypothyroidism may impair the body's ability to respond effectively to stress. Not being prescribers, again, we're not going to be diagnosing a lot of these things, but as being many people's first point of contact when they've got mood issues and things, it is helpful if you're aware of these things and willing and able to screen for them. And screening is not diagnosing. Screening is generally asking anywhere from three to six questions to Determine whether there might be something that probably should be evaluated. Issues related to HP axis dysfunction include cardiovascular disease, pain and inflammation. Pain and inflammation, where you see C and C, that means it's both can both cause HPA axis dysfunction and be a consequence of HPA axis dysfunction dysfunction. So somebody can get into a car wreck and have chronic pain and that causes them a lot of stress, which causes HPA axis dysfunction. Or they can have trauma of some sort, physical, emotional trauma, for example, and they have HPA axis dysfunction, which leads to increased inflammation and pain. So cause and consequence autoimmune issues can both cause HPA axis dysfunction as well as be caused by HPA axis dysfunction. We know there's a strong link between the development of autoimmune disorders and chronic stress trauma. HPA axis dysfunction, insomnia, fatigue, reduced libido and PCOs can all be caused by HPA axis dysfunction, cancer and diabetes. Now, oh wow, you're like cause and consequence. Yes, Stress produces inflammation. HPA axis dysfunction produces inflammation. And we know that cancer and diabetes are both stress related disorders. Now, distress, is stress the cause? No, you know, you can't say somebody's stressed, they're going to develop cancer. Can't say that. But we do know that there's a strong correlation between high stress and the development of inflammation and inflammation and the development of cancer. So it can be a cause and consequence. Effectively depression, all types, whether it's postpartum, persistent depressive disorder, depression, and even bipolar depression, can be caused or triggered by HPA axis dysfunction. And all of these things can contribute to the development of HPA axis dysfunction. And sometimes, I mean, people have situational, if you will, major depressive disorder or something else that causes depression or prolonged grief that is not the result of HPA axis dysfunction. But when that stress is extreme and ongoing, then eventually it can lead the system to start becoming miscalibrated or dysregulated. Anxiety and chronic stress, both a cause and consequence. Cognitively, cognitive impairment and dementia are often consequences of HPA axis dysfunction. And sometimes the cognitive impairment may be reversible once the person's hormones are back in balance and their HP axes are recalibrated as best as possible. HP axis dysfunction will not cause PTSD or cptsd, but it certainly can be caused by PTSD or cptsd. It's very common. And the video I have on the neurobiological impact of trauma goes through an article that was written, I think it was back in 2015 actually. That is a very detailed step by step walkthrough of the hormone and neurotransmitter and neurological cascade that we see in people who've experienced trauma who eventually develop HPA axis dysfunction. So what do we do? Told you we'd get here Blood work. We need to encourage people to get their blood work done to assess for nutrients again, even if they're eating a great diet may not be getting processed. Assess for nutrients hormones. Make sure to check the goadle and the and the hor and the thyroid. And your doctor, if you tell them you just you want a full blood panel that includes gonadal and thyroid hormones generally they know what all the different things are that they need to run. So you know, you don't need to memorize everything. Sleep quality sufficient sleep on a regular schedule essential. Just can't tell you enough how much sleep impacts the stress response. Insufficient quality sleep is actually associated with increased ruminations and intrusive thoughts. So we know that in addition to be physic, in addition to being physically stressful, it alters our cognitive cognitions and our ability to learn, our ability to think clearly and also we have those pesky old intrusive thoughts. So sleep huge step. Helping people figure out what's causing their sleep problems and helping them address those sleep problems is essential. Circadian rhythms they're different than sleep. That's your. Everything in your body runs on a circadian clock. And sleep is only one of those things. Trying to maintain a regular schedule is important. Circadian rhythms are set partially by light and the body's awareness of whether it's light or dark outside, but also by temperature and by social activity. So I bet you didn't know those last two supposed to be cool when you're going to sleep and it's supposed to be warming up when you wake up. Nutrition improvement can be super helpful. Increasing antioxidants which will help reduce inflammation in the body. That means eating colorful foods. It doesn't necessarily mean anything about supplements. Eating colorful foods. Greens, reds, purples, yellows. I encourage people to strive for three colors on their plate at every meal. Reduce inflammatory foods like highly processed foods and sugars and your processed meats that have nitrates and nitrites in them. Most people are not going to give these things up completely. I get it. I get it. So we want to look at in terms of living your rich and meaningful life, how much are you willing to cut back on some of these things you to see if it gives you more energy to see if it helps you feel better. I finally my, my daughter has Celiac disease. And to be supportive, I. I finally, you know, went the extra step and went gluten free myself. I've been fighting gluten even though I know I'm a little sensitive to it. I don't have celiac disease by any means, but I'm a little sensitive to it. Once I finally went gluten free, it was amazing how much better I felt, especially my gut. So, reducing anti inflammatory foods. Yes. I love bread. And do I miss it? Yes. Am I willing to give it up? Yeah. But that's a decision I had to make. And our clients are going to have to make their own decisions about how much of each type of inflammatory food they're willing to give up. Regulate blood sugar. And this looks different for different people. Some people do intermittent fasting. Some people don't eat processed foods. This can be got accomplished by talking to their doctor or a nutritionist in order to figure out how to reduce their insulin surges. Relaxation. When we relax, we trigger the vagus nerve. Huh? Imagine that. So strengthening that vagus nerve by helping people learn square breathing. Breathe in for four, hold for four. Exhale for four, hold for four. When you slow your breathing, the body interprets that as, hey, there's no threat out there, so I can slow your heart rate, because we don't need to keep running right now. Um, so breathing is one of the easiest ways to trigger the vagus nerve. Um, and strengthening vagal tone is the next one. So we're gonna talk about both of them together. Uh, massaging the tragus, which is the little flap on the front of your ear. Not hard enough to press the tragus down, just hard enough to move that skin, can activate the vagus nerve. Now you've also got the trigeminal nerve. Let me take my glasses off. That's right above the tragus nerve, kind of like right at the top of your ear. And that's another one that can be massaged in order to stimulate the vagus nerve. Those nerves are also. If you put your fingers there and act like you're chewing gum or eating or smiling, you can. That was a scary idea. You can feel the muscles around those nerves activating. And when those muscles move, they massage the nerve and activate that. That vagus nerve. That's why smiling, even if you're just forcing yourself to smile, it actually can help activate the relaxation response because you're stimulating that trigeminal nerve and that d. And the vagus nerve. We also want to help people address addictive and unhelpful behaviors, including gambling, drinking, and doom scrolling. Little caution about nootropics. It's the new thing out there and it's dangerous. Most everything in the body operates on the Goldilocks principle. Like the analogy I gave earlier about making spaghetti sauce. If you put too much oregano in there, you're not going to be able to really taste the garlic or the basil or and the other things that you put in there. So you need to have it in the appropriate balance to get it to taste right. The same thing is true for our neurotransmitters. To feel happy, they need to be in the right balance. And if we overload it with dopamine or something, it's not going to be in the right balance. Too much of one thing can overpower everything else. Interpersonally, we need to help people develop boundaries. Oh my gosh. And I have a video on boundaries. I use the analogy of a house. Your person is your house. And just like in your home, you wouldn't open the door and let some stranger walk in and, you know, start rifling through your drawers and go into your bathroom and whatever. We don't do that to people either. When in our, you know, interpersonal boundaries. We have physical boundaries. That's our personal space, and that includes eye contact. That includes touching, and that includes just how far you are away from me. That's my. Those are my boundaries. That's my space. We have interpersonal boundaries, and that's how we perceive our relationships and how intimate we perceive them and how we act in our relationships. It's not anybody else's right to tell us how intimate or not intimate a relationship should be. So that's, that's our boundary. This is how comfortable. This is how comfortable I feel being intimate in this relationship at this time. Our cognitive and our emotional boundaries, how we think, what we think, our. Our perceptions, our beliefs and how we feel, those are ours. Nobody has the right to tell us how to think and feel. They can tell us how they think and feel, and we can tell them how we think and feel, but we don't have the right to invade someone else's boundaries and tell them how they should feel, and they don't have the right to tell us how we should feel. Feel. And then environmental boundaries. This is one of my favorites. It's my stuff. Don't read my diary. Don't go through my desk. Don't borrow my sweater without asking. You know, all those things that if you had a little sister, you were probably telling her those Are your environmental boundaries. And a lot of people who struggle with anxiety and depression and what we tend to label as borderline personality or trauma, they've had their boundaries violated consistently by a lot of people. And they may have never learned to set boundaries or they set boundaries that were so thick and so impenetrable that they don't let anybody in. And then they feel isolated and anxious, which you see like in. In avoidant personality disorder or an insecure attachment. Communication skills. We need to help people learn how to communicate, to assertively state their thoughts, wants, and needs. To not mind read and to not expect mind reading because that just sets you up to either be wrong or to be disappointed. We need to teach relationship skills. How do we develop trust? What do we need to do in a relationship to have a healthy relationship? How do we communicate? How do we compromise? We need to help people develop self esteem and a support system emotionally and cognitively. Okay, we've got a new mnemonic. Yay. This one is Add air. To develop emotional intelligence. We want to add air. When people get anxious, they often quit breathing. They're like, so we want to help them breathe. Add air. They're aware of their feeling. I'm anxious. Okay. I'm anxious is what it is. Determine if there's a threat. I'm anxious. Is there a threat at this time? No. Okay. Downregulate. Use my distress tolerance skill skills to down downregulate that feeling so I can get into my wise mind and more clearly evaluate and figure out where that feeling came from. A assess the purpose and triggers for that feeling. Where did that come from? Oh, that person sounded just like so and so who was just verbally abusive to me for years. Okay, well, I can see why that would trigger a stress response. Identify the facts in this context at this time. That's your fit cat again. So, all right. That reminded me of that person. But in this context, with this person at this time, is this person being verbally abusive or do they just sound like the person who used to be verbally abusive? And I associate that pitch with, you know, danger. So evaluating in this context at this time, am I in danger? What's different and what's the same? How am I different and how am I the same as in those past traumatic events? And then R is respond with the best course of action. So awareness of feeling. Determine the threat. Downregulate. Assess the purpose of the feeling. Where did that come from? There was a reason. And the triggers for that feeling, what triggered it? Identify the facts in this context at this time and respond with the best course of action. Help people define their rich and meaningful life. It's hard to know how to spend our energy when, if we don't know where we're going, if we don't know the direction we're going, we don't know where to use our gas. Help people define what's important in their life. So then when they're faced with a stressor, they can ask themselves, is this thing that's causing me stress worth my time and energy? Is it worth taking time and energy from the things that are important in my rich and meaningful life to address this? Or is it a better choice to let this go and use my rich, use my energy to move towards the things that are important in my in my rich and meaningful life and just forget about that. I mean, not important. Address cognitive distortions that promote stress to improve feelings of safety and empowerment. Set small, specific, measurable, achievable, relevant and time limited goals. And yes, a lot of people think small and specific are synonymous. But after 20 years of trying to set smart goals with people, I've learned they're not. I've had some people come into my office with this goal that was very specific, but it was like a two page goal. I'm like no, no, no, no, no, no. Okay, let's back, back up. What's step one in this goal? That's what we're looking at right now. Step one. So small, generally something that can be achieved in a week and then you can have larger goals. But it's important to have those small goals that help you move toward that larger goal and help them learn how to do charting and progress monitoring. Help them learn how to evaluate the frequency, intensity and and or duration of their symptoms. Not all of them have them identify the, you know, maybe two or three that are most important for them to change. So maybe it's sleep, their mood and their pain level. So they monitor how much they sleep and the quality of their sleep each day. They monitor on a Likert scale, 1 to 5, for example, what their mood was and their pain level. They monitor on a 1 to 5 what their pain level was for most of the day, that day. There are other ways to monitor that can get more granular. But the important point is to look, have a chart, have a recording, have data that you can look at and see pro progress. You know, you're not going to have huge leaps. A lot of times it's going to be incremental progress, but it's incremental progress forward. Just like losing weight, you typically don't lose four pounds in a day. You may lose an eighth of a pound today and an eighth of a pound tomorrow. But eventually those eighths of a pound add up. Help people develop mindfulness of their status, how, what's going on with them, their needs, their triggers and their vulnerabilities so they can plan for those, they can be aware of those, and they can take action when necessary. Help the person understand what's happening and all of the interconnections. A lot of times people feel like there's no control over this. They don't understand that it's biochemical. It's not just all in their head. It's not something they can think away. There's a process to healing the body that has wired, it's rewired itself for trauma instead of being wired for safety. Help them grieve. If somebody has a dysfunctional or a dysregulated nervous system, they experience a lot of stress and they have experienced a lot of stress as a result of their HPA, axis disregulation, whatever that stress was. A lot of times there are things that they need to grieve as a result. And until they grieve, not having the childhood they feel like they deserved or not being able to say goodbye to somebody or whatever it is that there, those stressors and those traumas that they're still, you know, struggling with, whatever's keeping them from letting those things go, they need to, to be able to grieve. Help them identify and explore stressful schema and restructure when possible. And this can include inner child work. Those schema that were formed as a child in an unsafe environment often speak loudest to people when they're under stress. That that child yells as much as they can in, in the person's head and says, hey, you're not safe. Get to safety. So helping people examine the facts in this context at this time and understand why they're having such a strong reaction to something in the present, then they can start figuring out how to develop that sense of safety and empowerment. Environmentally add calming, empowering triggers to the environment. Sights, smells and sounds. Triggers don't have to be negative. Add things in the environment that make them smile, that make them feel confident. I have some aromatherapy stuff right now, and it's not an essential oil, it's just an aroma oil. But this one's called cupcake. Oh my gosh, it smells amazing. I walk into my office, I'm just like, oh, that's wonderful. Eliminate unnecessary stressful triggers to promote comfort and safety. Develop a plan to cope with inevitable triggers and stressors, including things like asking themselves is this person or situation deserving of my energy and what response in this situation helps me use my energy to move toward those things important in my rich and meaningful life. I mentioned earlier cbd CBD has been touted to have a lot of amazing anti inflammatory, pain management and even mood improving properties. However, it's broken down by enzymes and the cytochrome P450 pathway like most other meds and you can click on this link in the PDF of the PowerPoint and go to the University or Indiana University website that lists the different medications that are broken down by the different enzymes in the CB in the Cytochrome P450 family. What you need to recognize is that most things, whether it's blood clotting drugs or blood pressure drugs or mood medications, anti anxiety, antidepressants, opioids, antipsychotics, antihistamines, they're all processed or broken down by cytochrome P450 enzymes. And as I mentioned earlier, if you're taking those drugs and then you also start taking CBD, then they're competing for the cytochrome P450 enzyme to get broken down to get out of the system. Which means that the clearance of either the CBD or the medication is probably going to be slowed and that can cause a buildup of that medication in the system. Feelings or reactions caused by a neurochemical response. These, the chemicals involved in stress are also involved in happiness and energy regulation. Excess anger, anxiety or stress can cause a variety of changes in the nervous system that impact your hormone and neurotransmitter balances and consequently your mood as well as your health. A huge part of recovery is eliminating unnecessary physical, emotional and cognitive stress and developing tools to deal with inevitable stress while establishing a sense of safety, empowerment and hope. By doing this, you're taking some of the pressure off of the stress response and allowing it to actually, you know, turn off sometimes and heal itself instead of constant constantly being.