The Brain Vagus Nerve HP Axes and Neurotransmitters Continuing Education Training

Hey there everybody, and welcome to this video on the brain, vagus nerve, HP axes and neurotransmitters. We got a lot to cover today. I'm your host, Dr. Donnelly Snipes. And this is another video that is part of the PACER method training series. In overview of the PACER method, which was the first video in the series, you explored why it was important to address the mind body connection using a trauma informed, integrated cognitive behavioral approach. In this video, you're going to learn more about the communication of the body and mind through the brain, the HP axis, vagus nerve, gut microbiome, neurotransmitters and hormones. Now, I do have a lot of other videos on the YouTube channel that go more into depth on each one of the HP axes, each one of the neurotransmitters, but I really want to just kind of provide an overview. So we're going to expand upon what we talked about last week. So let's first start thinking about this. The mind body connection. As a body factory, the brain is the main office where a lot of stuff occurs. The frontal cortex is the CEO, the hypothalamus is the coo, the amygdala, or your fear processing is the risk manager. And the vagus nerve is the vice president of operations that carries signals or messages between the brain and the body. So the brain is the main office. The limbic system is responsible for emotional and behavioral processes and includes that frontal cortex, the CEO, the hypothalamus, the coo, the amygdala, risk manager and the vagus nerve. The functions of the limbic system are not just a process. Emotions. The function of the functions of the limbic system include digestion, heart rate regulation, blood pressure and respiration, blood sugar regulation, immune system responses, mood and neurotransmitter regulation, mucus and saliva production, which doesn't sound pleasant, but it's important. Skin and muscle sensations, speech, taste and urine output. So let's look at a couple of those really quick digestion. Why is that important? Well, if the food we eat is broken down in order to into its component parts, in order to make the hormones and neurotransmitters we need to feel feelings, to repair, to be happy and healthy. Then if our digestion is poor, then our health and mental health are likely going to be poor. The heart rate and blood pressure and respiration, our breathing and our cardiovascular system. Why is that important to mood? Well, if your brain is deprived of oxygen, that's a problem that's going to lead to all kinds of cognitive dysfunction. And if the body is under oxygenated, if your O2 saturation is, is low, your body perceives that as a stressor and is going to increase your heart rate and try to get oxygen where it needs to go. And all of these things can contribute to mood symptoms. Blood sugar is another issue that a lot of times we don't think about in terms of mood. But what happens when your blood sugar gets too low? The body says, oh, we're out of energy, it triggers the stress response in order to force your body to dump blood sugar into the system. So it's actually a stressor, if you want to think about it that way. When your blood sugar gets too low and if you have difficulty with blood sugar regulation, then you may be frequently tripping that stress response. Likewise, if your blood sugar gets too high, the body wants to maintain homeostasis. It wants to maintain a certain temperature, a certain blood sugar range, certain this, certain that. And when you get too high or too low on any of those ranges, the body may perceive that as a stressor. And your immune system responses. Now you may be kind of scratching your head about how that relates to mood, but remember, as inflammation goes up, mood symptoms tend to go up. As inflammation goes down, mood symptoms tend to go down. As chronic stress goes up, the body's ability to suppress inflammation goes down. And we've talked about this with the HPA axis before, that initially when the system is running well, when the stress response system is running well during an acute stressor, the body releases cortisol, which is a steroid of sorts that suppresses immunity or. And why does it do that? Because now is not the time to have pain and inflammation. Now is the time to fight or flee. As soon as the immune system. Sorry, as soon as the stressor passes, then cortisol subsides and the immune system kicks in and inflammation goes up. The body sends nutrients and blood supply to those areas that were damaged in order to repair them. So it makes sense. But when the HPA axis and the other parts of the limbus, limbic system start to get out of whack, then we may see sort of what we consider uncontrolled or systemic inflammation and mood. Obviously neurotransmitter creation is important. When the stress response is kicked off, then excitatory neurotransmitters that are helpful, designed to help us focus, fight and flee are released when we want to relax. When that rest and digest or feed and breed system is kicked off, then other neurotransmitters are Produced in order to help us achieve that goal. So it's important to recognize all of the different physiological issues that can contribute to mental health issues. So the frontal lobe is the center for emotions and thought processes that translate into personality and are responsible for higher cognitive functions such as memory, impulse control, problem solving, social interaction, organization, motor function. You know, we've. I've talked a lot in other videos about the frontal cortex and the prefrontal cortex, and that's where we do our executive functioning. Hence the reason I termed this the CEO. The hypothalamus is the chief operating officer. It is more involved in processing information and feeding it to the CEO so the CEO can make decisions. The hypothalamus is involved essentially in four Fs fight or fleet, which is, involves the HPA axis, feeding and energy regulation, which involves the HPT, or hypothalamic pituitary thyroid axis, and fornication, which involves the hypothalamic pituitary gonadal axis. So the hypothalamus has its greedy little mitts in just about everything. So if the hypothalamus is damaged in some way, then we may see problems in limbic system functioning. The hypothalamus also communicates with the pituitary gland to influence the endocrine system through the adrenal glands, thyroid glands, and gonads. And I just went through those. We have what I call the HP axes. Hypothalamus, pituitary, adrenal, hypothalamus, pituitary, thyroid, and hypothalamus, pituitary, gonadal. All three of those have their own independent functions, but they also interact with one another. They can. They get together and they work as a team in order to help the person stay safe. The hypothalamic neurons originate in the nose. Okay, well, that's interesting. And respond to odors, sending a signal to the pituitary gland, which communicates with the endocrine system. So when we talk about terpenes, when we talk about essential oils, or when you just smell a particular smell, we know that smell is one of our greatest memory triggers. And that's why, because there's a direct line between our nose and our hypothalamus, which helps process emotions and. And helps us expect. Know what to expect. It also synthesizes vasopressin and oxytocin, which are both involved in bonding and social behavior. Now, interestingly, and I'm going off on a tangent here, oxytocin increases when you're engaged in pro Social behaviors, like doing things that you enjoy with people that you enjoy. But it also increases when there's a threat to a loved one. So we see oxytocin levels increase in caregivers when there's a threat to their young, which I thought was kind of cool. The amygdala is what I think of as our risk manager. And the amygdala is integral in fear processing and initiation. And the fight or flight response, it helps trigger the HPA axis. When the amygdala kicks off, it says, bad things are happening. We need to be on high alert. It processes information and forms and stores memories associated with emotional events and responses, responses including fear, anxiety, and aggression. So a lot of your happy memories are not going to be stored here. This is where they store all of the. All of your memories of threats. Like a risk manager would. How do we mitigate threats? How do we prevent problems in the. In the factory? Well, the risk manager would be aware of that. And interestingly, the amygdala does change in size. It can grow or shrink in response to trauma or stress levels, what I call limbic office assistance. Now, we didn't talk about these a lot earlier, and we're not going to talk about them a whole bunch, but they deserve an honorable mention. The hippocampus is connected with the amygdala and assists with learning and emotional memory formation and schema formation. So the hippocampus takes in information, and I call it filing. They take all this information in and they're like, okay, let me try to collate this in a way that makes sense and forms a schema, writes a memo based on the information that it took in. So the hippocampus is really interesting in and important in schema formation, and it is important to know. Note that people who've experienced significant trauma often show evidence of hippocampal shrinkage. Now, you would think that they would have, you know, it would just be overflowing with stuff, but actually, it starts to become neurotoxic, and the hippocampus actually starts to lose neurons. And the thalamus. The thalamus is basically a relay station of sorts, involved in sensory processing and adapting our cognitive maps or how we interpret things. And it's also involved in circadian rhythm regulation. Just kind of throw that in there. Now for counseling and therapy, this isn't necessarily super important in terms of frontline treatment, but in terms of case conceptualization, it's important. If the person has physical traumatic brain injury, we need to know about that because that will. May alter how they respond to things. If they've experienced trauma, they may have brain changes which, you know, we can consider traumatic brain injury. That didn't happen from what they call mechanical means. It wasn't like they got a knock on the head, but it happened because stress levels increased the glutamate levels in the brain so high for so long, it started killing off brain cells. So we do want to reflect on that. We also want to reflect on any other changes that may have occurred in the brain as the result of, for example, alcoholism or hepatic encephalopathy. That is, when the. When the liver starts to not function well, there's basically a backup into the brain and it causes a toxic environment in the brain. So all of these things are important in order to understand the. The multiplicity of potential causes of symptoms as well as to formulate an effective treatment plan. Now, the vagus nerve. Everybody loves talking about the vagus nerve. Right now, the vagus nerve is the tenth cranial nerve, and it transmit message. Transmits messages between the brain and bodily systems. Now they call it the vagus nerve because vagus means wander. And it wanders throughout our body. It's got little projections just about everywhere from right up here in our face, in our voice box, in our gut. You know, it's got its grimy little mitts everywhere, but that's what a good manager is going to do. The vagus nerve takes information from the CEO and COO and it tells all of the different departments in the body factory, hey, this is what's going on. Likewise, it takes information from the body, the sensory information, the sensory input, and it reports back up to the brain and says, yeah, we got a dysfunction down here, or it's all clear, everything's going well. Increasing vagal tone or responsiveness improves the body's ability to switch off the stress response when a threat has passed. So a lot of activities that we talk about these days in terms of stimulating the vagus nerve and vagus nerve activation and improving vagal tone, what we're doing is we're strengthening the vagus nerve's ability to jump in and say, okay, threat has passed. Let's move on. Let's relax now. And making it, if you will, more authoritative. Now, we still have more in the nervous system. The peripheral nervous system is what I call the research and development team. They are out there gathering information and trying to figure out, you know, what's going on, especially with new information. The gut is the main receiving area, if you will, and Is staffed by microbes that alter the production of hormones and neurotransmitters in response to messages from the vagus nerve. So the gut, when you eat, the food, is taken into your gut. The food that you eat is broken down into component parts and distributed in order to make hormones and neurotransmitters. So the gut is the receiving bay. It's getting all those supplies that are needed in order to make the products that the factory is going to make. The food that's eaten arrives in the gut and is unpackaged or broken down with the help of the gut microbiota and then transported to the intestines, as well as out to various places in the body. In the intestine, there are many different types of workers that are called microbes that further break down the food or unwrap the individual products. So your food is broken down a little bit in the stomach, but it's further broken down in the gut. And a lot of your nutrient absorption happens in the. In the intestines, and a lot of the neurotransmitters are created in the intestines. You can see that people who have irritable bowel syndrome or Crohn's disease or something else where they have chronic intestinal inflammation, they're probably going to have more difficulty making those neurotransmitters and hormones. We know that stress and certain foods will make those kinds of conditions worse. So part of the treatment plan for them is going to try to help stabilize that factory so it can effectively make the hormones and neurotransmitters. Each type of worker in the gut has its own specialized job, and I've gone through this in videos on nutrition and mental health and the gut microbiome. But I do want to point out that some of those microbes that we have in our gut that are good, that we need include things that we typically get freaked out about, including E. Coli, streptococcus, and candida. Now, in excess, just like anything else, in excess, they're bad, but in small amounts in the right place, in the lower intestine, in the. In the intestine, they actually have a function to help make neurotransmitters. Sometimes the products are kept in the intestine, combined and made into neurotransmitters. Other times, the unwrapped packages or the nutrients are sent to other organs, like the liver and the gonads. So the body can make hormones, maintain the immune system, or keep the person energized in a fully functioning factory. Every department has just enough workers and resources to maintain steady production. Like I said, you don't want a candida overgrowth. You don't want too much E. Coli or streptococcus. You want just enough to do what it needs to do. And there is a fine balance. And unfortunately, when we take things like broad spectrum antibiotics, guess what? It wipes them out and you got to start rebuilding those. You, you got to hire a bunch of new workers. It basically is what it comes down to. So people who are on antibiotics may experience changes in their mood, especially if they're on long term antibiotics. If it's just, you know, a seven or ten day course, they may have a little bit of irritability or something, but it may not be huge. But if it's an ongoing thing, like for Lyme disease, where they're on really intense antibiotics for multiple weeks, you may see it starting to impact their mood. If the brain or the CEO receives information that there's a threat, the hypothalamus, the COO is notified. The hypothalamus says, okay, there's a problem, we need to trip off all these HP axes. The hypothalamus alerts the vagus nerve that there's a threat and to increase the production of excitatory neurochemicals and reduce the focus on non essential activities. So the beeping starts. The warning sign, the hypothalamus tells the pituitary, which triggers the HPA axis. Now, what does the HPA axis do? The hypothalamic pituitary adrenal axis is our main stress response axis. Now it works with, it cannot work without the HPT or thyroid axis and the HPG axis, gonadal axis, they're important and they're all recruited when there's a threat to the system. All hands on deck. But HPA axis is the main controller of the threat response system, part of the stress response that produces and releases adrenaline and spikes blood glucose and noradrenaline. It causes the release of cortisol. It promotes proper cardiovascular function and blood pressure control. Under stress, it helps control blood sugar. So when the body is fighting or fleeing, it has a steady state, a steady amount of, of resources, whether it's sugar or fatty acids, depending on how long the fight goes on. It assists the body in the use of carbohydrates and sugars as well as fats for energy. It helps distribute stored fat and promotes healthy GI function. When the HPA axis becomes dysfunctional, we have some related issues. Cardiovascular disease, when the Stress response system is dysfunctional, we tend to see hypertension, we see more problems with heart attack and stroke, we see a lot more pain and inflammation. Remember I said especially if the HPA axis is on too long or too consistently, then cortisol, the steroid, loses its ability to suppress inflammation. So we see inflammation start to increase despite the fact that the person is under stress. We also start to see a suppression of serotonin and an increase in pain. Autoimmune issues are also more common. Well, we know the key feature of autoimmune issues is inflammation. When we start seeing systemic inflammation, that means the immune system is being recruited too much and is trying to figure out, okay, where's this problem coming from. Insomnia is another HPA axis related issue. When serotonin is suppressed, then there's often a change in the amount of melatonin available. So the person may not be able to drift off to sleep as well. When the person is under stress and the HPA axis is activated, guess what? Cortisol is going to stay high. Of course, cortisol is high. Serotonin and melatonin levels stay low and they're probably not going to get that good quality sleep. They may sleep, but it's not quality sleep. So then we start seeing fatigue, poor quality sleep, poor regulation of blood sugar. Pain and inflammation are going to have consequences including fatigue and reduced libido. Interestingly now, and remember I said that the HPA axis is intimately involved with the other HP axes. People who have ongoing stress often or not often. But there is a strong correlation between ongoing high levels of stress and the development of polycystic ovarian syndrome. Because of the alterations of gonadal hormones. People with PCOS or polycystic ovarian ovarian syndrome tend to also experience hypothyroid as well as depressive symptoms. Weight gain, hair loss, oily skin, facial hair growth. So it is something that significantly, often impacts their quality of life. Their, their energy levels really low and they don't feel like there's anything they can do to address it because it's not going to resp to dieting or something. They're not gaining weight because they're eating too much, Their system has gone awry. HPA axis dysfunction is also related to cancer and diabetes, which is kind of interesting affectively. I've mentioned multiple times that stress and unrelated, or I'm saying unresolved traumatic stress keeps the HPA axis active. When people have unresolved trauma, they don't feel safe, they don't Feel empowered, which means they feel vulnerable, which means they always are scanning for threats, which means they always feel like they're at risk for a threat. And that HPA axis, although it may only be on low, that HPA axis stays on, which leads to dysfunction after a while. It's also related to depression of all types. Bipolar depression, postpartum depression and good old depression. Depression, unipolar and anxiety, and chronic stress. Cognitively, when the HPA axis isn't working well, we may see increases in cognitive impairment, difficulty concentrating, difficulty learning, foggy headedness. Well, it makes sense. If you're not getting good sleep and you're not regulating your cardiovascular system well, it's going to be hard to think clearly. And dementia, they actually have found a correlation between people with hypothyroid and dementia, the HPT axis. Now we're moving on. So the HPA axis is your main control center for your stress response system, but it brings along its buddies, the thyroid axis and the gonadal axis, the HPT axis. Most of us know thyroid influences how the body uses energy. The thyroid creates thyroxin, which is an excitatory hormone that helps us have energy and use energy for the fight orf flight response. The thyroid is involved in regulating breathing, heart rate, metabolic rate, muscle strength, menstrual cycles, body temperature, and even cholesterol levels. Imagine that. My dog, who is 9, but he's a boxer, so he's a big dog that's old, was recently diagnosed with hypothyroid and they suspect that's the reason that his cholesterol levels are way too freaking high. So that was just fascinating to me to realize that hypothyroid could actually increase even significantly, cholesterol levels. Hypothyroid is related to symptoms of depression. People who have hypothyroid may have all of the symptoms that one would look at and diagnose as clinical. Depression, fatigue, concentration problems, sleep changes, different food cravings, difficulty feeling pleasure. So all of those things because when the thyroid is dysfunctional, that means we have a hard time getting that pep that's in there that we need in order to feel pleasure as well as fear or anger. As I mentioned, it's been directly correlated with dementia. And they suspect that hypothyroid, because the system is slowed down, the brain is deprived of sufficient oxygen, and very importantly, hypothyroid in children, and it happens more commonly than you would think, can lead to cognitive dysfunction. If it's not caught, then that lack of oxygenation, that slowing of the system actually Impairs brain development and can cause learning problems and cognitive dysfunction. Now, hyperthyroid is associated with anxiety symptoms, high blood pressure. So if somebody's presenting with anxiety symptoms, we want to make sure we rule out thyroid issues. Supra, therapeutic thyroid hormone doses recently have been found to potentially level bipolar disorder. Now, there, this study that came out was published in 2018. There hasn't been a lot of research that has been published since then on this, but it makes you wonder if there is a connection between the development of bipolar disorder and thyroid dysfunction. I don't know that yet, but obviously, if you can basically trip somebody's thyroid and into being hyperthyroid, and it levels the mood symptoms and bipolar disorder, it may indicate that there's. That that's at play. It may also just indicate that you're upping their normal level of activity, if you will. So it's closer to what they are when they are in their manic or hypomanic state. But it said it levels it out, which means it brings down the manic symptoms, too. So I'm not sure how that works, and the researchers weren't either, But I thought it was really interesting to note. And finally, the gonadal axis regulates our reproduction and our immune system. Remember, after stress, the immune system has to go out and search for any damage. And if there is damage, cause inflammation, bring nutrients to the area, and heal it. Availability of gonadal hormones also directly, directly impacts the availability of neurotransmitters. For example, as serotonin goes up, estrogen goes up. And you may think, well, that's great, more serotonin, people are less depressed. Not so much the old Goldilocks principle. Too much serotonin is associated with anxiety in people. High levels of estrogen are also associated with anxiety and irritability in a lot of people. So we, we have to recognize that more is not better. We need to have the right balance for that person. Down regulation. Once the nervous system communicates to the brain that the threat has passed, it communicates to the body through the vagus nerve that relaxation and repair can begin. So this is what I usually call rest and digest. But I learned a new term for it today. Feed and breed. And I've always noted that when we're in that relaxation state, our body says, okay, we can procreate. There are no threats. When the HPA axis is activated, our body's saying, yeah, not now's not the time to bring a helpless little creature into the world. A note about trauma, significant trauma or so a Single significant trauma or complex ongoing trauma may lead to hypocortisolism or glucocorticoid resistance. What this means and. And it's sort of akin to tolerance that we see in alcoholism. When people drink initially, that alcohol has an effect on them. But if they continue to regularly drink, their body becomes resistant to the effects of it, and so they need to drink more in order to get the same high. Well, the same is true for cortisol. If we occasionally have a stress response, then the body responds like it normally would. When we are constantly stressed, then the body starts to become tolerant to that cortisol, and that cortisol starts losing its ability. So we need more cortisol in order to trigger that stress response. When our body is undergoing extreme trauma, it disrupts the functioning of the entire factory. When the HPA axis is dysregulated, it disrupts the entire factory, which can lead to emotional dysregulation. And the analogy I can make is thinking about it like factory workers that have had to work double shifts for months, and they are just completely and utterly exhausted. The boss says, hey, you've got to increase your production. And the workers look at them like. Like, you're crazy. I don't have anything left in me. You're crazy. And that's what hypocortisolism looks like. The person's stress response just doesn't get triggered by anything but the most extreme triggers. And then when it does get triggered, oh, boy, watch out. Same thing for these factory workers. If the boss comes in and says, all right, well, y' all are going to get fired if you don't pick up the pace, then they're going to pick up the pace, but at what cost? And it. So they have to have a lot more encouragement to pick up the pace. They do it, and they do what they need to do. But then when they're done, oh, boy, are they done. Many people who present with mental health or chronic health issues have some level of HP axis dysfunction, which must be addressed for optimal recovery. Now, notice I didn't say HPA axis. I said HP axis. So we want to look at that. They may have hypocortisolism from trauma, you know, which is most common. But they also may have dysfunction or inadequate testosterone or gonadal hormones. Again, because of birth control, because of aging, because of nutrition. There's a variety of reasons. If the gonadal hormones are insufficient, it's going to impact the HPA axis and the HPT axis. Likewise, the gonads and the adrenals may be doing just fine, but the thyroid is out of whack. They may have autoimmune thyroid thyroiditis. So we need to look at that and say, okay, you know, that is going to have to be addressed in order for the body factory to optimally function. There's a lot we can do with talk therapy and counseling and helping people become restructure their schema that cause distress and respond differently in environments and create environments where they feel safe so they're not hyper vigilant all the time. Yes, we can do that, but no amount of talking is going to increase thyroid hormones. If the problem is in the thyroid. Hormones and neurotransmitters are produced by the body factory to help us respond to our environment. When we do something that is good for us or pleasurable in some way, then our body releases dopamine and endorphins and serotonin and norepinephrine and other stuff. But really strong hits of dopamine and, and endorphins. Dopamine is our motivation chemical. It says, I want to do that again. When we are doing something that is painful, not so much dopamine, more glutamate. And this is painful, this is threatening, this is unpleasant, let's not do that again. So all of these things fluctuate. Alterations in any hormones or neurotransmitters are going to impact all other neurotransmitters and hormones. When you start looking at the research, when you look at increasing dopamine, well, you can't just increase dopamine. If you increase dopamine, then serotonin and norepinephrine are generally going to go up with it. Likewise, if you decrease it, serotonin and norepinephrine are likely going to go down with it. Now let's think about that for a second. People who are on antipsychotic medications, what do antipsychotics do? Lower dopamine. So we're lowering their dopamine, but we're also lowering their serotonin and their norepinephrine. What effect is that having on them? Many, many different neurotransmitters and hormones can be implicated in any symptom, including depression, anxiety, concentration issues, fatigue, pain, intolerance or sleep issues. So we don't want to assume it's just X. Too often we assume if somebody's depressed, they have a serotonin deficiency. That may not be it at all. It may be thyroid, it may be norepinephrine, it may be dopamine. There are a lot of different substances that can be amiss or systems that can be having problems that can cause depressive symptoms. So we need to be less single, focused, I guess. So let's briefly go through some of these hormones and neurotransmitters and moods. And I know that wasn't a very gentle segue. There was no nice place to just kind of plug this in to the body factory. But I think it's important for us to just briefly have a review of what these hormones and neurotransmitters do. And as I said, I have videos on the YouTube channel that go in depth into each one of them. But let's just hit the highlights. Now, serotonin is your multifunctional neurotransmitter. It does just about everything, including helping with sleep, mood regulation, pain perception, gut health and appetite. Now, there are a lot of serotonin receptors in your body. 5ht1a, 5ht2. You know, there's 17 different types of serotonin receptors, and certain receptors are turned on under certain circumstances, and other receptors are turned on during other circumstances. So saying we need to increase serotonin is far too simplistic. Or decreased serotonin is far too simplistic. It may be increase the activation of 5ht1a versus 5ht3. And that's something that a psychiatrist is going to think about more. And that's something that we may be able to start to discern from some of the genetic testing that's out there that may indicate if there are physiological differences in people's receptor systems. Norepinephrine, this is our focus neurochemical. And a lot of times people with ADHD are suspected of having a dysfunctional norepinephrine system. That's not always it, but it could be. Norepinephrine helps with focus, mood again and your circadian rhythms, and it actually helps synthesize serotonin. So without norepinephrine, we're going to have problems with serotonin. And remember I said when serotonin goes up, norepinephrine does go up, too. Acetylcholine is positively correlated with stress or HPA axis activation as well as depression. As acetylcholine goes up, serotonin tends to go down. Now, that's again, overly simplistic. But as acetylcholine and stress go up, our relaxation chemicals tend to go down and people may start feeling more anxious, depressed. Glutamate is our main excitatory neurochemical. So when we are under stress, when that HPA axis is kicked off, glutamate is the main source of energy mobilization that is released in our body. Unfortunately, high levels of glutamate for too long in our system can become neurotoxic. So we don't want too much glutamate for too long. But another interesting thing with glutamate is that it's broken down in order to make gaba. When we don't need to be stressed, when we can relax, glutamate is broken down in order to make gaba, which is our most potent natural relaxation chemical. And GABA is actually for physical as well as mental relaxation. When you start looking at muscle relaxers, they often work on the GABAergic system. Endorphins are our natural pain killers, and endo means internal. So endorphins are our natural naturally occurring pain chemicals and they also are our naturally occurring pleasure chemicals. When we do something that is really pleasurable, we generally get a surge with that dopamine of endorphins and then dopamine, everybody's favorite. Dopamine is responsible for helping us with motivation, but it's also an energy neurochemical. If we, if dopamine goes down, energy levels go down. When people take antipsychotics, they start to become sleepier. We know this Dopamine is also involved in movement. So too much dopamine can contribute to problems in movement. Parkinson's and restless legs syndrome are caused by dysfunction in the dopaminergic system. Dopamine is also involved in cognition or thought and indirectly in appetite. When people are deficient in dopamine, a lot of times they will gravitate towards high sugar, high fat foods that are pleasurable. And when they eat those, the body releases dopamine as well as endorphins. So indirectly, dopamine may regulate appetite. We know that some of our depression medications, our antidepressants, will increase dopamine. We have SSRIs, selective serotonin reuptake inhibitors, SNRIs, selective serotonin, norepinephrine reuptake inhibitors, and SNDRI, selective serotonin, norepine vitro and dopamine reuptake inhibitors. So they do realize that not all depression is caused by serotonin. Your endocannabinoids are involved in sleep, inflammation, mood and motivation. And actually I'm doing a whole series on your endocannabinoid system, marijuana and cannabis, that will be premiering on Friday of this week. But recognizing that endocannabinoids are integral in just about every bodily system and every bodily function. Who knew? The CB1 receptors in your endocannabinoid system are involved in mood and movement, and the CB2 receptors are involved in your immune system and pain. Cortisol, as I already mentioned, is your main stress hormone and it is highest upon awakening. You need cortisol for that awakening response and then it declines throughout the day, hitting its lowest when it's time for you to go to bed. So cortisol is regulated by and helps regulate your circadian rhythms. If you maintain your cortisol levels too high, then your circadian rhythms are going to get out of whack. Adrenaline and thyroxin are both useful from mobilizing energy for fight or flee. Testosterone increases in response to cortisol and stress, including competition. So when people are feeling threatened or challenged, testosterone often increases and it decreases under conditions of hypocortisolism. So if cortisol is not doing its job, the HPA axis is out of whack. Testosterone levels decrease, so that may increase feelings of depression. Oxytocin is generally thought as your bonding or preservation neurochemical. And there's a positive correlation between oxytocin and cortisol, suggesting a social support seeking response. So when we start feeling stress, oxytocin actually goes up because it's trying to prompt us to reach out for social support. Who knew? Progesterone is the building block for testosterone and is involved in regulating libido, thyroid function, sleep and estrogen balance. So think about birth control or hormone replacement therapy. A lot of times that has a progesterone component. Sometimes it's only progesterone. So think about how increasing that one hormone dramatically might throw the balance of the rest of the system out of whack. And estrogen is involved in general in mood management and reproduction. Talk therapy can reprogram the response to stimuli so our HPA axis isn't triggered as often. It can help us modify existing schema or the way we think about, interpret and respond to things, you know, because what, what, what was true in the past may not be true in this context in the present. And it can help us address our response to triggers in the present. So when this happens, what are my options? What can I do instead of something that's unhelpful? Hormonal deficiencies and neurotransmitter imbalances can also cause mental health symptoms, but can be caused by a variety of issues including autoimmune disease, age, nutritional deficiencies, sleep problems, et cetera. So we don't want to assume that the hormonal deficiencies or neurotransmitter balance imbalances are caused by just distressful thoughts. Additionally, brain damage from accident, stroke, or oxygen deficiency can also cause mental health symptoms. Full recovery and effective treatment planning requires exploring all of these and helping people understand how a healthy body contributes to a healthy mind.