Norepinephrine PowerPoint

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Norepinephrine The Get Up and Go Neurotransmitter Instructor: Dr. Dawn-Elise Snipes PhD LPC-MHSP LMHC Executive Director AllCEUs Counselor Education AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 1

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Objectives  What is it and what is it’s function  How does it interact with serotonin dopamine and GABA  What are symptoms of excess  How do you decrease it  What are symptoms of insufficiency  How do you increase it AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 2

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What is it  General function of norepinephrine is to mobilize the brain and body for action  Norepinephrine release is lowest during sleep rises during wakefulness and reaches much higher levels during situations of stress or danger  Norepinephrine functions mainly as a neurotransmitter with some function as a hormone being released into the bloodstream from the adrenal glands  NE affects the behaviors of individuals including a modulation of vigilance arousal attention motivation reward and also learning and memory AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 3 https://www.britannica.co m/science/norepinephrine https://www.caam.rice.ed u/cox/wrap/norepinephri ne.pdf Bipolar Disord. 2008 May103:349-59 https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3131 098/ https://www.ncbi.nlm.nih. gov/pubmed/10703757 https://www.anxiety.org/s erotonin-norepinephrine- reuptake-inhibitor-snri

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What is it  It enhances processing of sensory inputs attention and formation and retrieval of long-term and working memory  NE is involved in the clinical features of cerebral aging cognitive slowing and loss of behavioral adjustment  Both NE and 5-HT activity is lower in bipolar disorder  Neither 5-HT nor NE depletion induced clinical depression in healthy subjects or worsened depression in unmedicated symptomatic patients with major depression.  This finding suggests that the cause of depression is more complex than just an alteration in the levels of 5-HT and/or NE and may be more directly caused by dysfunction in brain areas or neuronal systems modulated by neurotransmitters. AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 4 https://www.britannica.co m/science/norepinephrine https://www.caam.rice.ed u/cox/wrap/norepinephri ne.pdf Bipolar Disord. 2008 May103:349-59 https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3131 098/ https://www.ncbi.nlm.nih. gov/pubmed/10703757 https://www.anxiety.org/s erotonin-norepinephrine-

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What is it  Like SSRIs SNRIs are thought to work by promoting neuroplasticity in the brain.  Higher levels of norepinephrine and serotonin may stimulate neurons to remodel themselves and their circuits in a variety of ways that promote increased flexibility.  NE plays a determinant role in executive functioning regulating cognition motivation and intellect which are fundamental in social relationships.  Social dysfunction is possibly one of the most important factors affecting the quality of life in depressed patients AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 5 https://www.britannica.co m/science/norepinephrine https://www.caam.rice.ed u/cox/wrap/norepinephri ne.pdf Bipolar Disord. 2008 May103:349-59 https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3131 098/ https://www.ncbi.nlm.nih. gov/pubmed/10703757 https://www.anxiety.org/s erotonin-norepinephrine-

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What is it  Phenylalanine-Tyrosine-L-dopa-Dopamine- Epinephrine-Norepinephrine  Norepinephrine is synthesized from dopamine tyrosine amino acid found in proteins such as meat nuts and eggs. Dairy products such as cheese also contain high amounts of tyrosine the amino acid is named for "tyros" the Greek word for cheese.  Modulates immune response. Suppress neuroinflammation when released in the brain.  Up to 70 of norepinephrine projecting cells are lost in Alzheimer’s Disease  Increase the force of skeletal muscle contraction and the rate and force of contraction of the heart.  Increase heart rate blood pressure and levels of glucose and fat in the blood AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 6 https://www.b ritannica.com/ science/norepi nephrine https://www.c aam.rice.edu/ cox/wrap/nore pinephrine.pdf Bipolar Disord. 2008

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What is it  In the eyes an increase in production of tears making the eyes moister and pupil dilation.  In brown adipose tissue an increase in calories burned to generate body heat.  In the kidneys a release of renin and retention of sodium in the bloodstream.  In the liver an increase in production of glucose  In skeletal muscles an increase in glucose uptake.  In fat cells an increase in fat burning.  In the stomach and intestines a reduction in digestive activity and decreases in gastrointestinal mobility AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 7 https://www.b ritannica.com/ science/norepi nephrine https://en.wiki pedia.org/wiki /Norepinephrin e https://www.c aam.rice.edu/

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Norepinephrine Deficiency Prolonged Stress  In the early stages of prolonged or severe stress the stress response system is overactive and norepinephrine and other adrenal stress hormone levels are typically elevated.  This increases arousal amplifies the emotional reaction to stress and can manifest as insomnia anxiety depression irritability or emotional instability.  But prolonged stress leads to underactivity of the stress response system resulting in norepinephrine deficiency along with cortisol and epinephrine depletion. Hypocortisolism  This lowers arousal and can result in low energy daytime fatigue concentration/focus issues and general apathy. AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 8 https://universityhealthnews.com/daily/depression/surprising-research-challenges-our-understanding-of-norepinephrine- deficiency/

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Symptoms of Insufficiency  ADHD  Parkinson’s disease and diabetes cause degeneration of norepinephrine neurons leading to bradycardia and hypotension  Low levels of epinephrine and norepinephrine can contribute to a variety of physical and mental conditions including:  Depression  Fibromyalgia  Hypoglycemia  Migraine headaches  Restless leg syndrome  Sleep disorders AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 9

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Increase Norepinephrine  Cocaine  Tricyclic antidepressants  Amphetamines  Steroids  Psychostimulants ADHD medications increase dopamine and norepinephrine AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 10

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Increase Norepinephrine  Exercise  Stress  Phenylalanine precursor  Tyrosine precursor  Carnitine  Levels of dopamine norepinephrine and serotonin all increase with nicotine usage AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 11

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Symptoms of Excess  Aches and pains  Rapid heartbeat  Elevated blood pressure  High blood pressure  Anxiety  Excessive sweating  Heart palpitations  Headaches AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 12 https://en.wikipedia.o rg/wiki/Norepinephrin e https://www.healthlin e.com/health/epineph rine-vs- norepinephrinedefici ency

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Drugs that Increase Norepinephrine  Norepinephrine reuptake inhibitors NRIs sed to treat major depressive disorder MDD anxiety panic disorder narcolepsy and ADHD Strattera atomoxetine  Norepinephrine-dopamine reuptake inhibitors NDRIs used for clinical depression ADHD and narcolepsy. Focalin dexmethylphenidate Wellbutrin bupropion  Selective serotonin reuptake inhibitors SSRIs used to treat MDD and anxiety disorders. Zoloft sertraline AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 13

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Drugs that Increase Norepinephrine  Serotonin-norepinephrine reuptake inhibitors SNRIs can be used to treat bipolar depression MDD ADHD generalized anxiety disorder GAD obsessive- compulsive disorder OCD chronic nerve pain and fibromyalgia. Cymbalta duloxetine Savella milnacipran--Fibro  Serotonin-norepinephrine-dopamine reuptake inhibitors SNDRIs developed to treat depression but can also be used to treat ADHD chronic pain and obesity. Effexor venlafaxine Serzone nefazodone AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 14

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Reducing Norepinephrine  Beta blockers are frequently used to treat glaucoma migraine and a range of cardiovascular problems.  Alpha blockers are used to treat cardiovascular conditions generalized anxiety disorder panic disorder and posttraumatic stress disorder.  They may however have significant side-effects including a drop in blood pressure. AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 15

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Reducing Norepinephrine  Alpha-2 agonists often have a sedating effect and are commonly used in treatment of drug or alcohol dependence.  Because alpha-2 receptors are inhibitory net effect of agonists is usually to reduce the amount of norepinephrine released Clonidine  Many important psychiatric drugs exert strong effects on noradrenaline systems in the brain resulting in side-effects that may be helpful or harmful: Amphetamines psychostimulants MAOIs NDRIs SNRIs AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 16

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Neurotransmitters and Mood  Norepinephrine improves cognition memory and energy levels  Dopamine improves motivation attention energy and reward responses  Serotonin helps us regulate our emotions  When participants were given an SSRI  The amygdala became less active. This indicates that our brains become less emotionally reactive after a single dose of an antidepressant.  There is increased activity in frontal regions of the brain including a region of the prefrontal cortex involved in regulating emotions suggesting that SSRIs may increase capacity to regulate our emotions. https://www.sciencedirect.com/science/article/pii/S0149763413001814 AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 17

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Summary  Norepinephrine is synthesized from dopamine  Tyrosine deficiency  Antipsychotics  Norepinephrine is one of the main fight or flight chemicals  Prolonged stress leads to norepinephrine reduction  Norepinephrine is involved in depression and Alzheimer’s migraines RLS and fibromyalgia  Too much norepinephrine can lead to symptoms of anxiety and panic. Parkinsons RLS ADHD depression AllCEUs Unlimited CEUs 59 | Addiction Counselor Certificate Training 149 | Specialty Certificates 89 18

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