Neurotransmitter Sliders and Diagnosis Primer

Neurotransmitter levels have profound effect on our ability to think, feel and behave. When our neurotransmitter levels are either temporarily or long term out of the Goldilocks Zone, we experience what we call mental ill health. The Goldilocks Zone can be conceived of like graphic equalizer sliders, increasing and decreasing the level to have various effects. Here we review various Diagnoses using the common 7 Neurotransmitter Sliders. Neurotransmitter Sliders and Diagnosis helps us to understand common

Goldilocks Zone Review

The Goldilocks Zone riffs off the story of Goldilocks and the Three Bears, where various aspects of the Bear’s home was too little or too much, and some were just right. We challenge that there is a “just right”, and more of a “zone” of good that exists between “too much” and “not enough”. Biology is full of mechanisms that try to keep various biological aspects in the right zone, such as our blood sugar. If it is too low, we experience hypoglycaemia, which can be very dangerous for us. If we our blood sugar is too high, we damage our bodies. Our body tries to keep it within two limits, and varies that depending on our current needs and environment.

We briefly looked at how our brains neurotransmitters, the chemicals that our brains use to function, can affect some aspects of our thinking, mood and behaviour. When in the Goldilocks Zone, our brain works well, with clear thinking, mood that is appropriate to the situation, and behaviours that are good for us.

Neurotransmitters are cyclic. Our neurotransmitters respond to our circumstances, body resources, thoughts and behaviours – they can be suppressed and lifted a minor amount by each of these, which can then affect our thoughts, moods and behaviours, which can then further affect our levels a minor amount. Sometimes we get caught in a self trigger loop. This effect, though, is generally only temporary.

Neurotransmitter Sliders and Diagnosis

Our neurotransmitter levels can also be affected by biology far more than average circumstances, thoughts, moods and behaviours. Certain common presentations are shown below using the major 7 Neurotransmitter Sliders. While you may have one of these Diagnoses, your particular levels may vary from these more platonic presentations and so your personal experience will differ.

Neurotypical, In the Zone

Neurotypical means neurologically typical. Neurology is about the brain, and to be typical form, connections and neurotransmitter levels must be in the Goldilocks Zone.

Idealised Neurotypical

Here I present an Idealised Neurotypical. All of the sliders (levels) for each of the big 7 Neurotransmitters is in the dead centre. This is not realistic, but it gives you a baseline to consider from. Take a look at the breakdown below the picture.

  • Dopamine: your person’s brain has full access to their Executive Function.
    • That is having a deep understanding of situations, spotting problems, solving problems, recalling temporary information.
  • Noradrenaline: your mood is properly responsive to their environment; not too reactive, not inaccurate, not understated; which means working out priority tasks is easy. Your Amygdala, with the right levels of Noradrenaline, correctly reports “safe”, or “not safe” with a fear/anger/disgust tone to prime your frontal cortex to identify and solve the problem (see Dopamine).
    • If you not safe (recognise a problem / danger), then you prioritise fixing that.
    • If you are safe, you prioritise healing, resting, preparing for the future, learning and creating.
  • Adrenaline: you have sufficient energy to get tasks done, so starting and continuing reasonable tasks is easy.
    • If your Adrenaline is low, you will feel exhausted and not want to do anything.
    • If your Adrenaline is high, you will feel energetic and want to do things. Often this is accompanied by feeling Anxious or Aggressive.
      • If your Endorphins are higher, then you can feel very happily energetic and or excited.
  • Serotonin: your levels are good for giving good feedback to brain sections to run properly, dampening on over-reacting is in place if needed.
    • We don’t have a good read on what experience function Serotonin actually does. When you try to look up what Serotonin does in the brain, mostly you get the description of Dopamine and the Dopaminergic System. This is because the 5-HT2C receptor Serotonin Receptor modulates how the Dopaminergic System works, and if this is insufficiently stimulated, the Dopaminergic System doesn’t work specifically because of this. This can exacerbate ADHD, but isn’t ADHD. Not all SSRI medication successfully increases the activation of this receptor, so is mostly useless.
    • Serotonin is the precursor for Melatonin, so if your Serotonin is low, your Melatonin is low.
  • Melatonin: your level of Melatonin is appropriate to the light level, which is one of the major mechanisms for being alert or asleep.
    • Bright light triggers conversion of Melatonin into inert chemicals, decreasing the feeling of sleepiness
    • Dim light triggers the conversion of Serotonin to Melatonin.
      • When Melatonin is pressing on enough Melatonin receptors and if your Adrenaline is low enough, you feel sleepy, go sleep easily and stay asleep until you have sufficient sleep or the light becomes bright.
  • Endorphins: you have enough endorphins to manage physical and psychic (emotional) pain, and you feel content to happy.
    • Pain uses Endorphins.
    • Low Endorphins means you don’t feel good.
    • High Endorphins means you feel good, happy or even risk manic.
  • Oxytocin: you will find that socialising is a positive experience if you have quality people to socialise with.
    • A toxic environment especially if it is toxic people will lead to not enjoying people as much or at all.
    • Low Oxytocin can lead to not enjoying even nice people in nice environments, or if you do enjoy being with them, you feel depleted (out of Social Spoons).
    • High Oxytocin can lead to being too trusting of people, feeling like you have great connection when you don’t, and over valuing the relationship. It isn’t the only thing that can cause this feeling.

Realistic Neurotypical

This is a more realistic representation of a Neurotypical Healthy person. Each of the neurotransmitters is in the green Goldilocks Zone, so mild on the fly adjustments mean that each neurotransmitter is doing its normal job.

If this person were to feel a bit more anxious, let us say the Noradrenaline was a bit high or a bit low but still within the green or amber, then they could just do a breathing exercise or a grounding exercise to get back to base line.

  • Dopamine: Is a bit higher than dead centre, indicating that the person is open to being creative, solving problems, and learning new things.
  • Adrenaline: Lifted Adrenaline indicates the person may be feeling a bit itchy to get on with doing something and burn off that excess adrenaline. It isn’t to the point of pushing mood to anxiety or anger, but it may be excitement and eagerness.
  • Endorphins: The Endorphins being a bit low indicates the person is not as content, and if they have an injury, it is feeling a bit painful. Basic pain relief medication, such as paracetamol will likely help relieve this.
  • Oxytocin: Elevated Oxytocin indicates the person is very open to socialising. This, combined with the elevated Adrenaline would be a good combination to do a social physical activity.

Hopefully this give you a bit of an idea about how to interpret the levels. These do not indicate what activity is occurring around the person, or exactly how the person’s brain will interpret or use the neurotransmitter. To get a better idea of what each neurotransmitter is primarily used for, look at our Neurotransmitter Page. This graph represents a simplified version of how these work.

ADHD

ADHD is a congenital highly hereditary neurological condition where Dopamine is not successfully activating enough Dopamine Receptors in the Synapses of the Prefrontal Cortex. ADHD is an umbrella term for many biological mechanisms that lead to this problem. The two major version of ADHD that cause this are producing insufficient quantities of neuronal Dopamine and too quickly converting Dopamine to Noradrenaline.

To explain that, the Dopamine, Noradrenaline and Adrenaline that we produce in our adrenal glands (just above the kidneys) cannot access our brain due to the Blood Brain Barrier. Instead, we produce Dopamine in our middle brain, which is then distributed throughout our brain (half goes to the frontal cortex). We convert some of the Dopamine to Noradrenaline, and we convert some of the Noradrenaline to Adrenaline. This is all part of the Dopaminergic System. If you don’t make enough Dopamine, it’s hard to get enough Noradrenaline (causing Anxiety) and enough Adrenaline in your brain (causing Depression).

For the most common version of ADHD, insufficient Dopamine is produced. This often makes it hard to wake up in the morning, hard to think clearly (brain fog), and hard to maintain focus and concentration. Low Dopamine means there is insufficient Noradrenaline, so your Amygdala can’t function properly, and so you are likely always feeling Anxious and Angry. To compensate, you are likely often pushing up Adrenaline, which decreases your available Dopamine and Noradrenaline in the conversion. Until you run out, then you are just exhausted, stressed and depressed. Melatonin is often difficult to make as your Adrenaline is too high, interfering with sleep at night, mostly due to Pre-Sleep Anxiety. Typical antidepressant / antianxiety medications (SSRI) doesn’t work in any meaningful way because your Serotonin is not low. Life is hard, and keeping the negative thought track going to maintain your compensating Adrenaline costs a lot of Endorphins to compensate against, leading to decreased levels of Endorphins – you aren’t happy most of the time. Oxytocin also is likely low, and you find it hard to trust people (low Noradrenaline keeps telling you that you are in danger), so you don’t get much of a social boost to your happiness, unless you take something to help that. That is, even if you enjoy being around people, you are exhausted by it.

ADHD medication management for this is going to be an amphetamine medication. The person may also need an NRI or SNRI such as Reboxetine or Desvenlafaxine. This will help bring the Dopamine, Noradrenaline, Adrenaline and Endorphins into line. While there is a mild risk of the Adrenaline going too high, I would expect that actually drops down once you have sufficient Dopamine and Noradrenaline to manage well, dropping you out of Survival Mode. At night time, I’d recommend Melatonin (4-10mg depending) and or Agomelatine (25 mg) to help beat the Pre-Sleep Anxiety.

The less common of the two major forms of ADHD is where you are too quickly converting Dopamine into Noradrenaline. The most common tell is that you avoid caffeine, often including chocolate. People with active ovaries may find themselves being mistaken for Bipolar Disorder [as discussed both in PMDD and Bipolar]. To compensate for a messed up Dopaminergic System, the Adrenaline is frequently pushed up. Frequently SSRI medication can help a bit for this form of ADHD as the Serotonin is likely a bit low, leading to over-reactions to stimuli and people. You’ll likely find that the SSRI medication gives you a bit of time to choose your actions instead of just over reacting. Sleep is also difficult. Much like the other common form of ADHD, you’ll probably fall exhausted rather than fall asleep. Endorphins and Oxytocin are frequently higher, leading to feeling good and happy, especially pre-ovulation for those with active ovaries, which can be mistaken for mania, or even be mania if the Oxytocin leads to the Noradrenaline going to “too high”. In this example, the person is likely a social butterfly and “gets energy” by being social.

This ADHDer is going to be more tricky to manage. We run the risk of triggering a psychotic or manic episode as the Noradrenaline is already high. A combination of Amphetamine and Beta Blocker medication should manage this well, however some people will have a better outcome with Methylphenidate (Ritalin) with probable Beta Blocker. My preference would be Dex + Clonidine, but other options work too. Some people find that Guanfacine works very well with this profile in the absence of Amphetamine or Methylphenidate. I would expect that the Endorphins and Oxytocin would drop down as the Noradrenaline is managed better. As above, Melatonin and or Agomelatine to help the Pre-sleep Anxiety.

Depression

Depression is a frequent side effect of ADHD, however in this case we are going to refer you to the ADHD above for that and assume this is one of the non-ADHD forms. Depression is an umbrella term for several different biological mechanisms that lead to you feeling underpowered and unable to function. It can include feeling sad and down.

The non-ADHD version of Depression generally has sufficient Dopamine to function, but is low in Noradrenaline leading to only priority tasks being initiated, and insufficient Adrenaline, leading to feelings of exhaustion and further avoidance of starting tasks. Serotonin is often low, which may be a causal reason why the Dopaminergic System is struggling (the 5-HT2C receptor Serotonin Receptor modulates the Dopaminergic System). Melatonin may be higher than it should be, especially if you find yourself staying indoors (the light brightness between inside and outside is huge). High Melatonin will lead to a desire to sleep more, although the quality may not be high. You probably don’t feel refreshed after you have slept. Endorphins are low and Oxytocin is low, so you aren’t enjoying activities like you may have in the past (a complete absence is specifically called anhedonia, a significant decrease in enjoyment is called Depression) and socialising with good people doesn’t feel good and may just be more exhausting.

I would start this person on the SSRI Sertraline, which will help lift the Serotonin levels and support the Dopaminergic System (Dopamine, Noradrenaline and Adrenaline). If Sertraline doesn’t help enough, then an SNRI medication like Desvenlafaxine or Duloxetine may be sufficient. Duloxetine at 90mg+ has similar effects to prefrontal cortex and midbrain Noradrenaline as Desvenlafaxine, but also helps with neuropathic pain management, which may be why the Endorphins are low.

I would also assess this person for ADHD in case this is relevant. While the Dopamine looks like it is high enough, it may be a form of ADHD where the Noradrenaline and Adrenaline are sacrificed to maintain Dopamine. With better Dopamine, the other two may regulate themselves far better.

Another presentation of Depression may be with significantly low Noradrenaline, leading to feelings of suicidal ideation (thinking about death and dying a lot), thoughts of self harm (deliberately harming yourself, which can also include not eating) and feeling generally very down in mood. Very low Noradrenaline makes it very hard to prioritise any task and get it started. Low Adrenaline interferes with the ability to sustain tasks, even if they feel very urgent. More energy is spent in procrastinating and feeling bad about not doing anything that actually doing the thing. In this example, the Serotonin is not low, so is not likely causing a Dopaminergic System problem. SSRI medication isn’t going to help this person at all. In this presentation, Melatonin is low, so sleep is going to be difficult, like experiencing colloquial Insomnia (poor sleep rather than medical grade insomnia). This presentation has low Endorphins, so the person may lack enjoyment in activities that usually would bring enjoyment, or may be experiencing pain sensitivity. The Oxytocin is in the Goldilocks range, so hanging out with friends feels good, but being alone is awful.

To manage this, I would first consider the SNRI Desvenlafaxine. This will effectively boost Noradrenaline, with a mild secondary action of bosting Adrenaline and Dopamine. We need to be mindful of Serotonins as the Serotonin is not low, and the S part of SNRI means SRI, Serotonin Reuptake Inhibitor. If the person shows any signs of reacting poorly to the SRI component, switch to Reboxetine (pure NRI). This will also help with any neuropathic pain, which may improve the Endorphins and thus enjoyment.

Schizophrenia

Schizophrenia is a complex neurological condition, where half of the people diagnosed experience problems with too much activation of the D2 Dopamine receptor, often with a side order of Dopamine being too present. Schizophrenia is complex to understand, so please look at the linked page.

In this profile, the Dopamine is too high, which is over activating the D2 receptor which is likely leading to hallucinations and interfering with the general ability to do reality checking, leading to the assumption that erroneous thoughts and or low probability explanations are true. You would look delusional and easily confused. Heightened Noradrenaline likely adds paranoid beliefs and conspiratorial thinking, especially as the reality checking is compromised by over activation of D2. Adrenaline is a bit higher than average, leading to feelings of physical agitation if not physically doing something, presented by pacing, twitching or general impatience. Serotonin is fine, so SSRI medication won’t help this person. Melatonin is low, so I would expect this person can’t sleep without some kind of sedative. Lack of sleep is probably driving the Noradrenaline and Adrenaline up, making things worse. Endorphins are a bit low, but not too low, so enjoyable things aren’t really working well, but aren’t awful. I would not be surprised if the person was using substances to try to boost enjoyment. The person may also be in some mild pain, physical or psychic, which has led to the depletion of Endorphins. Oxytocin is low, which indicates a lack of benefit from socialising, and reinforces the likelihood that he person is paranoid.

Antipsychotic medication would work well for this person. It would decrease the problems of too much Dopamine, block the D2 receptor which would decrease hallucinations and increase reality checking. The antipsychotic will also act as a sedative and trigger sleep through a different non-melatonin mechanism, which may decrease the Noradrenaline and Adrenaline enough. If not, I’d recommend a Beta blocker too. Not much can be done about the low Oxytocin in Australia.

Psychosis

Psychosis is a term used to refer to when a person has both perceptual hallucinations and compromised cognitive function.

In the following example, the person has too much Dopamine, which may be over stimulating the D2 receptor, which impairs reality checking and can trigger hallucinations. The Noradrenaline is far too high, which can cause manic presentation, paranoid presentation and impair the ability for the person to feel safe. With high Adrenaline, the person will feel energised and may be aggressive or just hyperactive. Serotonin is low, which may be impairing the ability to regulate the Dopaminergic System, so an SSRI may help stabilise this person, although it also may not. Endorphins are a bit low, which may interfere with the feedback system of enjoyment, leading to bizarre self regulatory mechanisms, which will look like strange behaviours.

I would try to treat this person with an SSRI and a Beta Blocker. The Beta Blocker will bring the Noradrenaline and Adrenaline back down to the Goldilocks Zone, while the right SSRI will help the 5-HT2C receptor moderate the Dopaminergic System. If that works, some talking therapy about how to make better use of the enjoyment feedback system to keep things stable should help. If that the SSRI and Beta Blocker were insufficient, I’d try a low dose atypical antipsychotic to see if that helps bring the Dopamine regulation into line. If the person’s presentation were initially poor, I’d start with the low dose atypical antipsychotic (because it doesn’t block all of the Dopamine Receptors and has better overall health outcomes) combined with the SSRI and Beta Blocker and then trial ceasing the antipsychotic to see if the gains are kept without it.

Paranoia

Paranoia is similar in certain ways to the Psychotic presentation, except that there are not hallucinations accompanying the difficulties with reality checking.

In this case, the person has low Dopamine, so is noticeably struggling with cognition due to brain fog. The odds are this person smokes a lot of cigarettes or cannabis to try to boost the Dopamine and manage the Noradrenaline. The high Noradrenaline is interfering with reality checking more than the D2 receptor, so an antipsychotic medication will have little benefit except for sedating the person for everyone else’s comfort – which is not a good solution, but it may be a necessary stepping stone. The heightened Adrenaline is going to lead to agitation, anxiety and possible aggression. Low Serotonin may imply that the Dopaminergic System is compromised and the right SSRI medication may help to moderate this. Endorphins being too high is likely to lead to the person being far too passionate about their faulty beliefs, and low Oxytocin will mean that this person struggles to trust anyone.

If this person has active ovaries, I would recommend Oestradiol levels be checked on the day of menstrual flow and a good feeling day around 14 days later to check for PMDD and Oestradiol led Bipolar. While this is a person who likely has ADHD, if they have been registered as psychotic, they may not be able to access ADHD medications, so Sertraline combined with a Beta Blocker would moderate the levels of Dopamine, Noradrenaline, Adrenaline and Serotonin. If the person is taking illicit substances, I would encourage them to slow that down, which should spontaneously decrease as they get the right neurological medications (as outline above) anyway. If the Endorphins remain too high, then his may need to be directly addressed with other medications (beyond the scope of this primer).