Norepinephrine is the primary signal for stress/distress. It triggers the negative emotions of anxiety/fear and irritability/anger.

Norepinephrine is also the primary signal for wakefulness. When inappropriately timed, one has insomnia.

Norepinephrine is also one of the signals for thermogenesis – body heat production. It can make a person feel hot. Usually, this is an illusion of being hot from the expectation it is going to work. Unfortunately, human beings have very few brown fat cells, unlike other mammals. And, if there are metabolic problems impairing ATP production, cells can’t respond to norepinephrine in heat production. Thus, norepinephrine may be ineffective in raising body temperature. However, the brain has the unconscious expectation it is going to work, thus the illusion of heat – a hot flash.

Norepinephrine signaling triggers sweating, after translation to acetylcholine prior to triggering sweat gland activity.

Norepinephrine signaling increases corticotropin releasing hormone (CRH) production, which then increases ACTH production. ACTH is created from a longer-protein which contains ACTH and melanocyte stimulating hormone. When ACTH is cleaved off this pro-hormone, melanocyte stimulating hormone is also cleaved off. Melanocyte stimulating hormone makes various parts of the skin darker – such as the eyelid skin, crotch area, palmar creases, neck, etc. etc. In ACTH secreting pituitary tumors, so much melanocyte stimulating hormone is produced, the affected person ends up having an all-over deep tan.

Norepinephrine and CRH are in a positive feedback loop. CRH is not only a hormone but also a neurotransmitter produced by various parts of the nervous system. CRH increases norepinephrine production. Norepinephrine increases CRH production. This positive feedback loop can spin out of control resulting in excessive norepinephrine signaling unless other signaling systems, such as cortisol, can control the loop by reducing either CRH or norepinephrine. Excessive norepinephrine can lead to anxiety attacks or panic attacks – a more severe form.

Thyroid hormone – either high or low – can increase norepinephrine production through effects on other signaling pathways.

Suboptimal cortisol production can result in failure to break the CRH-Norepinephrine positive feedback loop. This, in some people can lead to anxiety attacks.

Excessive supraphysiologic cortisol production can lead to excessive norepinephrine signaling through other signaling pathways.

Problems in other signaling pathways and metabolic problems can lead to excessive norepinephrine signaling. Thyroid and cortisol are only two of many other signals that influence norepinephrine signaling. When thyroid and cortisol are optimized yet anxiety attacks continue, then these other signaling systems and metabolism have to be evaluated for problems.

For example, excessive estrogen signaling can directly and indirectly (through intervening pathways) lead to excessive norepinephrine signaling if other control signals for norepinephrine are not in place.

Mental function problems – such as anxiety – are often a summation of many signaling problems and/or metabolic problems, not just the effect of single signal problems.

Mental function is highly preserved, protected by redundant system since it is necessary for survival in the wild. It takes many problems acting together to impair mental function.

When a person has a mental illness, it is often caused by multiple underlying problems.

This is why single treatments often do not work fully or even well. For example, when using a serotonin reuptake inhibitor for panic attacks, often the best care scenario is that 70% of patients still have panic attacks despite treatment. Serotonin is only one of the signals that controls norepinephrine.

Emotional Freedom Technique, Meditation, and other behavioral therapies are highly useful in helping reduce excessive anxiety.

Testosterone deficiency is one contributory factor in the development of anxiety in men. There are multiple other contributory factors.

When people have deep rooted emotional issues dealing with internal conflict hormones can get impacted.

Dr M how many patients do you see trying to blame there own motives and rational for dealing with internal conflict on hormonal imbalance? I see alot of people using the idea that hormones is the cause, but more likely they are actually using it as a control mechanism for the lack of control in their own life. I have become aware of how patients will try to redirect the health professional down what they think is the problem when in reality it is obviously something totally different.

But isn’t it true that when a person is feeling ‘sub optimal’ in any way shape or form, there HAS to be a hormone or neurotransmitter somewhere down the line which isn’t at an optimal level?

@DrMariano 3233 wrote:

When a person is not feeling well, then there is something wrong in the system. This may including structural problems, signaling problems, metabolic problems, nutritional problems, and psychosocial-environmental problems. Each of these levels interacts with the others. Each change may be secondary or be in response to a more primary or core change.

For example, when a person has a belief system (their internal model of reality) which directly conflicts with the data coming in from the senses, then stress may arise, and various signals (neurotransmitters, hormones, etc.) may change. And structure of the nervous system can change – to accommodate learning, for example.

Psychological factors can directly change structure and signaling in the nervous system.

The key is to determine where the problem is occurring when where to best approach treatment. This is guided by what is determined to be the core problem or problems.

For example, if a person is iron deficient, thyroid hormone signaling may not function despite having adequate hormone levels. Norepinephrine signaling may increase to compensate for ATP production loss. The treatment may not be necessarily aimed to reduce norepinephrine or increased thyroid but to address the more core problems of iron deficienicy.

Psychological interventions, behavioral interventions (such as meditation, exercise, psychotherapy) are also biological interventions in that they affect physiologic function in the mind and nervous system. These may be appropriate in many patients.

Iron deficiency may be hard to address.

I have adequate and steady testosterone and Hgb/Hct levels for last about 6 years (T is supplemented).
Low Ferritin
Was able to raise Ferritin from 28 to 44 (took 2 years, using iron pills)
44-80, took few months, using UNILIVER (dried compressed beef liver)
Preparing for surgery everything was ok in this area.

3 weeks after surgery check reveled very high Hgb/Hct, had to give a pint of blood.

Any explanation?

.

@DrMariano 3233 wrote:

When a person is not feeling well, then there is something wrong in the system. This may including structural problems, signaling problems, metabolic problems, nutritional problems, and psychosocial-environmental problems. Each of these levels interacts with the others. Each change may be secondary or be in response to a more primary or core change.

For example, when a person has a belief system (their internal model of reality) which directly conflicts with the data coming in from the senses, then stress may arise, and various signals (neurotransmitters, hormones, etc.) may change. And structure of the nervous system can change – to accommodate learning, for example.

Psychological factors can directly change structure and signaling in the nervous system.

The key is to determine where the problem is occurring when where to best approach treatment. This is guided by what is determined to be the core problem or problems.

For example, if a person is iron deficient, thyroid hormone signaling may not function despite having adequate hormone levels. Norepinephrine signaling may increase to compensate for ATP production loss. The treatment may not be necessarily aimed to reduce norepinephrine or increased thyroid but to address the more core problems of iron deficienicy.

Psychological interventions, behavioral interventions (such as meditation, exercise, psychotherapy) are also biological interventions in that they affect physiologic function in the mind and nervous system. These may be appropriate in many patients.

This is very interesting.

Dr. (and anyone else) could you elaborate or point me to any reading related to how in your view Psychological factors can directly change structure and signaling in the nervous system?
What type of psychotherapy do you suggest? Cognitive, psychodynamic?
Thanks.