The third neurochemical I will discuss is dopamine. This is an important chemical to balance in order to achieve optimal results with regard to feeling your best. I nickname dopamine the "pleasure chemical". The term "Dope" comes from dopamine, as illicit substances can temporarily balance this chemical, leading to pleasurable feelings.

I often add medications that balance dopamine to other baseline medications such as SSRI's and SNRI's, which I discussed the last two blogs. (Review the last three blogs if you haven't read them yet). The only norepinephrine and dopamine reuptake inhibitor, which focuses mostly on dopamine, is Wellbutrin XL( or generic Bupropion in various forms). The result expected of taking it if it is the right fit can be improved energy, focus, motivation, joy, passion for life, improved sex drive, happiness and reduction in feelings of depression. Since an SNRI such as Pristiq, Cymbalta or Effexor XR focuses more on de-stressing the body and mind, the SNRI-Bupropion combination is what I nickname the "dynamic duo" of medications, and is the top combination I prescribe to my patients. Less commonly SSRI's are better than SNRI's in certain patients. In some Wellbutrin works well on its own, but it's usually better when combined with other medications.

The other dopamine-balancing medications work by slowing down dopamine when it goes too fast through the nervous system, and this regulation of dopamine results in it flowing more normally, resulting in a calming of anxiety and stress, improvement of sleep, control of "racing thoughts", improvement of mood in general such as a reduction of depression and anxiety, and improved energy and happiness. I refer to dopamine as the "sex, drugs and rock-and roll" chemical. There are several medications in this class, and the ones I prescribe the most are Abilify, Seroquel, Saphris, Zyprexa, Risperidone, Geodon, Invega and Latuda. They are indicated for "treatment resistant" depression and anxiety, Bipolar disorder and other indications.

I often add one of these to others I mentioned for the best results, what I refer to as the "Wow". Refer to my book for further details. The combination of Wellbutrin and one of these balances dopamine "24/7", which means that dopamine is optimally balanced all day and evening every day. The secret with prescribing and taking medications is understanding the importance of combining them together properly, referred to as the "rational polypharmacy" approach. The goal is "full remission", which means feeling the real you or your old self, or even better than that. I see that happening every day in my office. Next time I will wrap up this series by discussing GABA. Bye for now.

The second neurochemical I will discuss is norepinephrine. If you haven't read the last two blogs, I would advise reading those before this one. Norepinephrine is an important chemical to recognize when it is imbalanced. There are certain symptoms and history that suggest the need to balance it. If there are somatic symptoms such as headaches, neck and back pain, jaw pain, joint pains, fibromyalgia, irritable bowel symptoms and others, it is highly possible that these symptoms are stress-related, and balancing norepinephrine would be the first chemical that I focus on. The serotonin related symptoms I mentioned in the last blog are otherwise similar to norepinephrine, but in addition balancing this one can improve focus, concentration, energy, insomnia and persistent anxiety and panic attacks.

The best medication class I can prescribe are SNRI's (which balance both of the above chemicals), which are Pristiq, Effexor XR and Cymbalta. They are the most common prescriptions that I prescribe and start with, as I consider them the best first-line agents. They are often more effective than SSRI's that I mentioned last time, and cause less side effects such as apathy, sexual side effects, weight gain and others.

The first SNRI Effexor XR came out when I first started in practice in the early 1990's. My discovery of the importance of this class with regard to improved results and dramatic reduction of physical symptoms such as pain associated with stress led to my discovery of the mind-body connection and why I wrote my book and switched my practice to treating neurochemical imbalances full time. See a recent blog about anxiety to read more about all the associated symptoms. Next time I will discuss Dopamine. Bye for now.

In my last blog I explained how and why neurochemical imbalances happen, so read that first if you haven't yet. Over the next several blogs I will discuss each neurochemical separately, and the typical symptoms that occur when each becomes imbalanced. I will also discuss the medications available that are designed to balance each one.

The first I will discuss is serotonin. This is the most basic one and the one that gets the most attention since it is the most heard and read about by patients and doctors. The first "modern" psychotropic medications that came out in the 1980's focused only on this neurochemical. These are the most prescribed and considered the "first-line" medications for most patients. Unfortunately, I think there is too much attention given to serotonin, and not enough on the other chemicals that can become imbalanced, but we'll get to that later.

The symptoms associated with a balance of serotonin are worry/rumination, obsessive thinking, hormonal-related mood changes like PMS/PMDD and perimenopausal/menopausal mood changes and other general symptoms associated with depression and anxiety. Read recent blogs for more details about these symptoms. OCD is usually associated with a significant imbalance of serotonin.

The SSRI's (selective serotonin reuptake inhibitors) act by attaching to the serotonin receptor site of the cell membrane and inhibit the abnormal reuptake of serotonin. Therefore serotonin is only allowed to move in the correct forward direction and does not allow it to move backward. The name brands of the SSRI's are Prozac, Zoloft, Paxil, Celexa, Luvox, Lexapro and Viibryd. They are effective in many, but the effectiveness may wane over time and not be as effective (what I refer to as the "serotonin poop-out syndrome"). It also can cause flattening of the personality with decreased emotion, sexual side effects such as decreased interest and/or delayed orgasm, fatigue, agitation, weight gain or can potentially cause worsening of mood if it is not the right fit. This would be the case if serotonin is not imbalanced to begin with.

SSRI's can be good for certain patients, such as if the person has early or mild forms of depression and anxiety, PMS/PMDD and OCD. It is not a bad first choice, however if it does not work very well, gives incomplete results or has side effects, I would try switching to a potentially better medication class, or add an augmenting agent. I will discuss norepinephrine next time, and discuss the overall best class of medications available. For more details about this subject, please refer to my book. Bye for now.

Let's go back to basics to review what happens in the body when chemical imbalances occur. The nervous system is the fundamental control center of the body, like the "computer" of the body. Its center is the brain, which continues with the spinal cord, and then nerves branch off from there to all parts and pieces of the body. The nervous system is where emotions occur as well as all the physical sensations of the body. This is why emotions cause physical changes, known as the “mind-body connection". For example, stress related headaches, neck and back pain, jaw clenching, irritable bowels, fibromyalgia, etc.

The cells that make up the nervous system are neurons. The system communicates   by a neuron passing chemicals to the next neuron. These chemicals pass from cell to cell about one thousand times around the body per second. There are over one hundred billion neurons in a human body, and over one hundred trillion connections between the cells, referred to as synapses. These are mind-blowing (no pun intended) numbers that are difficult to comprehend. A healthy optimally functioning system is when all the chemicals are moving in a forward direction and connecting properly.

Problems arise when certain chemicals move the wrong way or don't connect properly. The small holes at the end of the neurons are called receptor sites, and each receptor allows only one certain chemical. If there are defects on certain receptor sites of the cell membrane this allows the chemicals to back up and move the wrong direction, hence the term neurochemical imbalances. Another problem is when the chemicals are moving through the system too slowly. The main chemicals they focus on are serotonin, norepinephrine, dopamine and GABA (gamma-amino-butyric acid).

As I have stated in previous blogs, the main reasons these imbalances occur are genetic predisposition, hormonal changes and situational stressors. Also, seasonal changes (for example, the “holiday blues") and environmental factors can play a role. Be sure to reach      out to those affected this time of year! I will address each chemical that can be imbalanced and the symptoms associated with each the weeks and months ahead, and how psychotropic medications work in order to fix the problems. Merry Christmas and Happy New Year to you and yours!

Why do depression and anxiety symptoms occur more in some people than others? When faced with the same or similar stressors, why do some people cope well and get through the stressful times without a significant mood change while others fall into depression and/or anxiety? There are a few key reasons why this happens to some and not others.

The most important reason is genetics. One has a propensity for a mood disorder if there is a family history of same. This can be difficult to trace since many don't share intimate feelings with others. Clues are addiction such as alcoholism as well as turmoil and instability of the lives of relatives. It may not have been formally diagnosed then because much less was known about mood disorders years ago before science and technology were able to explain the chemical changes that happen within the body. Many were stoic and felt that suffering was their lot in life. Some don't like to admit what they perceive as weakness and don’t readily admit fault. There was and still is a high stigma associated with this subject.

The likelihood of developing a mood disorder is higher the stronger the genetics. If one has a history on both sides of the family, then the likelihood is higher than if just one side of the family has a significant history. I also notice that an individual follows the tendencies of whichever parent or relative the person takes more after, with regard to looks and personality.

The second most important reason for developing a mood disorder is when one is changing hormonally. One is more prone during puberty, post-partum, pre-menstrual and mid-life. When I ask patients when they felt best in life, the most typical answers are during childhood (before middle-school), late teens to early to mid twenties or maybe early thirties. These are times of life which are more carefree with less stressors. This may not be the case if there was significant abuse or neglect in childhood. Major stressors or trauma in any of these stages of life increases the likelihood of a mood disorder. These hormonal change times mentioned apply to males and females. For men it corresponds to "mid-life crisis" and for women, pre-peri-post-menopause.

The third factor has to do with what stressors that the individual is facing as well as the person’s ability to cope with stress. This has to do somewhat with a person’s personality and underlying self-esteem. Also, the more traumatic and severe the stressors as well as how many stressors are occurring within a short period of time, increases the likelihood that a mood disorder will occur.

It may seem surprising, but stressors are the least  important factor, with genetics and hormonal changes being more predictive. The tendency is to figure out how one is feeling based on what is happening externally rather than looking inwardly. I will continue next time with an explanation of what happens within the body associated with changes in mood. Bye for now and Happy Thanksgiving.

Since I focused on anxiety and stress-related symptoms the last couple blogs I will try to distinguish symptoms of depression. The two often coexist, as those with mood disorders often have features of anxiety and depression, though most people complain more about anxiety. For example, " I'm not really too depressed. I'm more stressed out".Depression is not just having a bad day here and there, but rather a persistence of symptoms that causes a disruption in one's life and decreases quality of life. A common description is " I'm just not feeling myself" Typical symptoms are:

-Recurent sadness, frequent crying

-Irritability, "Bad mood"

-Decreased interest in activities that were previously enjoyed(Anhedonia), Withdrawal and isolation

-Feelings of hopelessness, helplessness or worthlessness-

-Fatigue, Lack of motivation

-Insomnia, usually difficulty getting to sleep, early morning awakening with difficulty getting back to sleep or both.

-Decreased ability to focus and concentrate.

Recurrent worry/ Rumination/ Obsessive thinking.

Frequent thoughts of death and dying, suicidal thinking, or "If I don't wake up tomorrow I'm fine with that"

-Negative thinking.

-Change of appetite, either lack of one with weight loss or increased weight from incresed appetite ( typically "comfort foods" such as carbs and sugars).

-Increaed alcohol consumption or illicit drug use.

-Recurrent somatic symptoms such as pain and other physical symptoms (as discussed previous blog).

One can have only a few or several of these symptoms, and depression can vary from mild to moderate to severe. Seek help if anxiety and/or depression symptoms plague you. I'm here to help if you need me. Next time I will discuss myths and misconcepyions about medications. I will be discussing solutions for these common problems the rest of the fall and winter. Bye for now.

Before we go further regarding the discussion of and treatment options for anxiety, let me define what the word means. It refers to a constellation of symptoms that can result from adrenaline surges in the body that cause feelings of anxiety and panic, also referred to as the "fight or flight" response. This can cause stress on the body in emotional and physical ways, since the mind and body connect together. One can have one or a few or multiple symptoms that can affect a person in negative ways. Examples of symptoms are:

-Restlessness and agitation

-Irritability/ easily prone to anger

-Insomnia (difficulty going to sleep, staying asleep or both)

-Difficulty with focus and concentration

- Sweating and shakiness of the body

-Elevated heart rate and/or blood pressure (racing heart/palpitations/chest pain)

-Difficulty breathing/ Hyperventilation/ Shortness of breath

-Dizziness

-Fatigue (since anxiety can "burn you out")

Excessive worry/rumination

- Recurrent somatic symptoms, such as headaches of all types, neck/upper back/trapezius muscles/shoulders (this is the most common somatic stress symptom), TMJ/jaw pain from teeth clenching and grinding, joint pains, mid to lower back pain, irritable bowel symptoms such as cramping, bloating, diarrhea, constipation, acid reflux/heartburn, etc., numbness and tingling of hands and feet, skin changes such as rashes, eczema, acne etc, increased infections and many more.

Next week I'm going to define and describe depression, so stay tuned. I'll continue these subjects and what can be done about them during the rest of the fall and winter. Bye for now.

This is the most common complaint of patients in my practice, so I am going to cover this subject in my next several blogs. My practice focuses full time on treating depression, anxiety, bipolar disorder, ADD, OCD, eating disorders, addiction, etc, but the most common complaint is not "I'm depressed", but rather "I'm stressed out" or "I'm not really depressed, I'm more anxious". Anxiety is the symptom that more people relate to, since they know what that means, while the word “depression” is defined so differently by so many different people. For the most part, symptoms of anxiety and symptoms of depression occur together at the same time.

Anxiety is an experience that everyone has at times. It’s really a matter of degree and frequency that separates the normal stressors of life from a disorder that needs medical attention. It becomes a problem when the anxiety interferes with functioning and quality of life. A good way to explain these symptoms of anxiety it is by explaining the well-known “fight or flight response”, which is meant to protect us from harm by being alert when needed in order to avoid harm. For example, if you witness a car accident in front of you, you punch the break and swerve the car away from the accident and go past it. Afterwards, you notice that your heart is racing, your breathing has quickened, and you’re shaky and sweaty and have other stress-related symptoms. These are appropriate responses of the body that help to protect the person from harm.

The problem is when these responses and symptoms occur when one is not confronting a major life-threatening stressor. In fact, most anxiety symptoms occur when a person is at rest. They rarely occur when a person is active such as while exercising or when heavily involved with work. When the body is at rest is when the mind can be over-active in negative ways by ruminating/obsessing/worrying about negative things. Anxiety happens more in the evening after work, in the morning after awakening before work or school and during sleeping hours. These are the times when we tend to think about stressors of the previous day and week and the upcoming stressors of the next day and beyond. I will continue with this subject in a couple of weeks and through the fall. Bye for now.

I am closing the summer blog series on addiction with an editorial that I sent to the Orange County Register.

In response to the article "Tears for Dead Teens" 7/28/2011, I grieve for the families that have lost loved ones to the scourge of addiction. It became personal to my family and I when my brother-in-law Vernon Porter lost his daughter Vanessa. This happening far too often, with opiates (heroin and narcotic pain pills) being the ones that usually lead to overdose deaths. Doctors who over prescribe opiates are certainly not blameless and are a part of the problem, however it should be remembered that it is quite easy for addicts to get opiates, tranquilizers, muscle relaxants and others from drug dealers or "friends" without a prescription. If they can get meth, heroin, cocaine, marijuana, alcohol, tobacco, ecstasy and other hallucinogens, it’s quite easy to also get prescription medications from the same sources.

The real underlying problem is not being addressed adequately is the core reason for addiction, which is neurochemical imbalances/mood disorders such as depression, anxiety, bipolar disorder and ADD. Addicts "self-medicate" in order to feel better, since the addictive substances boost their mood, calm their anxieties and improve their focus and energy. They then become addicted because they want to keep feeling that way and don't like the "let down" when off of them, and then they need to take them just to "function". They are then trapped in the vicious cycle of addiction.

I treat a lot of addicts and those in recovery by focusing on non-addictive medications and mood stabilizers, which are preventative by treating the underlying neurochemical imbalances that lead to the mood disturbances that lead to addiction. There is a widespread misconception by many people, especially in the addiction community, that all pharmaceutical medications having to do with mood are bad for you. This uninformed and misguided thinking reveals the lack of understanding about the difference between non-addictive medications and potentially addictive medications. Minor tranquilizers, sleeping pills and pain medications should be given for short-term anxiety, panic attacks, insomnia and pain. In some they are appropriate for long-term anxiety and pain disorders. They are potentially addictive, but not for everyone. most people can use them appropriately while others can't.

The "Drug War" of trying to go after the manufacturers or doctors does not and will not work, since as I said before they are easy to get in the black market. The best solution to fight addiction is to treat the underlying causes and reasons for addiction by proper preventative medications to treat mood disorders, psychologically counseling for the individual and family, exercise and good nutrition, addiction specialists and rehab centers when needed and twelve step programs when they are helpful. We all need to work together and stop pointing fingers at others. This is easy to do when one is grieving, since it can be too painful to blame the addict and the parents or family. Let's rather focus on solutions to this destructive scourge of our society: addiction.

I hope this focus on addiction this summer has been helpful and informative to you and yours. I will move on to a new topic in a couple of weeks. Bye for now.

As I said, it is a struggle at times to convince people who have a strong anti-medication mentality to reconsider their views and allow themselves to be educated about the truth of this subject. Since our current drug war and attempts to curb illicit drug use is such a failure, what is the solution? It is not an easy answer, and the reality is that the war will never be won completely, though we can hopefully do the best we can to try to battle the root causes of addiction.

It takes a multi-disciplinary approach with doctors, counselors/therapists, parents, 12-step groups, rehab centers, sober living communities and addiction specialists all working together to help one individual at a time. All of the various aspects of addiction need to be addressed, including the acute physical addiction of the substance as well as the underlying chemical imbalances of the nervous system that drive the addiction to begin with. It is also important to address the psychological components and underlying stressors that drive addiction. It is very important for those struggling with addiction to have a good support system, whether it be church groups, 12-step groups, sponsors, parents, family and friends, and the support of the community.

Parents and others close to them need to make sure that they are not enabling them but rather empowering them. They need direction and love, with "tough love" when needed. Addiction is a difficult and challenging problem that there is no easy answer to, but if we remain hopeful and positive, we can tackle it together, and with love, patience and commitment, the drug war can be won.

Next week, I will conclude this subject with a rebuttal that I sent to the Orange County Register about the article that was written a couple weeks ago about teens with addiction that have overdosed and lost their lives. Bye for now.