Recall, neurotransmitters (such as serotonin and dopamine) are chemical messengers that control most of the body’s functions – everything from mood and the urge to pull to cravings and sleep. Stress can create both short and long-term imbalances in neurotransmitter levels, which can cause you to want to pull more.

Stress is a ‘loaded’ reaction

Stress affects everyone differently and can affect each individual differently on any given day. This is because the overall effect of stress is what is often called a ‘load reaction’. This simply means it is the combined effects of all the stressors in your life at any given moment that will determine the overall ‘load’ or impact that stress has on you at that time. This is the reason, for instance, that sometimes a certain stressor, like arguing with someone, affects you very little one day, but throws you into a state of utter turmoil on another day.

Many things can cause us stress, including:

It can be a fragile balance that keeps us functional when stresses mount. If the stressors overwhelm us, even for a period of time, many hormone and neurotransmitter imbalances can occur, which can increase the urge to pull. Under ideal circumstances (stress gets under control and neurotransmitter levels can rebalance), this increased urge will typically last 3-5 days. If the stress continues or your neurotransmitter levels do not rebalance, the increased urge can last a much longer time.

Addressing the causes

We know of two sure-fire ways to help restore proper neurotransmitter levels which will reduce or eliminate the urge to pull: (1) reduce the cause of imbalance and (2) replenish neurotransmitter function with amino acid therapy. The first has to do with reducing the effects of stress in your life. This may include exercise, establishing a regular sleep cycle, meditation, counseling or any number of other longer-term therapies to help mitigate the ongoing effects of stress.

The second acts more quickly, as providing the body the nutrients it needs to rebalance neurotransmitter function can lead to a dramatic decrease or elimination of the urge to pull, often within days or weeks. This allows you to incorporate the longer term stress reduction strategies into your life so you can have a life that is free of the urge to pull, no matter what stresses life throws at you.

In particular, we have been seeing a lot of people suffering from trichotillomania that also have insatiable cravings for sweets and/or simple carbohydrates, including breads, cookies, candy, chips, pastries and similar foods. Most people that have this combination of sugar cravings and trichotillomania don’t realize they are connected, and they often feel helpless on both accounts. However, I am here to tell you that not only are they related, they can both be resolved using the same techniques.

Balanced Amino Acid Therapy

Both the urge to pull and cravings for sugar and sweets are regulated by your brain chemistry. The chemical messengers responsible for this regulation are called neurotransmitters, which include serotonin and dopamine. Imbalances in your neurotransmitter function will cause miscommunication, which often leads to symptoms including the urge to pull, cravings and any number of the conditions listed above. However, restoring proper neurotransmitter balance will improve communication and alleviate these conditions.

One of the keys to establishing proper neurotransmitter function is the employment of balanced amino acid therapy. This means that a health care professional trained in the proper use of amino acids will help you determine exactly the right mix of amino acids and cofactors you need in order to establish optimal neurotransmitter function. Once this occurs, not only will your urge to pull disappear, your cravings will also be substantially reduced or eliminated altogether. This occurs because you are addressing the root cause of your problems, and by digging down to the root, you can manage a whole host of symptoms due to neurotransmitter imbalance.

Probiotics – good for your (brain) health

Probiotics are the “good” bacteria that normally reside in your gut. It is known that if  these bacteria become imbalanced in some way (due to illness, improper diet or toxin exposure), a condition called “dysbiosis” results, which can have many dire consequences including decreased immunity, improper immune function, food allergies, inflammation, indigestion and numerous other physical disorders. However, until recently it was not known that these bacteria can also generate neurotransmitters that can also affect your brain, impacting your mental and emotional states.

Researchers at Texas Tech University Health Sciences Center found that the following bacteria can produce neurotransmitters in the gut:

This could mean that the microbial balance in your gut could be a key player in improving and maintaining your neurotransmitter levels, and therefore alleviating the urge to pull. It also provides more scientific evidence for something that we routinely see in the clinic – that many people with gastrointestinal disorders develop or have one or more disorders related to neurotransmitter imbalance and that correctly the underlying gastrointestinal disorder is imperative to long-term recovery. Think of it like this – the gastrointestinal disorder (like IBS, Crohn’s disease, food allergies or Celiac’s disease) is like a hole in a bucket, causing neurotransmitter levels to decline (or become imbalanced). In order to fill the bucket back up (using amino acid therapy) over time, you have to first fix the whole.

Certain gastrointestinal disorders create neurotransmitter imbalances through inflammatory, immune or genetic influences. This research provides another potential way to explain, and address, the resulting neurotransmitter dysfunction. Obviously, more research needs to be done to define just how this can be useful in real life, but for now, it seems logical that anyone that suffers from trich or other disorders associated with neurotransmitter imbalance must heal any underlying gut issues while restoring proper neurotransmitter balance using amino acid therapy to achieve long term success.

However, we have found that a more effective way to implement amino acid therapy in regards to trichotillomania is to address the serotonin/dopamine system.  By providing the brain the proper proportion of the necessary amino acid precursors and cofactors necessary to achieve optimal serotonin and dopamine function we have had an 86% success rate with eliminating the urge to pull, as opposed to just reducing the urge to pull.

This increased success rate is attributed to the fact that dopamine exhibits control over the release of glutamate and GABA in certain parts of the brain. Therefore, the imbalance between glutamate and GABA that leads to trichotillomania in most people is likely to be caused by an imbalance with dopamine and serotonin (as they are farther upstream). By optimizing serotonin and dopamine function, all the systems downstream, including glutamate and GABA normalize as well. When this happens, the urge to pull disappears.

Another key distinction between using NAC or this balanced amino acid approach is the ability to remain symptom free once the amino acid(s) have been discontinued. With NAC, the urge to pull often returns once the supplement is discontinued (this provides further evidence that NAC may not be addressing the root cause of the imbalance). However, with balanced amino acid therapy we have found that once optimized neurotransmitter function is established and maintained for a period of time, most people can reduce or eliminate the amino acids and remain symptom free utilizing dietary and lifestyle factors to maintain optimal neurotransmitter status.  This means that it is very likely you won’t have to take these supplements forever and you can remain trichotillomania-free. This occurs because we are addressing the underlying root imbalance that seems to lead to the urge to pull for most people with trichotillomania. By correctly the underlying neurotransmitter imbalance with balanced amino acid therapy you effectively eliminate the problem, which allows you to stop pulling your hair out.

A literature search provided some unexpected results. Several research articles showed that long term use of SAMe causes depletion of serotonin, dopamine and norepinephrine, which can exacerbate symptoms of depression (and presumably other disorders related to neurotransmitter imbalance) over time. One of the studies even found that this depletion led to the development of Parkinson’s-like disease symptoms.

These are very interesting observations, as it appears that although SAMe is often recommended for symptoms of depression and other disorders relating to imbalanced neurotransmitter levels, long term use depletes the very neurotransmitters that are implicated with those diseases.

I obviously told my client that I would not advise that she use SAMe as a trich treatment. However, that if she chose to use it, she would need to take additional amino acid precursors at the same time in order to prevent further depletion of serotonin, dopamine and norepinephrine. This meant more pills and more money; she gratefully declined.

Sources:

1)      Striatal dopamine depletion, tremors, and hypokinesia following the intracranial injection of S-adenosylmethionine: a possible role of hypermethylation in parkinsonism. http://www.ncbi.nlm.nih.gov/pubmed/8748929

2)      Depletion of nigrostriatal and forebrain tyrosine hydroxylase by S-adenosylmethionine: a model that may explain the occurrence of depression in Parkinson’s disease. http://www.ncbi.nlm.nih.gov/pubmed/9247319

3)      Parkinson’s disease-like effects of S-adenosyl-L-methionine: effects of L-dopa. http://www.ncbi.nlm.nih.gov/pubmed/1359575

Most of the time, a person exhibits more than just one symptom of neurotransmitter imbalance, they just don’t make the connection that their symptoms are related.

“I wouldn’t have believed it if I wasn’t living it.
This is a miracle.”

As I explained this, I could see a light bulb go off in my clients head as her stare turned to an expectant grin, “Does this mean that I can address all of those problems using amino acid therapy?” To which I answered, “It most certainly does. As we continue to rebalance your neurotransmitter levels and restore optimal functioning, the symptoms associated with imbalance will disappear.”

She left the office with a new-found hope. That hope turned into amazement and disbelief as her symptoms began to disappear one by one. Now, she is living a life without the burden of constant anxiety or sleep problems; she no longer has restless legs and she is no longer pulling. “I wouldn’t have believed it if I wasn’t living it. This is a miracle.”

I replied, “It’s not a miracle – it’s better living through science.” Using a targeted approach incorporating amino acid therapy will help improve the status and function of your neurotransmitter levels. When this happens, the symptoms associated with the imbalances disappear, and you can get on with your life.

NAC has a direct effect on the glutamate concentrations in the brain (nucleus accumbens). This seem to restore reduce hair pulling in about half the people taking NAC (1). However, one would assume that discontinuation of NAC would also lead to a return in hair pulling because a lasting effect would be expected only if administration of NAC addressed the cause of neurotransmitter imbalance in the brain.

In a previous post, we discussed the priority of neurotransmitter systems in the body (Neurotransmitter Systems Priority). Research has indicated that the serotonin/catecholamine system exhibits primary control over many systems in the body. The catecholamines include dopamine, norepinephrine and epinephrine. This is also true of the nucleus accumbens, where dopamine-powered neurons exhibit control over the release of neurotransmitters from the nucleus accumbens (5). Therefore, the cause of imbalance in this area of the brain is more likely due to an imbalance in the serotonin/catecholamine systems somewhere upstream of the nucleus accumbens. Addressing the cause should restore proper glutamate/GABA balance in the nucleus accumbens and therefore, lead to a reduction in hair pulling. This is in fact, exactly what we have observed in clinical cases.

Once we restore proper serotonin and catecholamine (dopamine, norepinephrine and epinephrine) function using balanced amino acid therapy, people notice a marked decrease and most often elimination of hair pulling. Based on the observations noted above, balancing the primary neurotransmitter system (i.e., serotonin/catecholamine system), the secondary systems (such as glutamate/GABA)) also rebalance. Addressing neurotransmitter imbalances in this manner has the benefit of addressing the cause rather than the end effect of neurotransmitter imbalance, allowing for the possibility of continued relief from symptoms, such as hair pulling, once proper neurotransmitter status has been restored. We have observed this with clinical cases as well, where people suffering from trichotillomania achieve the elimination of the urge to pull with balanced amino acid therapy and are able to reduce and discontinue amino acid therapy over time without the return of symptoms.

In rare cases, we must augment balanced amino acid therapy with NAC to achieve complete relief of symptoms. It is thought in these cases that permanent damage may be present that inhibits proper neurotransmitter function. These people will most likely need continued amino acid therapy, including NAC, to achieve long-term relief; however, they can be free from the urge to pull doing so.

In summary, it has been our experience that properly addressing the primary serotonin/catecholamine neurotransmitter system facilitates changes in secondary and downstream neurotransmitter systems (such as glutamate/GABA) to produce more dramatic and lasting changes in reducing and eliminating the urge to pull in people with trichotillomania.

References

1. http://yale.tsocd.org/wp-content/uploads/2010/03/Trich-and-NAC-PDF.pdf
2. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, Saksa J, Wu-Y-T, Gueorguieva R, Sanacora G, Malison RT, Krystal JH. Riluzole augmentation in treatment-resistant obsessive-copulsive disorder: an open-label trial. Biol Psychiatry. 2005;58(5):424-428.
3. Odlaug BL, Grant JE. N-acetyl cysteine treatment of grooming disorders. J Clin Psychopharmacol. 2007;27(2):227-229.
4. Coric V, Kelmendi B, Pittenger C, Wasylink S, Bloch MH, Green J. Beneficial effects of the antiglutamatergic agent riluzole in a patient diagnosed with trichotillomania. J Clin Psychiatry. 2007;68(1):170-171.
5. http://en.wikipedia.org/wiki/Nucleus_accumbens

Image: dream designs / FreeDigitalPhotos.net

Probiotics and mental health

Probiotics are the “good” bacteria that normally reside in a health gastrointestinal (GI) tract. Different formulations are available in many health food stores containing one or more strains of different bacteria. Recently, Professor Mark Lyte and associates at Texas Tech University Health Sciences Center have come up with a radical new concept: that you may be able to affect your neurotransmitter levels – and therefore your psychological health – by taking and establishing the right blend of probiotics.

What these researches found was that several neurotransmitters (normally produced in the brain) are also produced by various probiotic strains in the gut. For instance, they found that bacillus and serratia strains of bacteria produce dopamine; streptococcus, Escherichia and Enterococcus strains produce serotonin; Escherichia, Bacillus and Saccharomyces produce norepinephrine; and Lactobacillus and Bifidobacterium strains produce GABA.

The Second Brain

This has potentially startling implications. First, it provides another pathway to help explain why a person’s neurotransmitter levels become imbalanced in the first place. If the microbial environment of the gut is abnormal from birth, let’s say, this research suggests that over time, neurotransmitter imbalances could result. This could help explain why some kids exhibit symptoms of trich from an early age and why others develop it over time. In addition, we have noticed that several people find a dramatic change in their urge to pull after a round of antibiotics; this research could help explain this as any shift in the microbial environment in the gut could lead to alternations in neurotransmitter levels.

In addition, it provides other possible avenues to correct those underlying imbalances. This research suggests that altering the bacteria in the gut could dramatically affect a person’s overall neurotransmitter balance.

More research needs to be done, but if this hypothesis is confirmed, probiotics could prove to be a valuable adjunctive therapy to help those who suffer from trich and other disorders relating to neurotransmitter imbalance.

“I was diagnosed with trich in 1^st grade and I’ve pulled every 1-3 days since then. By the time I found Dr. Oler I was 17 years old and had pulled out all my eyebrows, eyelashes and about 50% of the hair on my head. My dad’s a doctor, so I’ve tried pretty much every possible medical treatment and drug for trich out there. They didn’t help me get rid of the urge and I usually felt awful when I took them.

Within a month of starting the amino acid therapy my urge to pull was completely gone! It was great! And unbelievable! Dr. Oler told me to continue my current dosing for 2 months and follow up. Over those 2 months, I pulled a couple times, but it wasn’t an urge; it felt more like the hairs weren’t growing right and I just pulled those and left everything else alone. My eyelashes, eyebrows and hair on my head all started growing back. During this time, I stopped taking the amino acids a couple times, but noticed the urge to pull increased, so I went back to Dr. Oler’s recommendations.

After 2 more months, all my hair was grown back and I wasn’t having any urges anymore. However, I forgot to take my supplements with me when I went away from Christmas and New Years and the urges came back BIG TIME and I pulled everything out again in about 5 days. As soon as I got home, I started the supplements again and didn’t have any urge to pull after about 5 days.

I continued at this dose for 6 months. I wasn’t pulling, my energy levels were great, I slept well, my cravings were gone and I started playing rugby again. I also noticed that my focus, concentration and memory had improved and I was doing better in my classes. I was very content.

After a couple more months, Dr. Oler recommended that we start to decrease the amino acids, as by this time, my neurotransmitter stores should be back to where they belong. I was apprehensive, but reassured that I could always go back to taking what I was currently taking and get the same results within a few days even if the urge to pull returned. I had a little bit of an increased urge to pull after changing the dose, but it only lasted a few days and it wasn’t too bad, but no urges after that.

We continued to decrease the amino acid dosing over time, adjusting as needed if I had an increased urge to pull or stress triggered me to pull. I also started learning some other ways to manage stress, like deep breathing, taking a quick walk around the block and aerobic exercise which helped.

It’s now been two years since I started working with Dr. Oler and I (1) don’t have any urges to pull, (2) am no longer taking medications for trich, and (3) haven’t taken any of the amino acid supplements for over 3 months. All my hair is grown back and I have absolutely no urge to pull anymore unless there is a lot of stress in my life. Even then, I can get through it without pulling very much. I am very content where I am at. Thank you for helping me beat trich!”

-Stephanie, 08/02/11

Image: Graeme Weatherston / FreeDigitalPhotos.net

“I started pulling when I was 13 years old. At first it was more of a nervous habit, but pretty soon, I couldn’t help myself. I lived with it until I was an adult, then I began trying medications; none of them helped, and many of them made my symptoms worse or made me feel horrible. Over this time, I also started to developed terrible anxiety which got worse and worse with each pregnancy (she has 3 kids).  I also started to gain weight. The worst part is that I am starting to see signs of trich in my kids.

When I first started working with Dr. Chad, I immediately started to feel better, with some decrease in anxiety and a substantial increase in energy. I also started to work with my doctor to decrease the Wellbutrin that I was taking by 50%. The trich wasn’t doing so great, as I still had urges, but I didn’t pull.

Dr. Chad adjusted the amino acid therapy and within 3 weeks my urge to pull was gone, my anxiety was doing really well and my appetite had gone down, so I was starting to lose weight. I was also able to completely get off my Wellbutrin with no increase in symptoms. Now I am going to try and get off the amitriptyline that I am taking for anxiety as well.

I am so grateful to Dr. Chad for helping me get my life back. I can now enjoy my time with my kids because I’m not so stressed out and not thinking constantly about pulling. I’ve started to go out socially again and it feels wonderful. Thank you Dr. Chad for all you do and for helping me get rid of trich!”

Margaret’s story goes to show that no matter how long you may have suffered from trich, you can still get your life back and eliminate the urge to pull. Now we are working with Margaret’s kids to help them eliminate the urge to pull and stop the trich before it starts.