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Adrienne Dellwo

Norepinephrine: What Does (or Doesn't) It Do For You?

By July 29, 2008

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When you hear about neurotransmitters involved in fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS), serotonin usually gets all the attention. When you talk about stress response, the focus is generally on cortisol.

But norepinephrine, which is both a neurotransmitter and a hormone, is a key component of these conditions as well. It's also called noradrenaline, and it's what makes your heart rate and blood pressure soar during a "fight or flight" reaction. A sudden, rapid rise of norepinephrine causes panic attacks. A somewhat high level makes you happy, and a really high level makes you euphoric.

In FMS and ME/CFS, norepinephrine is low. Symptoms attributed to low norepinephrine include:

  • Loss of alertness
  • Memory problems
  • Depression
  • Lack of arousal and interest

So far, we don't know why norepinephrine is low in FMS and ME/CFS. Some known causes of low levels are constant fear and anxiety.

Some medications that raise norepinephrine levels are serotonin norepinephrine re-uptake inhibitors (SNRIs), such as Cymbalta (duloxetine) and amphetamines, including Adderall (dextroamphetamine), which is often used to treat ADD.

Other things that raise norepinephrine include:

  • Sleep
  • Exercise
  • Meeting goals (even small ones!)
  • Love
  • Aggression (this is NOT an excuse for bad behavior - maybe try aggressive video games?)
  • Alcohol (this is NOT an excuse for over indulging, which does very bad things to your brain chemistry!)

Like with serotonin, doctors don't generally test norepinephrine levels, so they diagnose it based on symptoms. Talk to your doctor about whether you need treatment and what treatment is best for you.

Have you taken steps to increase your norepinephrine? Tell us about it here or in About.com's Fibromyalgia & Chronic Fatigue Syndrome forum (under Newsletter & Blog topics.)

Suggested Reading:

July 29, 2008 at 10:08 am
(1) Maritzia says:

One thing to keep an eye out for is the FDA approval of milnacipran. It increases norepiniphrine levels at a rate much higher than those currently on the market, so it could be a real boon for those with FMS and/or CFS. I’ve been on it for almost 2 years now in the clinical trials and it’s made a huge difference to me both in pain control and fatigue levels. It has some significant early side effects, but those mostly pass after about a month.

August 1, 2008 at 6:16 pm
(2) Eric says:

I have had CFS for 15 years and have tried about half a dozen different antidepressants during the first 10 years – results were generally only slightly helpful,mainly in pain reduction, until a locum suggested taking mirtazapine (because of its action on norepiniphrine) as well as the venlafaxine that I was already on. I very quickly went from about 10% up to 40% fitness, which to me was tremendous. I should add that my cfs was sudden onset and probably the result of years of continuous (self imposed!) stress.

@Maritzia. Thankyou for highlighting milnacipran, could be just what I need!

August 2, 2008 at 2:55 am
(3) Andrew Porter says:

I have been through drug treatment to increase levels of Serotonin and Noradrenaline. The results were a disaster, as it greatly exacerbated my symptoms, make sleeping impossible, increased my fatigue, blurred eyesight, etc. No surprise when all my M.E. test results point towards chronic viral infection with Human Herpes Virus 6 in my CNS as being the central cause of my ill health.

August 5, 2008 at 2:37 pm
(4) Adrienne - Your Guide to FMS/CFS says:


I find it so infuriating that doctors will mess with our neuro chemistry without testing! I suspect I had a similar problem, with a medication increasing one neurotransmitter to much. It’s horrible, painful and frightening, and I really wish our healthcare system would start testing these levels routinely when imbalances are suspected.

August 6, 2008 at 9:18 am
(5) VaBreeze says:

Serotonin, Norepinephrine & Dopamine…if you have problems with all of these it’s very difficult to get the right combo of medications. I think it’s important to mention here that one should familiarize themselves about “serotonin syndrome” effects. Most doctors just write out prescriptions like candy…without thought to how it may cause serious side-effects when mixed with other medications.

October 30, 2012 at 12:28 pm
(6) Todd Stevens says:

Its too expensive and time consuming to test.

March 26, 2013 at 1:44 pm
(7) Margaret says:

well all i know is that my insurance pays vons over 200 bucks a month for 30 cymbalta pills…… i think some of the money that lilly makes of this drug should be used for testing…….. i also wish i had never gotten on this drug which has so many side effects and is extremely difficutl to get off of….. wish i would have been told all this before i started it…….. oh and now my doc wants to put me on more drugs…. the reason i went in was to lower the drugs i take… go figure.. my doc was saying goodbye to a pharma rep as i was entering his office…… is there a connection???/ ya think?????

February 6, 2014 at 5:03 am
(8) Laverne says:

cup full strength chlorine bleach to it and allow it to sit for 30 minutes. which compound or customize medication according to the unique needs of clients.

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