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:
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.
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!
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.
Andrew,
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.
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.