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Norepinephrine in Fibromyalgia & Chronic Fatigue Syndrome

Not Enough NE: What It Does & What to Do About It


Updated November 11, 2013

Norepinephrine (NE) is both a neurotransmitter and a hormone. Also called noradrenaline, NE plays a key role in the "fight or flight" response by spiking your heart rate and blood pressure. NE is similar to adrenaline and many experts believe it helps determine your basic levels of stimulation and arousal. NE also is linked to anxiety and depression. High NE levels are associated with feelings of joy, and sometimes euphoria.

Since joy and euphoria aren't exactly typical of fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS), it's no surprise that research suggests most people with these conditions have low NE levels.

The connection to low NE is more definite in FMS, but a growing body of research shows people with ME/CFS have an imbalance between NE and dopamine, and experts also point to successful treatment with drugs that increase NE levels as evidence that NE is low in ME/CFS.

Low Norepinephrine

No neurotransmitter acts alone. They all work together in a complex web of activity that scientists are really just beginning to understand. Still, experts have been able to associate different neurotransmitter imbalances with certain conditions and symptoms and find some ways to help boost or decrease activity.

Norepinephrine activity takes place in several areas of your brain, and even elsewhere around the body (where it acts as a hormone). Those different areas of your brain use NE differently, and they contain several different kinds of receptors that also influence how NE is used.

Low NE levels are associated with these symptoms:

We don't yet know why NE is low in people with FMS and ME/CFS. Constant fear and anxiety are known causes of low NE, so people who live with a lot of those emotions may be especially at risk for developing these illnesses.

Increasing the Availability of Norepinephrine

To make more norepinephrine available to your brain, you can take serotonin norepinephrine re-uptake inhibitors (SNRIs), such as Cymbalta (duloxetine) or Savella (milnacipran) or amphetamines, including Adderall (dextroamphetamine), which is often used to treat ADD.

Several things that are part of life are generally believed to boost NE levels in your brain, including:

  • Quality sleep
  • Exercise
  • Meeting goals (even small ones!)
  • Love
  • Aggression (this is NOT an excuse for bad behavior - maybe try aggressive video games?)

We don't have a lot of research confirming that food can boost NE levels in your brain, and it would likely take prohibitively huge amounts to have the desired effect. In spite of the lack of hard evidence, some practitioners say they've seen clinical evidence to support diets high in the following:

  • Theanine/L-Theanine (a unique amino acid in black and green tea, also available as a supplement)
  • Apples, bananas & watermelon
  • Beets, beans & legumes
  • Chicken
  • Cheese
  • Eggs
  • Fish
  • Wheat germ

A note on theanine: Studies show theanine increases both norepinephrine and dopamine while lowering glutamate levels, all of which can have a positive effect on those of us with FMS and ME/CFS. Research is mixed, however, on how theanine impacts serotonin levels. If you decide to try theanine, track your symptoms to see if serotonin-related symptoms get worse.

While it's generally safe to experiment with these kinds of foods, don't expect miracles and avoid extreme changes to your diet. Be sure to make changes slowly, and track your dietary changes and symptoms in a symptom journal to get an accurate gauge of what may be helping. You should always work with your doctor to decide what methods to try and how successful your treatments are.

Symptoms of High Norepinephrine Levels

When you take medications that raise your NE levels, you might be told to notify your doctor if you become "too happy." That's because it's a sign of high NE levels, which can also cause symptoms such as:

  • Worry, anxiety, irritability and jumpiness
  • Fears of crowds and confined places
  • Impaired concentration
  • Restless sleep
  • Muscle tension or cramps

Many anxiety disorders are associated with too much NE. The effects of several street drugs, including cocaine and illegal amphetamines, stem from increased NE levels and the resulting physical arousal and feelings of elation, which is part of what makes these drugs addictive.

Be sure to include your doctor in any decisions about increasing your NE levels and notify him or her if you experience any symptoms of too much NE.

Also See:


Amino Acids. 2008 Jan 15. [Epub ahead of print] All rights reserved. "Theanine, gamma-glutamylethylamide, a unique amino acid in tea leaves, modulates neurotransmitter concentrations in the brain striatum interstitium in conscious rats."

Expert Review of Neurotherapeutics. 2008 Jun;8(6):917-27. "Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate."

Goldstein, J. Alasbimn Journal2(7): April 2000. AJ07-5. "The Pathophysiology and Treatment of Chronic Fatigue Syndrome and Other Neurosomatic Disorders: Cognitive Therapy in a Pill."

Psychoneuroendocrinology. 2008 Feb;33(2):188-97. All rights reserved. "Genetic evaluation of the serotonergic system in chronic fatigue syndrome."

2008 University of Maryland Medical Center. All rights reserved. "Chronic Fatigue Syndrome"

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