What Norepinephrine Does (or Doesn't Do) for You

Understanding Neurotransmitter Dysregulation

Scan of a human brain
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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 the hormone 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 can cause panic attacks. A somewhat high level makes you happy, and a really high level makes you euphoric.

In FMS and ME/CFS, norepinephrine activity is low, which could be due to low levels or because our brains don't use it efficiently. While serotonin has more symptoms attached to it, norepinephrine is believed to be linked to some of our big ones, including:

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

Those symptoms are probably familiar to anyone with one of these illnesses. Loss of alertness and memory problems are part of our cognitive dysfunction ("brain fog" or "fibro fog"), which is one of the top complaints among us, often ranking just behind pain and fatigue. Sometimes, people list it as their worst symptom, especially when it's the symptom causing bigger problems (such as the inability to do your job.) A lot of us have left careers because we no longer had the mental ability to do what's required.

Depression is often a normal response to negative aspects of life, and a chronic illness is certainly a negative aspect! Almost everyone gets depressed now and then, in the garden-variety meaning of the word. Lack of arousal and interest often goes hand-in-hand with depression.

When these symptoms are severe, though, and don't get better on their own, it could mean that you're depressed in the medical sense, meaning that it's become major depressive disorder. That's a serious and very real condition that needs to be diagnosed and treated. Be sure to talk to your doctor about depression and other symptoms that may be related to norepinephrine dysregulation.

So far, we don't know why norepinephrine is low in these conditions. Some known causes of low levels are constant fear and anxiety, so that may contribute in those of us who have a big problem with anxiety and panic attacks.

Giving Norepinephrine a Boost

We do have ways to raise how much norepinephrine is available to our brains.

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

SNRIs are a type of antidepressant, so they could do double duty if you have more than one condition involving norepinephrine dysregulation.

Other things that raise norepinephrine include:

  • Sleep
  • Exercise
  • Meeting goals
  • Love
  • Aggression
  • Alcohol

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.

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