In part I of this blog, I covered the neurotransmitters of mood and the type of depression I see most often in my practice, low Serotonin “anxious depression.” I also addressed the dietary and amino acids suggestions most helpful in addressing this deficiency.
If you missed part I or want a review, click here.
Now, our attention turns to the other kind of depression I frequently see, low Catecholamine, “low energy/low motivation” depression. It’s amazing how different these two kinds of depression are.
The Year That Jake Was Sleepwalking
“I just don’t feel like I’m awake. It’s like I’m walking through life half asleep, experiencing everything through a film”
This was the first thing that Jake said to me in our initial appointment.
At the time of our first conversation, he was a 38-year-old man that came to see me exhibiting crushing symptoms of depression.
He had tried a number of antidepressants.
“But” he said, “they either made me more exhausted, which I didn’t think was possible, or made me wired so I couldn’t sleep. It was like a bad joke.“
After four or five attempts at using medication, he was done, but didn’t know where else to turn.
His drug of choice was coffee, which was the only thing that he felt kept him going. Sometimes, he had to have five or six large mugs a day just to stay alert and upright.
It was clear within five minutes of talking with Jake that he definitely had what I would call an “Eeyore” depression (think back to what Eeyore from Winnie the Pooh was like.)
Jake told me that his depression so consumed him, that he could barely lift his head, his energy was in the toilet, and he wasn’t really interested in doing any of the things that he used enjoy. Mostly he wanted to sleep. To me, the most striking thing about Jake was how joyless he seemed. He was just flat.
All in all, he felt totally “dead inside” and didn’t see any way out of his depression.
The hardest part for Jake seemed to be, that he felt had no reason to feel depressed. He had a great family, and a job he loved, and though he travelled a lot for work and often worked more than 70 hours a week, he said to me “I really have a great life” and I believed him.
Finding What’s Out of Balance
As I heard Jake’s case I was saddened by his despair, but I knew if we could identify the “root” of the problem, I could help him.
So, I began to think about the most likely causes of Jake’s depressive symptoms. I came up with a list of probable culprits (there were many others possibilities that we would might address later if necessary, but these were the most obvious.):
- Adrenal Fatigue
- Low Thyroid
- Low Catecholamines (CATS)
After comprehensive testing, we ruled out problems with his adrenal glands or thyroid issues, and started to get to work on supporting his CATS.
So what are the Catecholamines (CATS)?
The CATS are family of three neurotransmitters that you may have heard of, that are intimately involved with the chemistry of depression.
Dopamine is Involved with focus, and regulating pleasure and reward. Often memory issues happen when Dopamine is either too low or high.
Common symptoms of low Dopamine include lack of focus, addictive behaviors, and loss of pleasure and satisfaction in life.
Norepinephrine is synthesized by the adrenal glands from Dopamine. Norepinephrine helps with attention and focus and a deficiency of it can cause low energy, and lack of focus and motivation.
Epinephrine (Adrenaline) is synthesized from Norepinephrine in the adrenal glands, low levels of which, lead to decreased energy, fatigue, depression, burnout and chronic stress. High levels of it, are associated with ADHD, anxiety, and sleep issues.
In short, when we you have enough (but not too much) of the CATS, you’re alert, attentive, and feel that life is rewarding and pleasurable. Life is good!
But, when the CATS are depleted, everything is just, BLAH! It’s like you are in a slump, with no energy, not enjoying anything and unable to focus. It really feels like you are walking through life half asleep.
Low CAT Symptoms
Here is the questionnaire I use in my practice to determine whether someone has a low CATS depression. It’s adapted from Julia Ross’ book, The Mood Cure.
(3 points) ___Do you feel depressed- low, bored, and apathetic
(2 points) ___Are you mentally and physically low energy?
(2 points) ___Is your drive, enthusiasm, motivation low?
(3 points) ___Do you have a hard time with focus and concentration?
(3 points) ___Is it hard to get out of bed in the AM, or to get going?
(3 points) ___Do you need to have caffeine, or other “uppers” (like chocolate, diet drinks, or prescription drugs like Ritalin, or cocaine” to be more alert or motivated
A score of six or higher would suggest that one’s Catecholamines need support.
Jake’s score was 16!
Are Your Catecholamines low?
Though Jake’s case of low Catecholamines was extreme, so many of us live in a way that taxes our ability to support and replenish this essential brain/stress system.
Lifestyle factors that put you at risk for LOW Catecholamines
The Standard American Diet (SAD)
The SAD is high in carbohydrates and, low in protein and whole foods, which contain most of the vitamins and minerals needed to support the chemical pathways of the body. The acronym for this diet is SAD couldn’t be more accurate, because eating this way really does make us SAD!
- Low protein in the SAD, limits the amino acids necessary to make all neurotransmitters including the CATS.
- Eating Too Many Carbs causes the hormone insulin to surge, which tells the cells of the body to absorb blood sugar and most of the amino acids from the blood. With all of the amino acids moving into the cells for important bodily functions like building muscles, little is left to be turned into the CATS.
- A diet low in fruits and vegetables lacks the vitamins and minerals the body needs as cofactors to convert the amino acids L-Tyrosine and DL-Phenylalanine (DLPA) into Dopamine. These include vitamins B6 and C, iron and others. If these cofactors are limited from the diet, production of the CATS can be limited or even stopped entirely.
The CATs are “stress coping” chemicals. Norepinephrine and Epinephrine (a.k.a Adrenaline), are made by the adrenal glands, the part of the endocrine system tasked with managing stress.
This system usually works well until our stress levels overwhelm the body’s capacity to make enough of the CATS. This leads to low CAT production, which manifests as symptoms of an “Eeyore” depression.
Three Things You Can Do To Replenish Your Catecholamines
1) Eat a whole foods diet
Focus on eating:
- 25 grams of protein per meal.
- Consume carbohydrates low on the glycemic index to avoid insulin surges.
- Eat real food (grass fed/pastured meats, lots of vegetables, and good quality fat
2) Practice Stress Management
Stress management will help downregulate your central nervous system to help your CATs and adrenal glands rest and repair. Practicing gentle yoga, meditation,or breath work are a good place to start. Follow the links provided for simple practice to get started.
Find a practice you enjoy, because if you do, it will be easier to do it regularly.
Start by practicing 20 minutes every other day for a few weeks and then see if you can practice daily. You can choose a single practice or try a different one every day. One tip is to practice at the same time of day, in the same place. This will make it easier to make practice a habit.
3) Try the supplements L-Tyrosine or DL-Phenylalanine (DLPA)
The easiest and fastest way to increase the amount of the CATS available to your brain is to take the amino acids precursors L-Tyrosine or DLPA as dietary supplements. These supplements are readily available at any heath food store.
If the problem is low CATS, I have found these supplements to be an invaluable tool in addressing symptoms of low energy/low mood depression.
Which one do you start with?
In my experience L-Tyrosine is stronger of the two. If your primary issue is: fatigue, loss of interest, low mood, and poor focus start with L-Tyrosine.
If you have some anxiety along with the symptom above, I would start with DLPA. Also, if you experience cravings for comfort and sensitivity to pain along with the low energy/low mood symptoms, start with DLPA, because along with addressing symptoms of low Catecholamines, it also helps with low Endorphins.
How do you take L-Tyrosine and DLPA?
The most common reason that amino acids don’t work is that people aren’t sure how to take them. They often take them at the wrong times of day and/or don’t take the right amount.
Because of this, here is a detailed explanation of how to do a trial to find the optimal dose of L-Tyrosine or DL-Phenylalanine for you.
Take L-Tyrosine or DL-Phenylalanine supplements 20 minutes before, or 1 1/2 hours after food with protein (these supplements are protein fragments, so if taken away foods with protein, they will work more effectively.)
Buy 500 mg capsules of these supplements (the starting dose).
DAY 1: Start with (1) 500 mg capsule right when you wake, four hours later (and possibly mid-afternoon.) If you find that taking the afternoon dose disrupts your sleep stop taking it and just do the two morning doses.) Notice how you feel throughout the day on this dose.
DAY 2: increase to two 500mg capsules (1000 mg) at the same time intervals as Day 1. Pay attention to how you feel throughout the day Specifically, do you notice a reduction in the symptoms that you are taking the supplement to address (i.e depressed mood, fatigue, lack of motivation and pleasure,cravings for substances etc.)
DAY 3: If after day 2, you felt nothing or better than you did on Day 1, then increase to 3 caps per dose (1500 mg), following the dosing schedule of Day 1.
Continuing to increase your dose in 500 mg increments per dose until you see no improvement or feel worse with the increased dosage and back down to the last positive dose. This will be your Tyrosine or DLPA dose.
If you are experiencing no benefit after going up to 3000 mg each dose, I would assume that it will not be helpful to go any higher. At this point switch to the amino acid you have not tried yet and repeat the dosing process starting at the beginning. If you have tried both, consider other interventions besides amino acids to raise the CATS.
How do you know when to stop?
If you have found a helpful dose of either DLPA or L-Tyrosine it is typically advised to stay on the supplements for at least three to six months before considering a trial of coming off.
I suggest waiting long enough to make habits out of the CATS supportive lifestyle changes I have outlined in this blog. These changes will increase the likelihood of coming off of the supplements successfully. If you experiment coming off, and feel more depressed, just restart the supplements at the helpful dose. Then, wait a few more months before experimenting again with coming off.
Here’s a Dosing Example
You feel better than you felt before trying L-Tyrosine or DLPA when taking two 500 mg capsules 3x day. For examples, you feel more energy, better focus, less depressed.
The next day you try going up to 3 caps 3x day. Now, you feel more anxious and “not as good.” You would then go back down to two 500 mg capsules, 3x day as your ongoing dose of L-Tyrosine or DLPA.
A few words of caution:
Speak to your medical provider before starting either L-Tyrosine or DLPA to discuss if he or she recommends it as part of your treatment plan.
This is especially important if you are taking an SNRI antidepressant (including Wellbutrin, Cymbalta or others.) If your medical provider is ok with it, and you do decide to do a trial of either, they should be taken at least 6 hours before or after you take your antidepressant medication. Since, these amino acids need to be taken earlier in the day, the medication would have to be taken at night if tolerated.
Do not use Tyrosine or DLPA (or use with caution under a doctor’s supervision) if you have any of the following: Overactive Thyroid (Grave’s Disease,) Melanoma, High Blood Pressure, Migraine, Bipolar Disorder
Jake’s L-Tyrosine Experience:
Jake started a number of supplements typically used to raise his Catecholamine levels. L-Tyrosine was the main one, but we also gave him certain vitamins and essential fatty acids to support production of the CATS.
These included two forms of vitamin B6 (regular B6 and P5P, a methylated form), a B-complex, Vitamin C, and a large dose of fish oil (5000mg, which has been shown to support CATS production.)
Jake did not notice any improvements in his symptoms until we got up to 3000 mg of L-Tyrosine, three times a day (we kept the afternoon dose because it did not affect his sleep and helped him get through his afternoon “slump” which was the hardest part of the day for his fatigue. After a few days of taking 3000mg three times per day, Jake noticed his internal “lights coming on.” At first the lights were pretty dim but after a few weeks on this regimen, they grew consistently brighter.
Over time, he was waking up more energized. He only needed one coffee to get going (and on a few occasions he even forgot his AM brew.) Overall he felt less fatigued, more hopeful, and an increased ability to stay focused on daily tasks.
Little by little, Jake started to do things that he enjoyed, and with each success he felt encouraged and motivated to do more.
He started to spend more time with family and friends, and after a few weeks felt the energy and motivation to start exercising again.
The ability to get back to the gym (which is something that provided him with a big mood boost in the past, was a real turning point.)
After about a month of just focusing on the supplements and reengaging in life, he was able to take a hard look at his diet and cut out gluten and dairy. After about 3 months, he did a Paleo elimination diet, and found that he had several food sensitivities that contributed to his depression (he felt more depressed after reintroducing gluten and corn and noticed how much better he felt when they were out of his diet.)
At about the three month mark, Jake started a regular meditation practice which would not have been possible before he started L-Tyrosine.
Six months after starting taking L-Tyrosine he felt close to normal, but knew that maintaining a balanced lifestyle was essential to him not becoming Eeyore again.
What’s next for you?
Did you score above a six on the Catecholamine questionnaire?
Which of the low CATS symptoms prevent you from being who you want to be?
If you scored above six on the questionnaire, I wonder if you are willing to accept a challenge?
Take two months and do an CATS makeover!
Follow the three steps I outline in this blog and see how you feel!
Please share your experience in the comments section below or on my Facebook Page.
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In good (mental) health,
Dr. Josh Friedman has more than 25 years experience in mental health as a client, psychologist, and functional nutrition practitioner. After working in the field for a few years, he realized how many people were still struggling with depression and other mental health issues even after years of therapy and medication. Over time he became increasingly uncomfortable with the limitations of standard psychiatric treatment and knew there had to be a better way. Over the past decade and a half, he has committed himself to learning as much as he could about the root causes of mental health symptoms. To share this information and to help people get unstuck, he started Alternative Mental Health Solution.