Mental health disorders are often caused by physical imbalances and chemical changes that influence how the brain reacts and responds to situations. The stigma surrounding mental health can be prevented when society starts to understand that most mental health conditions are caused by an imbalance of physical substances in the body.
Mental health is extremely complex; however, we do know that physical neurotransmitters are actually the reason behind the imbalances associated with a range of disorders, such as:
- Anxiety disorders
- Depressive disorders and episodes
- Stress-related disorders
- Dissociative disorders
- Somatic symptom disorders
- Eating disorders
- Sleep disorders
- Disruptive disorders
- Substance-related disorders
- Obsessive-compulsive disorders
- Hormonal-related disorders
- Personality disorders
Neurotransmitters are physical substances that trigger the body to react in a certain way. There are over 40 neurotransmitters and hundreds of derivatives and substrates of these neurotransmitters, which signal the body how to respond in a range of situations. They are the reason we 'feel’ the way we do – excited, relaxed, happy, sad, sleepy, awake, aroused – and the list goes on.
Neurotransmitters likewise tell us to be alert, fight, or flee. Everything we do and feel is influenced by neurotransmitters. Mental health disorders are essentially imbalances in these neurotransmitters and the manner by which the body signals itself how to feel and react.
Essentially, a mental disorder is a chemical imbalance.
This subtle but important differentiation can help us better understand these disorders and destigmatise mental health disorders.
Types of neurotransmitters in the body
gamma-Aminobutyric acid (GABA)
Releasing hormones from hypothalamus
What causes neurotransmitters to become imbalanced?
Neurotransmitters are chemical messengers in the body, so it's important to know what causes these messengers to become imbalanced in the first place. Usually, it is a combination of factors that leads to the ultimate imbalance-triggering mental disorders. Let us explore the common contributing factors of neurotransmitter imbalance.
There is a strong genetic influence on any mental disorder. We all carry our unique genetic code created over generations, which makes us unique and particularly susceptible to mental health conditions.
New research into the genome identifies susceptibilities that span back multiple generations and can lie dormant for centuries. Our current hyper- acceleration in society is triggering more and more of these inherent tendencies, which explains the rise in mental health conditions these days.
There is a well-proven link that the formative years from ages 2 to 13 are potential risk factors for mental health conditions predominantly related to substance abuse. A history of abuse and household instability seems to hardwire the brain to more extreme neurotransmitter fluctuations, which are carried into adult life.
At the same time, dietary and lifestyle factors play a critical role in the expression of genetic tendencies. The rise in attention deficit disorder and hyperactivity linked to dietary factors can predispose children to mental disorders later in life, as these conditions are heavily dependent on the body’s control of neurotransmitters.
In a study that observed 400 adults with substance abuse, it was found that “greater exposure to childhood trauma events significantly increased the odds of several adverse adult outcomes, including PTSD, alcohol dependence, injection drug use, tobacco use, sex work, medical problems, and poor quality of life.”
This indicates the importance of early prevention and intervention for children during their formative years. You can read more about the study here.
Allergies and food intolerances can have a predisposing tendency towards mental health conditions. An allergic reaction and/or food intolerance create ongoing stimulation and excitation of the neurotransmitters.
In a study on seasonal allergies and psychiatric disorders, it was shown that individuals with seasonal allergies had a significantly higher predisposition for lifetime mood disorders, anxiety disorders, and eating disorders. Interestingly, these allergies did not predispose individuals towards alcohol and substance abuse disorders. This indicates that different triggers affect different neurotransmitter pathways and gives an insight into the variations in neurotransmitter imbalances and different disorders.
Research indicates that lifestyle factors like exercise, general diet, and smoking are commonly linked to mental disorders. It is unclear, however, if this is a chicken and egg situation where these factors are causing mental disorders or resulting from mental disorders. For instance, do factors like smoking and lack of exercise trigger mental disorders or are individuals with mental disorders more likely to smoke and exercise less?
It is well known, however, that exercise is an excellent way to 'reset' neurotransmitter function through regular physical exertion. The secondary effects of exercise also include reducing stress hormones such as cortisol.
The nutritional deficiencies associated with smoking can likewise certainly be a reason for neurotransmitter disruption, as magnesium and B vitamins are necessary for correct neurotransmitter function.
Substance abuse is both a mental health disorder AND a cause of mental health disorders. All illicit substances have an impact on neurotransmitter balance. This is the reason why we feel the effects of the substance.
The artificial stimulation of neurotransmitters can trigger the development of mental disorders, especially chronic conditions like schizophrenia and bipolar disorder. It may be a single consumption or years of abuse to trigger the mental disorder.
Chemical drugs such as ecstasy and ice have a dramatic effect on neurotransmitter levels. It is prevalent for individuals to develop long-term mental disorders, especially anxiety and depression.
Alcohol is, of course, a well-known trigger of mental health disorders. Like all other forms of substance abuse, it can become a vicious cycle. Because substances can trigger mental health disorders and, at the same time, the cyclical nature of moods, substance abuse can become a way of self-medication.
One of the most common triggers for mental health disorders is post-traumatic stress disorder or PTSD. PTSD can result from many causes, such as exposure to violent situations, child molestation, sexual assault, and accidents, among others. It is very common among war veterans. Exposure to extreme situations can disrupt the neurotransmitter balance and lead to chronic and long-term mental health disorders.
Similarly, simple, long-term exposure to stress also disrupts neurotransmitter balance, with elevated levels of cortisol leading to anxiety and depression disorders. Long-term stress also significantly impacts sex hormones and hormonal balance, a common trigger for anxiety and depression.
An individual's nature of work is also a common contributor to anxiety and depression. In a study of 3366 Finnish workers, it was shown that work stress is associated with mental disorders in both sexes. Among men, in particular, it is a risk factor for mental disorders treated with antidepressant medication.
Inflammation plays a role in all chronic illnesses and has a pivotal role to play in mental health disorders as well. Research indicates that several mental health disorders, such as major depressive disorder, bipolar disorder, and schizophrenia, have increased levels of peripheral inflammatory markers and systemic inflammation.
This research further strengthens the link between diet and mental health disorders, as diet is one of the primary drivers of inflammation in the body. You can read more about Inflammatory Foods here.
Some hormones, such as serotonin and dopamine ( our 'happy hormones') act as both regulators and neurotransmitters in the body. Although sex hormones are not neurotransmitters, they also act in a similar fashion. Sex hormones such as oestrogen, progesterone, and testosterone are interconnected in this delicate hormonal and neuroendocrine balance.
Hormones have a powerful influence on how we feel, and the connection between sex hormones and mood fluctuations or anxiety is well established.
Sex hormones may be relevant to psychiatry in three ways:
- Sex hormones may play a role in the pathophysiology of psychiatric disorders.
- Sex hormones may be utilised for treatment of psychiatric disorders.
- Administration of sex hormones may cause psychiatric side-effects.
Mental health disorders have a physical basis is certainly not a novel idea. However, I believe that as a community, it is important to understand the physiological reasons behind mental health disorders to remove the current stigma. It also encourages doctors and those caring for people with mental health disorders to understand the importance of involving physical factors such as exercise, diet and lifestyle in developing treatment programs for these conditions. Everything boils down to addressing the physical to solve the mental symptoms.
In a large scale meta-analysis study, it was concluded that, "There is now a vast body of research examining the efficacy of nutrient supplementation in people with mental disorders, with some nutrients now having demonstrated efficacy under specific conditions, and others with increasingly indicated potential."
I certainly do not advocate the removal of any medications used to treat mental health disorders and recognise there are many more causative factors than the ones listed above. An integral approach to treatment utilising diet, lifestyle, and stress management techniques to complement traditional medications will deliver better results.
If you would like to start to develop a holistic treatment plan for any mental health disorder our team of specialists are available for online consultations.
Hans Oh H, Koyanagi A, DeVylder J, Stickley A. Seasonal Allergies and Psychiatric Disorders in the United States. International Journal of Environmental Research and Public Health. 2018 Sep; 15(9): 1965.
Firth et al. A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020 Oct; 19(3): 360–380.
Golightly L and Young A. Sex hormones and mental health. Advances in Psychiatric Treatment. 1999 Mar; 5(2): 126-134
Firth et al. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry. 2019 Oct; 18(3): 308–324.
Firth J, Veronese N, Cotter J, et al. What Is the Role of Dietary Inflammation in Severe Mental Illness? A Review of Observational and Experimental Findings. Front Psychiatry. 2019;10:350. Published 2019 May 15.