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Clinician’s Corner: Mental health services

Mental health services are challenging to get for our patients.  Most psychiatrists are booked in advance, and mid-level practitioners such as CRNP’s and PA-C’s are carrying the burden.  Even with their help mental health services are difficult to get for our patients.  More and more mental health care is being provided by the family practice clinicians.  At the request of the Physician Assistants that I work with at Empower-3, we will begin the journey through drug therapy for mental health disorders.  Before we start the drug categories, we need to do a quick overview of the neurotransmitters.

In addition to depressed mood, abnormalities of neurotransmitter function are associated with different symptoms:

Dopamine: (decrease in dopamine function)

  • Decreased ability to experience pleasure
  • Decreased motivation
  • Decreased attention
  • Cognitive slowing
  • Weight gain

Norepinephrine (decrease in norepinephrine function) (also known as “adrenalin”)

  • Low energy & lethargy
  • Decreased alertness

Serotonin (decrease in serotonin function)

  • Obsessive –compulsive behavior.


Too much serotonin causes:

  • Sexual dysfunction
  • Weight gain
  • Suppression of dopamine effects which may result in:
  • Decreased ability to experience pleasure
  • Apathy and decreased motivation
  • Decreased attention
  • Cognitive slowing
  • Stomach upset
  • Sleep Disturbances

Too much norepinephrine (“adrenalin”)

  • Tremor
  • Tachycardia
  • Dry mouth
  • Insomnia

Too much dopamine:

  • Aggravation of psychosis
  • Activation of motivation: rewards pathway
  • PERIPHERAL effects of dopamine:
  • Heart palpitations and rhythm disturbances
  • Difficult breathing
  • Goose bumps

GABA (gamma-aminobutyric acid)

GABA is the chief inhibitory neurotransmitter of the CNS.  Opposes the effect of glutamate. When released latches onto the GABA receptor which has a calming effect.

NET EFFECT on the GABA receptor

  • Benzodiazepines (Valium, Xanax and others) increase the frequency of the chloride ion channel opening at the GABA receptor to increases the potency of GABA. This provides a calming effect from the drug


Glutamate is the major excitatory neurotransmitter. Glutamate pathways are linked to many other neurotransmitter pathways, and glutamate receptors are found throughout the brain and spinal cord