The Dopamine-Adrenaline Connection

A Most Important Linkage for Self-Understanding

Introduction

The internal quest for generating dopamine is as extremely engaging and compulsive for us humans in the modern day, as it was for our Palaeolithic ancestors. Back in those days, dopamine generation was an intrinsic part of our internal survival guide, driving our thoughts, behaviours, and actions towards the things that enhanced our survival chances, and away from potential harms, and dangers. In the mis-attuned modern world which we have created for ourselves, where most of our survival needs are largely met, the distractions of our current society can, in some cases, deliberately, lead our insatiable quest for dopamine astray, resulting in dopamine deficit states (anhedonia), chronic brain and body symptoms, and severe addictions.

Dopamine can make us feel good, and hence is part of our internal reward system for behaviours that increase our chances of survival. However, a lack of dopamine is an even greater force, there to move us away from harmful or dangerous things, behaviours and situations. This drive is mediated by the fact that not having enough dopamine makes us feel terrible, and hence forces us to do something about it, in order to feel better.

Indeed, a lack of dopamine can be painful, and is intrinsically associated with suffering, precisely because the motivation to avoid pain and suffering is so very strong. In this way, suffering is often a signal that we need to get out of our current situation fast, or change something in our lives or environment. Unfortunately, modern society does such a poor job of teaching us how to read our own signals, and indeed trains us to largely try to ignore them, and not to trust them, that we tend to not take the required action, and get stuck in the suffering.

Understanding the things in life which can alter our dopamine levels, either up or down, is therefore most insightful for self-understanding of our own drives, thoughts and behaviours, and guides us how to avoid too much suffering. It can also help us to be less harsh on ourselves when the way the modern world has been set up makes our quest for dopamine take us down the wrong path. It also helps us make sense of our collective behaviours and drives, as a modern society and culture, including the ability to see all the ways others are deliberately hijacking our quest for dopamine: hence learning about dopamine provides tools for the resistance.

Here, we consider one of the most crucial pieces of this dopamine puzzle, the dopamine-adrenaline link. When I first stumbled across this connection, several years ago now, almost no-one I asked had ever heard about, let alone had fathomed the profound consequences for people with chronic illness like me, and for wider society.

The only other person I encountered who had figured it out was therapist

Lilian Sjøberg

of

The HOPE shortcut

, and this shared, but independently arrived at, understanding was in fact the basis for our ongoing collaboration. More recently, the dopamine-adrenaline link has become more well known through the Huberman podcast, but I still don’t think most folks have gleaned the profound ramifications, both for our individual suffering, and for society at large.

The Dopamine-Adrenaline Link

In my article for people with Parkinson’s Disease,

PHENYLALANINE, TYROSINE, L-DOPA, DOPAMINE AND PARKINSON'S DISEASE,

I summarized the basic biochemical pathway for generating dopamine in our bodies and brains as:

PHENYLALANINE (from food) -> TYROSINE (from food or made in body from phenylaline) -> L-DOPA (from food or made in the body from tyrosine) -> DOPAMINE.

However, this chain of chemical events doesn't stop with dopamine, and in fact:

DOPAMINE -> NORADRENALINE (made in the body brain from dopamine) -> ADRENALINE (made in the body and brain from noradrenaline).

While I very rarely ever see this discussed, this basic bit of biochemistry, that not only are adrenalines created by the same chemical pathway as dopamine, but actually are built from dopamine itself, would seem profoundly important to me.

First, some brief notes, taken from Wikipedia, about these “adtenaline” chemicals:

“Noradrenaline, aka Norepinephrine functions in the brain and body as a hormone and neurotransmitter. The general function is to mobilize the brain and body for action.”

“Noradrenaline release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress or danger, in the so-called fight-or-flight response. In the brain, noradrenaline increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety. In the rest of the body, noradrenaline increases heart rate and blood pressure, triggers the release of glucose from energy stores, increases blood flow to skeletal muscle, reduces blood flow to the gastrointestinal system, and inhibits voiding of the bladder and gastrointestinal motility.”

“Adrenaline, aka epinephrine, is a hormone, neurotransmitter, and medication, normally produced by both the adrenal glands and certain neurons. It plays an important role in the fight-or-flight response by increasing blood flow to muscles, output of the heart, pupil dilation response, and blood sugar level”.

We see that the “adrenalines” are strongly connected with Sympathetic Nervous Systems arousal, mobilization of brain and body, and with the fight-or-flight stress responses, in particular.

Now, tying this together with the fact that dopamine is the precusor building block of these chemicals, what are the logical consequences for people’s internal dopamine levels? Here are my own conclusions/musings on this.

When fight-or-flight (stress responses) are triggered, this converts some of our dopamine supplies into [nor]adrenaline, very rapidly. When needed in fight-or-flight situations, the conversion occurs extremely rapidly and suddenly. Meanwhile, dopamine generation is relatively extremely slow (with the Tyrosine step above being the rate limiting step). Stress thus rapidly depletes the pool of our baseline levels dopamine.

Indeed, the slowness with which dopamine supplementation (still the mainstay medical treatment for Parkinson’s Disease) increases the available dopamine pool for people with a PD diagnosis is quite telling in this regard. For myself, the very best I can hope for a dose of the PD drugs to kick in and switch off my symptoms is about 30 minutes. Compare this with the depletion of dopamine into adrenaline in acute stress situations - timescales of seconds or less.

Thus once the stress is removed, fight-or-flight is likely to leave us with low levels of dopamine, and hence potentially in state of pain an suffering, for some time, until the dopamine stockpiles can be slowly built up again.

However, when we are chronically stressed, and hence making adrenalines as part of an ongoing stress response very often throughout the day, we will be constantly depleting our dopamine supplies. If we are stressed out for prolonged periods, we will be using up dopamine as quickly it is created, before the baseline levels can really build up. Chronic stress will therefore manifest symptoms similar to those associated with dopamine deficit conditions, such as Parkinson’s Disease, dystonia, and anhedonia.

In fact, we can ask whether many symptoms in people with idiopathic diagnosis of conditions such as PD are really due to the brain not being able to produce enough of its own dopamine, or whether they seem to have low dopamine simply because the person is chronically stressed, and hence constantly eating up their own dopamine supplies.

The prediction of this hypothesis is that if we could calm and relax folks with these types of diagnosis for long enough, they will be able to start re-generating dopamine for themselves, and hence the symptoms will melt away. This is indeed our (Lilian and mine) experience in working on ourselves and with other people, and is the basis for our regeneration strategies for folks with chronic conditions or trauma.

In this framework, we then have to question the wisdom of dopamine replacement strategies as the mainstay treatment. If we are feeding people who are chronically stressed with dopamine replacing supplements, without teaching them about stress, and without arming them with stress reduction and stress management toolkits, are not addressing their trauma and body memories, and are not teaching their systems how to relax, we will in fact by feeding them adrenaline replacing supplements. They will be converting any dopamine supplements directly to [nor]adrenaline! We will be literally feeding their stress! This will lead to the vicious circle of needing ever more “dopamine” replacing supplements to keep going, until they are taking so much that the side-effects become unmanageable. Currently, this is invariably what happens to people, and the path they are put on.

Our approach, based on this understanding, is to first intervene in the chronic stress, help people to reduce and manage stress, teach them how to be calm and relax, understand the messages that their suffering is trying to send them, address trauma and body memories, and identify and make the necessary lifestyle changes. When people take this approach early enough, we find they don’t need to go on dopamine replacing supplements, as they start to be able to inhabit calm, relaxed states long enough to build up their own dopamine supplies.

Note that people suffering from chronic stress will also be profoundly impacted by episodes of even more pronounced acute stress, as any residual dopamine supplies will then be totally and instantly used up, leaving them for some time in an even more depleted dopamine state. Indeed, anyone who has experienced chronic conditions like PD will know just how rapidly acute stress (e.g. being yelled at) can exacerbate symptoms, increasing tremors, rigidity, pain, and the abnormal beta brain waves (anxious thoughts) markedly. Likewise, we can attest to how ongoing higher levels of background stress, with more continuous Sympathetic arousal makes us feel more ill generally, and makes our medication less effective.

States which are associated with chronic stress, and hence low dopamine levels, and thus suffering, include chronic fear, anger, envy and resentment, and hence we need to watch out for these, and for forces in the modern world which seek to instil them in us. Social isolation and loneliness is particularly pernicious. It can not only be our present situation which is causing us chronic stress, but trauma, body memories and PTSD can be keeping us trapped in past stressful events. Trauma healing is thus crucial.

One point of subtlety: there are factors and signals from the body which can also tell the brain and body to stop making dopamine or switch off dopamine production. These include signals from the gut to the brain, via the dorsal vagus nerve, when it detects internal threats and stressors in the digestive track, or signals from the activation of the habenula part of the brain, due to too much disappointment:

The Role of Disappointment in Chronic Illness and Modern Society

Another factor is dopamine itself, when it comes in the form of quick hits which require no effort. This leads to the viscous cycle of addiction, where the more quick dopamine hits, the lower the baseline of dopamine becomes, the more the addicted person suffers, and hence the more and more quick hits are compulsively sought:

Book Review: "Dopamine Nation: Finding Balance in the Age of Indulgence"

In these low dopamine states, where the brain isn’t producing much dopamine supplies in the first place, this means that there will also be very limited supplies to make any adrenalines. So, in these states, it will be difficult to create enough adrenaline to mobilize the brain and body, and hence the type of suffering is more akin to frozen states, apathy, abulia or chronic fatigue. It is possible to briefly escape the freeze by forcing adrenaline production through engaging in very risky behaviours, but with the consequences of a massive dopamine crash afterwards.