About 15 years ago I was introduced to histamine, the neurotransmitter. Before that, I only knew him (come on…it has to be, right? Histamine) as an immune molecule, an allergy mediator, a chemotactic agent of chaos! Given my interest & previous work in mental health, I knew the rest of the chemical cast pretty well. There was Sunny Serotonin, Dance-Party Dopamine, Nervous Noradrenaline &Go-Go Glutamate. So it came as a bit of shock to realise that an equally important member of this cast had never had a mention in all my previous education…
With 64K neurons dedicated to its production & an extensive axon network all over our brains to ensure its excitatory effects are felt everywhere…I was a bit embarrassed we hadn’t met sooner! I’m not Robinson Carusoe in that regard though, our awareness and recognition of this key neurotransmitter has been snail-like in its pace and progress. A recent review paper on the development and evolution of antihistamines kicks off the conversation with, ‘Oh, so histamine is just another neurotransmitter now’…which gave me a bit of a laugh. Seems like we were all duped…even the dudes making the drugs to block it! But once I did meet Histamine, the neurotransmitter, it really did change my clinical practise, forever. And as I have gotten to know him better and better over the last 15 years, how his excesses and deficiencies present in my patients and how best to manage these, I can confirm, it is far from the answer to every patient’s prescription for mental health but this an imbalance is evident, addressing it is exceptionally effective and I remain forever grateful to those that have contributed to my learning in this area, passing on the knowledge from its originators: Car Pfeiffer & Abraham Hoffer. These pioneers of orthomolecular psychiatry gave Histamine a platform and presence that no one else had or would for decades still to come.
And now every practitioner and their pet poodle seems to want to talk about Histamine! But, my friends let me tell you, CNS Histamine imbalance has little to do with eating tuna, umami flavours and the state of your gut!
Hype-Guy Histamine is made on-site, in your brain. We don’t import it in over the BBB mountain range. So, in terms of a histamine imbalance in your neurochemistry, we need to narrow in on the noggin and get crystal clear about what could be behind such an imbalance and therefore how to tailor treatment to address each cause. I owe a lot to those who first taught me this model and I think it’s time the model had a mini-makeover, thanks to our vastly improved understanding of Histamine, methylation, genes, mast cells, behaviour driven biology etc etc. etc. that has been generated now mainstream medicine has finally met Histamine, the neurotransmitter! 🥳🥳 And now, be warned folks, contemporary psychiatric pharmacy has its sights set on histamine as a key target for new medication development and the improved management of mental health. Better late than never, I guess. Have you met your Hype-Guy Histamine?
Histamine Imbalances in Mental Health About 15 years ago I was introduced to Histamine as a neurotransmitter. Not the allergy mediator or the ‘basophil baddy’ but rather this prolific and potent neurochemical we all produce in our brains which, in the right amounts, regulates almost every biological rhythm, helps with memory and mood & much more. Being able to recognise excesses or deficiencies of CNS histamine in mental health presentations and, ever since then, fine-tuning my ability to support patients with these, has changed my practice forever and has been the key to some of my patients’ greatest recovery stories. Forever grateful to the pioneers of this model, 70 years on, the model is ready for a mini-makeover, to bring it in line with the current scientific understanding of histamine, methylation, genes and much more. This recording, together with two hugely helpful clinical resources, will give you the confidence to recognise and remedy this important imbalance in mental health.
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Stop press. No, seriously. This new research warrants the attention of every practitioner working with children & teenagers. In the largest paediatric study of its kind to date, which included 2,480 children aged 10-18yrs diagnosed with hyperthyroidism (Grave’s or otherwise), Zader & colleagues found
Double the rate of ADHD diagnoses
5 times the rate of Bipolar diagnoses (almost 7 times in males)
5 times the rate of suicidality
That’s what I said: in 10-18 year olds
What is most alarming of course is that these mental health diagnoses were made in half of these children >3 months prior to the diagnosis of hyperthyroidism. What does this mean? It means we are missing this critical biological driver in this patient group. We all recognise the potential for some psychological presentations people affected with thyroid conditions, however, perhaps we are more alert to this in adults and letting it slip off our radar in kids? There’s been renewed talk about the over- and mis-diagnosing of ADHD lately and given that research has found up to 80% of hyperthyroid children meet ADHD diagnostic criteria this is one of the 1st place arguably to look! It also means, as these researchers discuss in detail, these kids are being medicated with psychiatric meds that in fact may, at the least mask their abnormal thyroid, lead to the incorrect diagnosis of hypothyroidism (lithium & even stimulants for example) or exacerbate their hyperthyroidism (quetiapine). But wait there’s more and it’s essential to understand.
Zadar & colleagues note that while we can not be 100% clear about the direction of the relationship…e.g. were these children already at risk psychologically and the hyperthyroidism just exacerbated that, they note that correction of the TFTs does not always equate to ‘cure’ of the mental health issues. This is not entirely surprising of course. What the problem emerges via a combination of biology and psychology & we resolve or remedy the biology…guess what you have left? PLUS the learned behaviours etc from suffering from anxiety, impaired cognition, suicidality they’ve been battling at the hands of excess T3 and a subsequent tsunami of reactive oxygen species.
This is one of those papers we should all have to read top to toe and therefore ideally be able to access for free but alas 🙁 What you can read is the Medscape review of this, which is a reasonable summary but the full paper is worth it if you can. You know the other key take home here…the diagnosis of hyperthyroidism was only made with overt out of range TFTs… which begs the question what about all those subclinical hyperthyroid cases we know exist? Yes, no wonder this paper has RACHEL’ S FAVOURITE written all over it…paediatric thyroid assessment and missed biological drivers of mental health and the opportunity to get better at both…can my research reading get any better this week?!🤓
Currently in Australia there is limited use of age specific reference ranges for thyroid parameters in children & teenagers yet they are essential for correct interpretation and diagnosis. Even doctors & specialists seem to be at a loss with diagnosing thyroid problems in kids unless they are extreme presentations. Subclinical thyroid presentations, however, are increasing in both children and adults. Many practitioners competent in adult thyroid identification & management are less familiar and confident with knowing when why and how to test in this population. Make sure you’re not missing thyroid imbalance in your paediatric patients…early detection makes treatment easy.
Hear Hear…on all levels, right. But this is actually the first recommendation of an easy to read patient resource for families dealing with adolescent depression, that you and your patients can access here. As lovely as the picture above makes parenting look, the one to one (or even 2 to 1) ratio isn’t realistic or necessarily optimal for anyone. I think we can all make a great addition to any parent’s team, especially given the emphasis these recommendations place on nutrition, sleep and exercise as being central to improving mental health…full-stop..and in this age group.
But while some things are the same between depressed adolescent and adults, there are important differences we need to be aware of: like the best assessment tools and the barriers for teenagers (and parents) in admitting there is an issue. Think, parent guilt and over-attribution, standing defiantly on the top rung of that ladder!
They also mention different types of therapy for this age-group and I have to say the old CBT…oh yes it gets wheeled out yet again…really does offer something, given the kind of kids I’ve seen this work a treat on. This is a developmental staged characterised by curiosity and a desire to understand more about the real stuff of life…rather than the soft focus lens we got them to look through in primary school. I’ve seen teenagers benefit enormously from sitting with a good psychologist or GP who can explain the ‘brain mechanics’ of depression, or anxiety (amygdala activation that sends the frontal lobe executive control offline etc). They love the demystification and, in the best cases, feel re-empowered by this knowledge. Not perfect for every teenage but it does work for many. And then there’s the parental advice to discuss suicidal ideation.
Yes parents, even more than practitioners, fear the ‘planting of seeds’ when contemplating this topic with their teens but the opposite is true. This paper is hot on the heels of an editorial, revealing that 50% of parents were unaware of their teenager’s suicidal thoughts.
There is much to be gained from the ‘knowing’ and so much to lose from avoiding this one. It’s the beginning of another school year (at any level) and with this can bring significant stressors and provocation for mental health challenges. Let’s encourage every parent, to get themselves a team and take our own place in that invaluable roadside assist crew.
This is a succinct recap of the many investigative paths we need to follow when presented with kids or teenagers with behavioural disorders. From grass roots dietary assessment through to the key pathology testing that is most helpful in clarifying the role & treatment approach of integrative nutrition for each individual child.
Want to start 2017 with some good news? Sometimes working with patients challenged by mental health I get scared. A well-known colleague of mine introduced me to the notion of the ‘clinician in crisis’. The practitioner who, in the face of their patient’s extraordinary pain & distress feels overcome by the need to Do Something…Anything. Over time I have learned to spot, what we call a ‘desperation prescription’, the patient who is on 3+ psych medications all from different drug classes and still remains tragically symptomatic. It is potentially frightening stuff. I’ve had the same experience with patients using herbs and nutrients. The patient’s biological drivers may seem straight forward on paper, but they fail to respond as predicted. Nobody has a 100% success rate…not me, not Ben Lynch, not Kelly Brogan…as much as their marketing machines might make you think otherwise.(more…)
Language is such a powerful thing and the art of ‘reframing’, to express a concept differently in order to facilitate a fresh perspective, can be the difference between engagement and disengagement. I see the power of this in my clinic and with each year of practice I pay more and more attention to this aspect. I’ve come to appreciate, that the way I describe what’s happening in someone’s health and the way I articulate what their role is in their own recovery, is such a key determinant of what my patients leave with and ultimately the success of treatment.
Recently at a conference I heard an international speaker, a doctor and researcher, take a blow torch to the language we use around insulin resistance and diabetes. It went something like this:(more…)
I became interested in working in mental health not entirely of my own free will. I guess you could say, it had made it’s way into my world via family members and friends as well as my own problems when I was younger. So when I was at uni and I came across any information about mental illness, whether it was pathology or prescription, it was when I undoubtedly resonated most strongly with what I was learning. I’ve had some great opportunities throughout my career to feed my interest, met some wonderful mentors and some other powerful teachers who were often my patients. It’s now become a running joke among my teenage children that all my friends are either psychologists or have some sort of mental health diagnosis, ‘…and what does that say about you?’ they love to add teasingly. Well it says a lot probably: that I enjoy people who are comfortable talking about the psychology of our lives and ourselves, that I deeply appreciate that to be human is to suffer and we all suffer it’s just a question of degrees and the bravest of us share that with others. Lastly, I think it tells you that I live in the real world with real people 🙂(more…)
Fresh faced students, new graduates and seasoned practitioners alike, are forever reminding me of the challenge we experience as practitioners when it comes to instigating real change in our patients health related behaviours … the change we KNOW will make a difference to their health and wellbeing. ‘If only they actually listened to us!?!’ has been screamed by the novice and seasoned practitioner alike. With an overwhelming desire to share our wealth of knowledge, the discovery that information ≠ change can lead us to despair at times.
In a recent interview with Dr. Azita Moradi (Consultant Psychiatrist) as part of our Access the Experts webinar series, I was quite surprised (and pleased) to hear that Azita sometimes spends awhole sessionwith a patient discussing the possibility of change, before even touching on the reality of change. Azita’s discussion surrounding the neuroscience of change and the challenges this may pose in the therapeutic relationship was fascinating, and certainly resonated with the practitioners taking part in the webinar. Azita’s interview was full of clinical gems reminding us that just as in other settings, if we give a man a fish he eats today but if we teach a man to fish we feed him for life. Hand and in hand with this, we need to have a strong understanding and appreciation of how to engage clients in making positive changes to their lives, often when it seems most difficult to do, such as in mental health patients.
Knowing how to improve behavioural change in patients generally, is integral to everyday practice, and its value cannot be underestimated.(more…)