Lupus can attack any part of the body, and that includes the brain – causing lupus fog, memory problems and even mood swings.  Neurotransmitters, are your brain’s chemical messengers and they are definitely part of the possible.  What are neurotransmitters and why does it matter to those living with lupus?  Read on to find out! 

• Introduction
• The Neurotransmitters and How They Relate to Lupus
• In Conclusion

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Introduction:

The neurotransmitters are your nervous system’s chemical messengers. As it turns out, nerve cells (neurons) do not actually touch each other.  So, chemicals are needed to send messages  from one neuron to another.  These chemicals are called neurotransmitters.  Neurotransmitters not only allow neurons to communicate with other neurons, but also with muscles, glands and other organs that are either controlled or influenced by the nervous system.  They can even act like hormones and can affect mood and emotions.

Here are some facts:

• Scientists have identified at least 100 different neurotransmitters, though more may exist, and each one is used by different parts of the nervous system for different reasons.
• Many neurotransmitters help regulate the immune system and can even reduce the inflammatory response.
• Up to 80% of lupus patients show cognitive problems, include brain fog, which may be related to neurotransmitters.
• Antibodies against neurotransmitters, in particular glutamate, can be produced by lupus and these can cause neuron death, possibly affecting brain function.

As it turns out, some neurotransmitters send limited messages to some neurons with little effect on our emotions, while others can affect larger areas of the brain and have very dramatic emotional effects. In this way, they act like hormones.

For purposes of this article, we will focus on the neurotransmitters most important to those with lupus: dopamine, serotonin, oxytocin, and the endorphins.

The Neurotransmitters and How They Relate to Lupus

Dopamine

Dopamine is often called the “feel good“ neurotransmitter, but it is far more than that.  It has several important roles and pathways in the brain.  One of the most important is its role in the “reward system,” which drives our motivations and desire for things such as junk food or gourmet food, fun experiences, intimacy/sex – pleasures of all kinds.  If you have ever tried positive reinforcement – for example, treating yourself with ice cream after finishing a particularly difficult task – then, you were using a dopamine pathway!  Dopamine also is important for body movement and coordination, and it can affect your ability to learn, plan and find things interesting.

Some drugs, like opiates, alcohol, nicotine, amphetamines and cocaine can mimic dopamine and over-activate its pathways, leading to addictive and compulsive behaviors.

Some interesting facts about dopamine:

• Low levels of dopamine in a particular part of the brain that causes Parkins
  on’s disease and are associated with Attention
  Deficit Hyperactivity Disorder and restless leg syndrome.
• High levels of dopamine have been associated with mania, obesity and certai
  n types of addiction.
• You may have heard of L-dopa, the name of the chemical precursor to dopamine and is produced by both the brain and the kidneys.

Dopamine and Lupus:

• Research has found that dopamine can actually help regulate inflammation – the bane of those with lupus and other autoimmune diseases! How?  It is still not clear, however we know that dopamine is used by the central nervous system to communicate with the immune system.  In that way, it acts like a hormone.
• We also know that dopamine can be produced by some lymphocytes – a type of white blood cell in the immune system that can pass the blood-brain barrier. This means that dopamine has a role in how the brain might regulate the immune system and could mean great potential for future lupus therapies!

 

Serotonin

Serotonin is another neurotransmitter that can act as a hormone and is central to you mood.  Just like dopamine, it has several roles in the body, including:  Maintaining a calm or relaxed mood; controlling digestion and protecting the digestive tract; providing quality sleep, and helping in healing wounds by narrowing the smallest blood vessels and forming blood clots.

Some interesting facts about serotonin:

• Even though it is a neurotransmitter, only 10% of serotonin is found in the brain. The other 90% are in your gastrointestinal tract.
• Not only does serotonin help determine how well and how long you sleep, but the brain uses serotonin to produce melatonin, the hormone that regulates your sleep-wake cycle.
• Serotonin is produced from the amino acid tryptophan. So, some believe that food high in tryptophan may help maintain higher serotonin levels, though the research findings are mixed.

Serotonin and Lupus:  So far, the research is inconclusive.  However …

• It has been found that serotonin can be produced by blood platelets in the formation of blood clots. This could have significant ramifications for vasculitis or similar types of tissue damage associated with SLE.
• Also, high levels of serotonin in the blood can lead to increases in B and T cells – both of which play important roles in autoimmunity.

How to improve serotonin levels? 

• Since low serotonin levels are associated with depression and anxiety, many anti-depressive therapies specifically increase serotonin levels in the brain such as serotonin reuptake inhibitors like Paxil or Effexor.
• You can increase serotonin with regular exercise and sunlight, though the latter can be problematic for those with lupus.
• Some supplements, like St. John’s Wort and ginseng, may increase serotonin levels.

 

Oxytocin

Oxytocin, sometimes called the “cuddle neurochemical” or the “love hormone,” is released when we feel a sense of closeness to someone else. Oxytocin is responsible for those feelings of euphoria during sex and what mothers feel when breastfeeding their newborn.

Interesting facts about oxytocin:

• Oxytocin levels can increase when we hug, make eye contact or socially bond with others. If a person is deprived of these things, it could lead to low oxytocin levels.
• Women usually have higher levels of oxytocin than men.
• Smiling works! Even when we don’t exactly feel joyful, smiling has been shown to boost oxytocin levels and improving overall mood.

Oxytocin and Lupus:  No direct relationships have been found to date, however:

• Some research indicated that oxytocin may be able to turn off an overly inflammatory immune system by inhibiting the production of some cytokines and interleukin-6 and by increasing regulatory T cells.
• COVID has also been found to disrupt oxytocin, and some researchers have suggested giving oxytocin as a way to limit inflammation in autoimmune patients after a Sars-CoV-2 infection.

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Endorphins

Endorphins are the body’s natural pain killers – technically endogenous opioids.  They promote feelings of pleasure, sometimes significantly in what is termed an “endorphin rush.”  They also are important to temporarily masking the pain of an injury.

 Interesting facts about endorphins:

• Endorphins act as analgesics. They interact with receptors in the brain to reduce pain perception.
• Opioids, like Vicodin and morphine, mimic endorphins in the brain and peripheral nervous system and can lead to addiction.
• Exercise is a great way to release endorphins and is the basis for the feeling of a “runner’s high.” It is also thought that endorphins may be the reason behind how some people can become addicted  to some forms of exercise.
• There are many kinds of endorphins, though the most studied are the beta-endorphins.

 Endorphins and Lupus: 

• Endorphins are known to support a healthy immune system and can lessen inflammation.
• Diminished levels of natural endorphins have been found in patients with SLE and other rheumatoid conditions.

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In Conclusion

While the links between lupus and the neurotransmitters is still not well-known, we know how important they are to emotional health and to the neurocognitive symptoms caused by SLE.  It is critical for anyone with lupus to be aware of the role of the neurotransmitters and to notice any changes that should be brought to the attention of your healthcare team.  Fortunately, there are things that you can do to improve the health of their neurotransmitters and perhaps improve the cognitive and emotional symptoms of lupus.  Eat a healthy diet, get regular exercise and do things that make you happy!

 

 

References

 Aranow, C., Diamond, B., & Mackay, M. (2010). Glutamate receptor biology and its clinical significance in neuropsychiatric SLE. Rheumatoid Diseases Clinics of North America, 36(1), 187-201. doi: 10.1016/j.rdc.2009.12.007

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Cleveland Clinic. (2022, March 23). Dopamine. Retrieved August 26, 2022 from https://my.clevelandclinic.org/health/articles/22581-dopamine

Cleveland Clinic (2022, March 18). Serotonin. Retrieved August 26, 2022 from https://my.clevelandclinic.org/health/articles/22572-serotonin

Dopamine. (2022, August 29). In Wikipedia  The Free Encyclopedia. Retrieved 06:36, September 7, 2022, from https://en.wikipedia.org/w/index.php?title=Dopamine&oldid=1106001237

IOS Press BV. (2012, October 11). New model explains role of dopamine in immune regulation. ScienceDaily. Retrieved September 3, 2022 from www.sciencedaily.com/releases/2012/10/121011123740.htm

Longevity Med. (2019, January 1). 6 interesting facts about oxytocin, the love hormone.https://www.longevitymed.com/blog/6-interesting-facts-about-oxytocin,-the-love-hormone.html#gref

NIH/National Institute Of Arthritis And Musculoskeletal And Skin Diseases. (2001, November 23). Lupus brain damage pathway illuminated. ScienceDaily. https://www.sciencedaily.com/releases/2001/11/011120043704.htm

Phuoc-Tran, D., & De Kok, V. (2022). Could oxytocin reduce autoimmune disease in COVID-19? Autoimmunity Reviews, 21(2). https://doi.org/10.1016/j.autrev.2021.102994

Psychology Today. (n.d.). Dopamine. https://www.psychologytoday.com/us/basics/dopamine

Vidal, P. M., & Pacheco, R. (2020). Targeting the dopaminergic system in autoimmunity. Journal of Neuroimmune Pharmacology : The Official Journal of the Society on NeuroImmune Pharmacology, 15(1), 57–73. https://doi.org/10.1007/s11481-019-09834-5

Wan, M., Ding, L., Wang, D., Han, J., & Gao, P. (2020). Serotonin: A potent immune cell modulator in autoimmune diseases. Frontiers in Immunology. https://doi.org/10.3389/fimmu.2020.00186

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Author: Greg Dardis, MS

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University.  His focus has been human biology and physiology with an interest in autoimmunity.

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