Large segments of the global population suffer the effects of a burned-out brain and subsequent symptoms of anxiety, depression, sleeplessness, fatigue, poor memory and concentration, and chronic pain. Functional medicine clinicians have long referred to this constellation of symptoms as “adrenal fatigue,” but by refocusing on the true dysfunction, the hypothalamus and its inability to organize a proper stress response, we can help patients overcome their anxiety and mood disorders. 


What Causes Brain Burnout?

Before devising a treatment plan, it is essential to understand the contributing factors that lead to a burned-out brain. There are three broad categories to consider, most often in combination.


1. Stress and HPA-Axis Dysfunction

Excessive or prolonged stress with chronic activation of the HPA axis eventually depletes neurotransmitter levels in the hypothalamus and leads to poor response to stress.

    • Mental and emotional stress, including jobs, relationships, finances or major life changes
    • Poor sleep patterns, including insufficient time in bed, sleep disturbances, sleep apnea or biochemical imbalances like low melatonin
    • Poor glycemic control, including habitual skipping of meals, high-carbohydrate diets or frequent alcohol use
    • Inflammation, including inflammatory diets, chronic GI pathogens or oral infections, among others

Testing to consider: Salivary or urinary testing measure the cortisol awakening response (CAR), which is the best-known test for HPA axis function.

2. Biotoxins

Lipophilic biotoxins disrupt neurologic communications, which leads to aberrant control by the hypothalamus over other body systems, such as the autonomic nervous system. Postural orthostatic tachycardia syndrome (POTS), central sleep apnea and elevated TSH with normal T4/T3 are some examples of clinical presentations that frequently have biotoxins as contributing factors. The following are the most common biotoxins that clinicians should be aware of:

    • Mycotoxins produced by mold
    • Lipopolysaccharides (LPS) from gram-negative bacteria such as H. pylori and SIBO
    • Exotoxins and hemolysins produced by the nasal mucosal bacteria like MARCoNS
    • Other chronic infections, such as oral or periodontal infections, tick-born infections, and others

Testing to consider: Urinary mycotoxin testing, stool pathogen testing, nasal culture, and cone-beam CT are helpful for identifying these biotoxins.


3. Nutritional Deficiencies 

Nutritional deficiencies that disrupt cellular operations including—but not limited to—mitochondrial dysfunction Notably, mitochondrial respiration consumes 20% of the body’s oxygen and yet the brain represents only 2% of body mass. The most common deficiencies seen in testing include B vitamins, magnesium, glutathione and omega-3 fatty acids.

Testing to consider: Organic acids testing, micronutrient testing


The Bottom Line

There are many considerations when evaluating patients who are dealing with brain burnout. It is necessary to consider functional testing for underlying causative factors, such as HPA-axis dysfunction, biotoxins or nutritional deficiencies. Armed with this knowledge, we can provide patients a treatment plan that best fits their needs and help them overcome the debilitating symptoms of a burned-out brain.

Want to keep learning about ways to assess and treat stressed-out patients? Check out the SOS Stress Recovery Program In-Practice Guide, your go-to resource for resolving stress-related illnesses.




Christopher Mote, DO, DC, IFMCP earned his doctorate in osteopathy from the Chicago College of Osteopathic Medicine at Midwestern University. He earned his doctorate in chiropractic and Bachelor of Science in human biology from the National University of Health Sciences (NUHS) in Lombard, Illinois, and is certified in Functional Diagnostic Medicine. With a focus on addressing the root cause of health concerns, Dr. Mote specializes in the diagnosis and treatment of chronic health disorders.