Anxiety or Depression? Test the levels of your neurotransmitters to guide therapy.


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Happy New Year!  A new era began at the Vreeland Clinic on January 1st this year.  Dr. Carrie and I would like to thank all of our friends and family for their well wishes.  We looked forward to continuing to serve the community for years to come!

Today I’d like to touch on something that has revolutionized the way I practice.

People come to me for many reasons.  Some people come to my clinic for weight loss or to get more energy.  Others for help with a chronic condition that hasn’t responded to traditional care.  Still others come to see me for a wide range of neurologic conditions.  These include things like Parkinson’s disease, multiple sclerosis, depression or anxiety.  It is the last two that I’d like to focus on today.

Anxiety and depression are extremely common in America.  Millions of Americans suffer from anxiety, depression or both.  These conditions may have many etiologies but one theory is a chemical imbalance in the brain.

Just what is this chemical imbalance?  When someone states that they have a chemical imbalance they are referring to an imbalance in the neurotransmitter system of the brain.  These neurotransmitters are really just proteins that each nerve in the brain uses to communicate with its neighbors.  Sometimes people can have too little of a certain neurotransmitter or too much of another.  This is problematic because it alters the way the brain functions.  It may cause anxiety and/or depression.

The pharmaceutical industry has figured that out and makes a large class of drugs that alters neurotransmitter function in the brain.  These are drugs like Prozac, Zoloft, Wellbutrin and Lorazepam to name a few.

Neurotransmitters are broken down into two categories – they are either excitatory or inhibitory.  That means they either tell the brain to go or tell the brain to stop.  The complexities of the neurotransmitter system are extensive and there is much more to it than “go” and “stop” but that basic principle holds true in most cases.

Examples of neurotransmitters include serotonin, GABA, epinephrine, norepinephrine, glutamate and dopamine.  Serotonin and GABA are inhibitory while epinephrine, norepinephrine, glutamate and dopamine are excitatory.

If you have anxiety and depression often times an imbalance exists in the levels of these neurotransmitters.

For example, high levels of glutamate may cause anxiety or seizures.  Low levels of GABA may cause anxiety.  Low levels of serotonin may cause depression.  Same goes for norepinephrine.

So how do you tell which neurotransmitters are low or which are too high?

Measuring Neurotransmitters

Measuring your neurotransmitters with a urine test is the best way to estimate your levels of neurotransmitters.  We do this routinely in our office for many patients.  It is incredibly insightful and directs our care for patients with anxiety, depression and many other conditions.

The measurement of neurotransmitters in the urine has been around for many years.  I’ve read studies dating to the 1960’s of scientists using similar methods to evaluate neurotransmitter levels.

Until relatively recently, perhaps the last 10-15 years, it has not been used frequently in clinical practice.  Now, through specialized laboratories, it is available to the general public and it is very affordable.

The knock on urinary neurotransmitter testing is that it does not correlate with brain levels of these hormones because the urine test is in fact testing whole body levels of neurotransmitters.

The very neurotransmitters that exist in our brain to make us happy exist outside the brain to serve the body in other ways.  So, yes, it is true that checking urinary neurotransmitter levels is technically a check of the entire body’s store of neurotransmitters.  But, through hundreds of thousands of tests these specialized labs have shown with high correlation that when neurotransmitter levels are abnormal certain psychiatric and neurological conditions are much more common.

Clinically, I have seen an almost one to one correlation in my patients with certain conditions an alteration in their neurotransmitter system.

The lab that I use will test all of the basic neurotransmitters plus a slew of metabolites of these neurotransmitters.  It provides a wonderful window into the neurological system.

If I find that serotonin is low, I supplement with something called 5-HTP.  If dopamine is low, I like to use L-tyrosine or an herb called mucuna pruriens.  The list can go on and on.

Once someone has been on a program for 6-8 weeks we recheck their neurotransmitter profile to gauge our therapy and adjust it if necessary.  We find that once a person’s profile returns to normal, their symptoms resolve.

If you have anxiety or depression, consider seeking out someone who does this kind of testing to improve your outcomes.  The brain is incredibly complex.  It never hurts to have a little extra information to guide your therapy.


Filed under Brain Health

10 responses to “Anxiety or Depression? Test the levels of your neurotransmitters to guide therapy.

  1. Pingback: How What You Eat Affects Your Mood | The Vreeland Clinic's Blog

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  3. Pauline

    Hi I was wondering once your level becomes normal can you stop taking the supplements or do you have to continue taking them. Thank you

    • Hi Pauline –

      That actually depends on a lot of factors. If you make changes in your lifestyle like incorporating regular exercise and a healthy diet, you will rely less on the supplements. With that said, there is a certain population that will need continued support forever. The goal is to have as little in the way of supplemental support as possible.

  4. Rick

    Everything i have read states the validity of this test is suspect. Especially since one of the labs who administers this test, NeuroScience, also sells the nutritionals to fix the problem. Can you comment on this?

    • Yes, you are correct there is controversy over the urinary neurotransmitter testing. It should be used as an adjunct to the rest of a treatment program. Remember, urinary neurotransmitters are biomarkers. Biomarkers show associations with something biological. Associations, as you probably know, do not always mean cause and effect. A biomarker most people are familiar with is cholesterol. One cannot simply look at a cholesterol profile and say that a person will unequivocally develop heart disease not matter how poor the profile might look. However, if I give you this person’s full medical and family history in addition to their cholesterol profile you might be able to more accurately predict whether or not they will develop heart disease. You must apply this principle to urinary neurotransmitter testing. Simply looking at a person’s neurotransmitter profile may not provide an accurate or complete picture of that patient. One person with depression may not have the same profile as the next (although there are consistencies). You must properly evaluate the person and use good clinical reasoning in conjunction with the test for it to be of any diagnostic value. I would never use a urinary neurotransmitter test as a stand alone diagnostic tool. It’s not meant for that.

      The fact that the company sells nutritional supplements to fix what is found on their testing may perhaps be a conflict of interest but it’s really no different than pharmaceutical companies participating in research in establishing lower cholesterol reference ranges and selling the statin medications. Is it ideal? Definitely not, but it’s the system we live in.

      • Rick

        Thank you for taking the time to comment. My wife is having depression and anxiety issues and we sought the advice of a local Naturopath/D.O here in Cleveland. This was one of the tests she recommended, in addition to micro nutrient testing and adrenal testing. I’m still skeptical of the value, especially at the high cost of the test, but your honest explanation does provide some clarity and perspective.

      • I’m glad I could help. Thanks for reading!

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