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 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.