Mood Issues

Alternatives to prescription meds do exist. In many cases both can be used together if done carefully.
 
Psychiatric conditions that respond well to neurotransmitter therapy include: anxiety, depression, insomnia, ADD, ADHD, addiction, dysthymia and some bipolar disorders. We have been treating patients in Boulder for over 12 years using neurotransmitter testing.
 
Neurotransmitters are recognized as the primary biochemical messengers of the central and peripheral nervous systems. Studies have demonstrated that urinary neurotransmitter measures are reflective of circulating levels as evidenced by renal neurotransmitter clearance mechanisms. Laboratory methodology for the accurate assessment of urinary neurotransmitter levels has been established. Urinary measures are not recognized as a direct reflection of central activity, however definite associations exist.

The ability to measure neurotransmitters has led to the generation of scientific literature that demonstrates urinary neurotransmitter measurements have clinical value as representative biomarkers of various neurological, immunological, and endocrinological conditions. Urinary neurotransmitter assessment carries a long history as a means to assess nervous system activity.
 
Early investigations date back to the 1950s when von Euler, et al, first described the measurement of urinary catecholamines as biomarkers for pheochromocytoma, a rare tumor of the adrenal gland. Since then, many studies have been published regarding neurotransmitter excretion and its relevance to neurological, endocrinological, and immunological function. While urinary neurotransmitter measures are not considered direct reflections of central nervous system activity, various disease states stemming from central nervous system imbalances have been associated with urinary neurotransmitter alterations. There is a definite association between urinary and central neurotransmitter concentrations and many studies have examined that association through various neuro-endoimmune communication mechanisms. 
 
A biomarker is a measurement used as an indicator of biological actions. A neurotransmitter test is a biomarker test. Currently, there are no biomarkers available for psychiatric disorders; therefore, diagnostic tools and treatment decisions are restricted to the evaluation of clinical signs and symptoms that lack objectivity. That said, treatments for managing psychiatric symptoms are relatively effective. However, no single treatment works for everyone with a given disorder, and selection of the best treatment in mainstream psychiatry remains a challenge.  Neurotransmitter testing provided a novel method for treating the unique attributes of an individual patient, its personalized medicine.
 
As in any other disease state, a primary goal in natural psychiatry is the identification of specific biomarkers that would permit a more precise definition of specific disorders and, in turn, enhance the ability to develop targeted patient treatments. In fact, research has highlighted a need for biomarkers in psychiatry to enhance patient management and ensure treatment success.
 
In a recent article by Cook (2008), an outline of desirable characteristics of biomarkers in psychiatry was described. Cook (2008) stated that certain criteria must be met for a biomarker to be considered for psychiatric management. First, the biomarker must be timely, clinically useful, and cost-effective. Second, the technology needed to assess the biomarker must be well tolerated by the target patient population. Third, methods that can be easily integrated into the practitioner’s current practice patterns are more likely to be accepted than those that require a major change in the delivery of care.
 
Urinary neurotransmitter analysis has a breadth of data to support its usefulness in clinical practice. In the late 1950s, publications revealed correlations of urinary catecholamine measures to various psychiatric symptoms. Since then, research on urinary neurotransmitter analysis has expanded to encompass methodological improvements and further development on clinical utility for psychiatric disorders.
 
Specifically, research has focused on categorizing subsets of depression and anxiety through urinary neurotransmitter analysis, as well as determining biochemical changes with pharmaceutical intervention.
 
Roy and colleagues (1986) examined subsets of unipolar depressed patients and compared these subjects to non-depressed controls. Overall, depressed patients had high urinary norepinephrine and its metabolite normetanephrine, but lower urinary output of the dopamine metabolite dihydroxyphenylacetic acid (DOPAC) compared to controls. Subjects that met DSM-III criteria for a major depressive episode with melancholia, characterized by irrational fears, guilt, and apathy, exhibited significantly higher urinary outputs of normetanephrine than controls. Subjects with a major depressive episode but without melancholia or subjects with dysthymic disorder had levels comparable with controls. It was concluded that high urinary output of norepinephrine and its metabolite, normetanephrine, reflected abnormal sympathetic nervous system activity and thus, may be helpful in determining subsets of depression.
 
Later studies confirmed these findings, which reported elevations in urinary norepinephrine output in depressed and anxious individuals.
 
Although research shows significant correlations between depression and urinary neurotransmitter levels, its clinical application is not validated unless changes in urinary values and symptoms can be observed with treatment.
 
Mooney and colleagues (1988) conducted a study in which depressed patients who had favorable antidepressant responses to alprazolam, a benzodiazepine, had significantly higher pretreatment urinary catecholamine levels than control subjects. In addition, non-responders to alprazolam did not have significant elevations in urinary neurotransmitters output compared to control subjects. After only eight days of treatment with alprazolam, urinary catecholamine levels declined significantly, which contributed to the improvement in depressive symptoms.
 
Additionally, a double-blind, placebo-controlled, block-randomized, two-way crossover study revealed that after administration of 20 mg/d of paroxetine, urinary serotonin excretion significantly increased when compared to placebo, and correlated with an improved symptom profile. Lastly, fear and anxiety were analyzed in patients who underwent outpatient surgery, by examination of urinary catecholamines. Duggan and colleagues (2002) examined the effect of the benzodiazepine diazepam on the stress response in patients after outpatient anesthesia and surgery, by the measurement of urinary catecholamines. The study showed significant reductions in urinary norepinephrine levels in the group that received diazepam compared to placebo. These findings, along with earlier studies, illustrate the importance of urinary neurotransmitter measurements in the determination of treatment effectiveness.
 
Attention-Deficit-Hyperactivity Disorder (ADHD) has also been a primary target for the utilization of urinary neurotransmitter analysis. Research has shown that subjects with ADHD tend to have decreased urinary beta-phenylethylamine (PEA) levels. Beta- PEA is a monoamine neurotransmitter that has amphetamine-like functions that can alter mood and attention, and decreased beta-PEA levels may contribute to symptoms of inattentiveness.
 
After treatment with methylphenidate (ritalin), those that responded to medication had significantly elevated urinary beta-PEA levels. Other studies have reported decreased urinary epinephrine levels in ADHD children compared to controls. These findings are consistent with prior studies that demonstrated an inverse relationship between epinephrine excretion and inattentive, restless behavior.
 
Urinary norepinephrine levels were found to be positively correlated with the degree of hyperactivity in ADHD children. The same study showed that after one month of Pycnogenol treatment, a bioflavonoid extract from pine bark, norepinephrine levels decreased significantly and correlated with improvement in ADHD symptoms.
 
Overall, urinary neurotransmitter analysis can be a useful tool when dealing with psychiatric disorders. In addition, other neurotransmitters such as glutamate, gamma-aminobutyric acid (GABA), histamine, glycine, and taurine are being measured with high specificity and selectivity. Urinary neurotransmitter analysis is cost-effective, timely, non-invasive. Objectivity is essential to treating patients with psychiatric disorders. Medical history and DSM-IV criteria may suffice for the diagnosis of psychiatric disorders, however, the wide differences in patient biochemistry can decrease successful treatment outcome with conventional drugs. Neuropsychiatric biomarkers may aid in determining successful treatment regimens based on patient biochemistry rather than simply relying on standard diagnostic protocols.