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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jonh kimble on June 28, 2003, at 22:20:26
i didnt know these things existed to the general public until recently. are they available in most major cities (calgary canada) that would help so much thanks
Posted by Larry Hoover on June 29, 2003, at 8:49:38
In reply to neurotransmitter tests, posted by jonh kimble on June 28, 2003, at 22:20:26
> i didnt know these things existed to the general public until recently. are they available in most major cities (calgary canada) that would help so much thanks
John, my exceedingly cynical and biased opinion is that these neurotransmitter tests are a cash-grab targeted at a desperate population.
If reliable tests were available, or even useful, I would feel certain that they would be routine practise for all doctors. Why on Earth would doctors use "educated guesswork" to both diagnose and select treatment (e.g. which antidepressant to try) if a urine test would give the answer?
Lar
Posted by stjames on June 29, 2003, at 10:05:39
In reply to Re: neurotransmitter tests » jonh kimble, posted by Larry Hoover on June 29, 2003, at 8:49:38
We do not have a model that describes mental illness from a neurotransmitter context that works, or even comes close to working. All we can say is that NT's have something to do with it.
Until we have a model for mental illness that is quite specific, testing "levels" of NT's and making predictions is a pipe dream.
Posted by djmmm on June 30, 2003, at 11:11:01
In reply to neurotransmitter tests, posted by jonh kimble on June 28, 2003, at 22:20:26
> i didnt know these things existed to the general public until recently. are they available in most major cities (calgary canada) that would help so much thanks
You can only test for metabolites. This is a useful test, despite what others say. For example, there is a disorder of the adrenal gland called Pheochromocytoma, which is a tumor or tumors that secrete epinephrine and norepinephrine which can cause a variey of anxiety disorders.
Your psychiatrist, before giving you medication, SHOULD make sure that this test, along with a complete blood count, and an EEG (to rule out epilepsy) and a PET scan to rule out ANY organic cause of what may or may not be a psychiatric condition.
Posted by stjames on June 30, 2003, at 17:05:21
In reply to Re: neurotransmitter tests, posted by djmmm on June 30, 2003, at 11:11:01
> You can only test for metabolites. This is a useful test, despite what others say. For example, there is a disorder of the adrenal gland called Pheochromocytoma, which is a tumor or tumors that secrete epinephrine and norepinephrine which can cause a variey of anxiety disorders.
That is great for mental illness secondary to a primary cause. This test id's the primary cause and not the mental illness. I am talking about primary mental illness.
Posted by HenryO on July 1, 2003, at 2:51:56
In reply to Re: neurotransmitter tests, posted by stjames on June 30, 2003, at 17:05:21
I recently went to a naturopathic doctor about my depression. He gave me (sold me) a take home urine test that I am to send off to the company in the link below. I also got a lot of other unusual and expensive products, but I am primarily intrigued by the urine test.
Do you think this is a subterfuge? Snake oil?
Does anyone know of some legitimate sites with information about these tests?
Posted by HenryO on July 1, 2003, at 4:00:57
In reply to neurotransmitter tests -LINK- and questions, posted by HenryO on July 1, 2003, at 2:51:56
The link I gave in the above post was incorrect. I apologize. The link below is corect. This is the company to which I am to send my urine test. They call it "neuroregulatory profile 9001" it is to "assesss neurotransmitter levels" I have three pages of questions and information that came with the kit. They want the second leak of the day between 9:00 A.M. and 11:00, mid stream. Is this a scam?
Posted by djmmm on July 1, 2003, at 8:02:11
In reply to neurotransmitter tests -LINK- and questions, posted by HenryO on July 1, 2003, at 2:51:56
> I recently went to a naturopathic doctor about my depression. He gave me (sold me) a take home urine test that I am to send off to the company in the link below. I also got a lot of other unusual and expensive products, but I am primarily intrigued by the urine test.
>
> Do you think this is a subterfuge? Snake oil?
>
> Does anyone know of some legitimate sites with information about these tests?
>
> http://www.neuroscience.com/
this has some info:
http://www.pndassoc.org/testing.htm
Posted by Larry Hoover on July 1, 2003, at 9:18:54
In reply to neurotransmitter tests -LINK- and questions, posted by HenryO on July 1, 2003, at 2:51:56
> I recently went to a naturopathic doctor about my depression. He gave me (sold me) a take home urine test that I am to send off to the company in the link below. I also got a lot of other unusual and expensive products, but I am primarily intrigued by the urine test.
>
> Do you think this is a subterfuge? Snake oil?It's irrelevant (the testing). And probably, predatory (the testing and the expensive products). See below.
> Does anyone know of some legitimate sites with information about these tests?
>
> http://www.neuroscience.com/The following abstract gives evidence that depressed subjects have elevated norepinephrine metabolite (MHPG) in their cerebro-spinal fluid, but that is not seen in urine. Metabolites of serotonin (5-HIAA) and dopamine (HVA) are *elevated* in urine, in both depression *and* mania, but only women had elevated 5-HIAA levels in their CSF, while men had elevated HVA levels in CSF. I don't see any predictive value here.
Arch Gen Psychiatry. 1983 Sep;40(9):999-1010.CSF and urinary biogenic amines and metabolites in depression and mania. A controlled, univariate analysis.
Koslow SH, Maas JW, Bowden CL, Davis JM, Hanin I, Javaid J.
Levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) in the CSF, and norepinephrine (NE), epinephrine (E), vanillylmandelic acid, normetanephrine, metanephrine, and MHPG in the urine, were measured in 151 hospitalized patients with affective disorders and in 80 healthy controls following a two-week drug-free period. Unipolar and bipolar depressed subjects differed only in NE and E levels. Compared with controls, depressed subjects had higher CSF MHPG levels, women had higher 5-HIAA levels, and men had lower HVA levels. All urinary metabolites were elevated in depression and mania, with the exception of MHPG. The patterns of NE-E differences discriminated among the forms of affective disorders. These data suggest an imbalance of monoamine transmission in depression, characterized by the hyperactive sympathetic nervous system and adrenal medulla. However, MHPG may not be the measure of choice to reflect this imbalance, necessitating measurement of total body monoamine output.
For the next abstract, I'll just emphasize this quotation: "There is no correlation neither between urinary sulfate-MHPG and scale evaluation before treatment, nor between urinary sulfate-MHPG and clinic improvement after antidepressive treatment."
Pathol Biol (Paris). 1988 Mar;36(3):217-23.[Determination of 3-methoxy-4-hydroxyphenyethylene-glycol and its urinary conjugates. Value in the diagnosis and therapeutic follow-up of depression]
[Article in French]
Tapie M, Garnier JP, Tremine T, Bousquet B, Manet L, Dreux C, Lauzel JP.
Laboratoire de Biochimie, Centre Hospitalier Robert Ballanger, Aulnay-Sous-Bois, France.
In psychiatric illness like depression, difference is essential between noradrenergic and serotoninergic sources. Therefore the measurement of urinary excretion of MHPG (3-methoxy-4-hydroxy-phenylethylene-glycol) is interesting, because MHPG seems to be the best reflect of central noradrenergic activity. Analytical assay of MHPG includes an enzymatic hydrolysis and an extraction by ethyl acetate. Separation is conducted by HPLC with fluorometric detection for MHPG and VMA, and electrochemical detection for 5-HIAA, which measurement is simultaneous. Quality control is evaluated (detection limit, linearity, precision, reproducibility, hydrolysis and extraction efficiency). Control values of 15 healthy subjects are 18.9 +/- 8.0 mumol/24 h of total MHPG, 1.5 +/- 1.0 of free MHPG, 8.5 +/- 2.0 of sulfate, and 10.7 +/- 4.4 of glucuronide MHPG (m +/- 2 sigma). In our study on depression, the best biological witness seems to be the sulfate-MHPG: in 16 depressed patients without treatment, its rate is very lowered (1.2 +/- 1.2 mumol/24 h). Total and glucuronide MHPG decrease weaker than sulfate (respectively -51% and -65%), while free MHPG increases (+ 193%) versus controls. Urinary VMA and 5-HIAA, peripheric catabolites of respectively adrenalin and serotonin are not significantly altered. There is no correlation neither between urinary sulfate-MHPG and scale evaluation before treatment, nor between urinary sulfate-MHPG and clinic improvement after antidepressive treatment. At last, the association clomipramine + mianserine shows a clinic improvement faster than clomipramine only, although no significative difference appears in biological markers.
For this one, again, I'll just quote: "The biogene amine metabolites were in reference values before initiation of the therapy, although values of 5-HIIA in women and were closer to the lower limit."
Vojnosanit Pregl. 1993 Jul-Aug;50(4):379-85.[The neurohumoral status in depression]
[Article in Serbo-Croatian (Roman)]
Preradovic M, Savanovic V, Lazarov A, Mihajlovic M.
Vojnomedicinska akademija, Klinika za psihijatriju, Institut za nuklearnu medicinu, Centralna klinicko-hemijska laboratorija.
In 66 patients with endogenous depression (34 males and 32 females) the concentrations of biogene amine metabolites (vanilmandelic acid (VMA), 5-hydroxyindole acetic acid (5-HIIA), adrenaline and noradrenaline) were examined in 24-hrs urine and hormone in the serum: iodothyronine (T-3), thyroxine (T-4), thyroglobulin (Tg), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), cortisol, prolactin and growth hormones. The examination was performed prior to the initiation of antidepressant therapy and 30 days after its application. The biogene amine metabolites were in reference values before initiation of the therapy, although values of 5-HIIA in women and were closer to the lower limit. Thirty days after the initiation of the antidepressant therapy the statistically significant difference was found at the level of p < 0.05 for adrenalin in men and for VMA and 5-HIIA in women. The hormone values before initiation of the therapy showed increased values of growth hormone, cortisol in men and of thyroglobulin, growth hormone and cortisol in women. At the end of the antidepressant therapy the statistically significant difference was found at the level of p < 0.05 for thyroglobulin and TSH in men and for thyroglobulin, growth hormone and cortisol in women. By comparing the results obtained before and after the antidepressant therapy, the statistically significant difference was found at the level of p < 0.05 for Tg in men and for Tg, T-3, prolactin and growth hormone compared to the women. It has been concluded that in patients with endogenous depression the important role in pathogenesis of the disease have some neurobiogenic disorders.
Again: "MHPG concentration did not distinguish unipolar from bipolar depressed patients and was not significantly different from that in healthy volunteers."
Psychiatry Res. 1999 Jul 30;87(1):21-7.
Catecholamines in depression: a cumulative study of urinary norepinephrine and its major metabolites in unipolar and bipolar depressed patients versus healthy volunteers at the NIMH.Grossman F, Potter WZ.
Lilly Corporate Center, Indianapolis, IN 46285, USA. fgrossman@lilly.com
Studies comparing urinary norepinephrine (NE) and its metabolites in unipolar or bipolar depressed patients and healthy volunteers have not yielded consistent findings. However, in unipolar depressed patients, most studies in non-elderly populations consistently report elevated concentrations of plasma NE, at least following an orthostatic challenge. Expanding upon previous studies which showed elevated plasma NE in depression, we compared the urinary excretion of NE, normetanephrine (NMN), 3-methoxy-4-hydroxyphenylglycol (MHPG), and vanillylmandelic acid (VMA) in age- and sex-matched unipolar and bipolar depressed patients versus healthy volunteers hospitalized at an inpatient unit at the National Institute of Mental Health. Only depressed subjects with a minimum 4-week drug-free period were included. Total turnover (NE + NMN + MHPG + VMA) was reduced in this sample of unipolar and bipolar depressed patients. MHPG concentration did not distinguish unipolar from bipolar depressed patients and was not significantly different from that in healthy volunteers. A construct of the average fractional extraneuronal concentration of NE (NE + NMN/NE + NMN + MHPG + VMA) was significantly higher in unipolar and bipolar depressed patients than in healthy volunteers. This finding extends data suggesting that unmedicated unipolar and bipolar depressed patients have a 'hyperresponsive' noradrenergic system and provides a framework which ties together plasma and urinary findings.
Now, my opinionated commentary. You've sought help for treatment of depression, not for having your urine chemistry assessed and modified. There is no predictive value in urinary analysis. Your symptoms are all that are necessary for presumptive treatment of depression.When I went to the website for which you provided a link, I see that the testing lab sells the nutrient supplements. They also tell you what's in them. I'm sure you could take the same substances, and spend less money.
There is no a priori (before the fact) method of predicting responsiveness to nutritional therapy. It works, or it doesn't work. End of story.
Lar
Posted by Larry Hoover on July 1, 2003, at 9:37:29
In reply to Re: neurotransmitter tests, posted by djmmm on June 30, 2003, at 11:11:01
> You can only test for metabolites. This is a useful test, despite what others say. For example, there is a disorder of the adrenal gland called Pheochromocytoma, which is a tumor or tumors that secrete epinephrine and norepinephrine which can cause a variey of anxiety disorders.I must express my disagreement here. Pheo has an incidence in autopsy of between 1 and 3 per thousand. As pheo can be fatal in itself, and certainly contributes to other causes of death, incidence in the general population must certainly be less than found at autopsy. I cannot support the idea that screening for such a rare disorder, absent the signs and symptoms (e.g. hypertension, palpitations, profuse sweating), is reasonable, except in the case where routine therapies for e.g. anxiety prove ineffective.
> Your psychiatrist, before giving you medication, SHOULD make sure that this test, along with a complete blood count, and an EEG (to rule out epilepsy) and a PET scan to rule out ANY organic cause of what may or may not be a psychiatric condition.
I must again disagree. Searching for zebras before you've ruled out horses as the source of the sound of hoofbeats is not prudent medical practise. Blood count, fine. PET scan? The cost does not justify the outcome, IMHO.
Lar
Posted by bookgurl99 on July 1, 2003, at 10:43:55
In reply to Re: neurotransmitter tests » djmmm, posted by Larry Hoover on July 1, 2003, at 9:37:29
> I must again disagree. Searching for zebras before you've ruled out horses as the source of the sound of hoofbeats is not prudent medical practise. Blood count, fine. PET scan? The cost does not justify the outcome, IMHO.
>
> LarLar,
but what about medical tests to discover problems that may be contributing causes?
for example, I will always wonder if my severe depression at age 19 is related to the thyroid disorder I have that was discovered 6 years later. All those years of believing that I was depressive, lethargic, and lazy could have been avoided if my dr. had given me the TSH test before Prozac.
Maybe depression is more statistically common than thyroid disorder, yet the population of the people seeking help for depression are more likely than others to have these disorders.
Posted by Larry Hoover on July 1, 2003, at 11:05:55
In reply to Re: neurotransmitter tests, posted by bookgurl99 on July 1, 2003, at 10:43:55
> > I must again disagree. Searching for zebras before you've ruled out horses as the source of the sound of hoofbeats is not prudent medical practise. Blood count, fine. PET scan? The cost does not justify the outcome, IMHO.
> >
> > Lar
>
> Lar,
>
> but what about medical tests to discover problems that may be contributing causes?
>
> for example, I will always wonder if my severe depression at age 19 is related to the thyroid disorder I have that was discovered 6 years later. All those years of believing that I was depressive, lethargic, and lazy could have been avoided if my dr. had given me the TSH test before Prozac.
>
> Maybe depression is more statistically common than thyroid disorder, yet the population of the people seeking help for depression are more likely than others to have these disorders.To go back to my metaphor, I'd suggest that thyroid dysfunction is a horse, rather than a zebra.
My thyroid function was assessed immediately when I first presented to my doctor with depression (and a number of times, subsequently). I would think that a screening panel of bloodwork would be the standard of care.
I'm not meaning to sound like I'm dismissing your concern, because I'm not.....but it's possible you didn't have a thyroid problem six years earlier, isn't it? What I'm leading up to is, the mental process of "What if....?" questions doesn't do anything to relieve the distress. Quite the contrary, I think.
Also, you weren't lazy. You were sick. And I really hope you're feeling better today.
Lar
Posted by HenryO on July 3, 2003, at 15:47:52
In reply to Re: neurotransmitter tests » bookgurl99, posted by Larry Hoover on July 1, 2003, at 11:05:55
Thank you for all the good info and links.
This is the end of the thread.
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