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Invalid: Urine testing for neurotransmitters in the brain

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Alternative practitioners sometimes order urine tests to ascertain neurotransmitter levels in the brain. A researcher, Marty Hinz (http://www.neuroassist.com/ ) has examined the validity of urine tests for serotonin, dopamine, norepinephrine, and epinephrine for this purpose and questions their validity.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Altostrata

Research and Reports in Urology Published Date October 2010 Volume 2010:2 Pages 177 - 183

DOI: http://dx.doi.org/10.2147/RRU.S13370

Neurotransmitter testing of the urine: a comprehensive analysis

Authors: Marty Hinz, Alvin Stein, George Trachte, et al

 

Abstract and full text at http://www.dovepress.com/neurotransmitter-testing-of-the-urine-a-comprehensive-analysis-peer-reviewed-article-OAJU

 

This paper analyzes the statistical correlation of urinary serotonin and dopamine data in subjects not suffering from monoamine-secreting tumors such as pheochromocytoma or carcinoid syndrome. Peer-reviewed literature and statistical analyses were searched and monoamine (serotonin and dopamine) assays defined in order to facilitate their proper interpretation....

 

Baseline assays completed with no monoamine precursors differ from baseline assays performed on a different day in the same subject. There is currently no scientific basis, value, or predictability in obtaining baseline monoamine assays....

 

Results: The statistical analysis failed to support the UNT model. Peer-reviewed literature search failed to verify scientific clams made in support of applications of the UNT model in many cases.

 

From the paper:

....

The third approach defining applications for the use of monoamine assays is the urinary neurotransmitter testing (UNT) model. This paper discusses the UNT model in depth because it is the only model of the three that lacks valid scientific literature discussing the model or supporting the monoamine assay applications that are being promoted.

 

The goal of this writing is to assess monoamine assay applications statistically and define the validity of mono- amine assays in the absence or presence of supplemental amino acid precursors. The premise of the UNT model is that baseline monoamine assays correlate with and are a good predictor of the peripheral and central nervous system neurotransmitter functional status. The basic assumption for this assertion is that serotonin and dopamine cross the blood–brain barrier6–8 and are then filtered at the glomeru- lus and enter the urine without further interaction with the kidneys.6,8 This argument is used on the basis of the UNT model to justify the conclusion that monoamine assays, in the presence and absence of serotonin and dopamine amino acid precursors, correlate with central nervous system and peripheral neurotransmitter functional status. It also asserts that baseline testing is the best approach to determine the neurotransmitter functional status of the central and periph- eral nervous systems....

 

Significant challenges to the urinary neurotransmitter testing model include the widely recognized finding that sero- tonin and dopamine do not cross the blood–brain barrier.16–19 In support of applications for urinary serotonin and urinary dopamine assays, the UNT model claims that serotonin and dopamine do cross the blood–brain barrier.6–8 This assertion is widely known to be untrue.16–19.

 

No significant amount of serotonin and dopamine filtered at the glomerulus reaches the urine. Serotonin and dopamine found in the urine are newly synthesized in the kidneys, and their levels are a function of the interaction between the basolateral monoamine transporters and the apical mono- amine transporters of the proximal convoluted renal tubule cells.19 The UNT model claims that serotonin and dopamine are merely filtered at the glomerulus, and then enter the urine without further renal interactions.6 This assertion is not sup- ported by review of the relevant science.

 

Urinary serotonin and urinary dopamine found in the urine have no correlation with brain or peripheral serotonin and dopamine levels. Significant levels of urinary serotonin and urinary dopamine molecules assayed in the urine have never been shown in the brain or peripheral nervous system.3,5 The UNT model, based on assertions that serotonin and dopamine cross the blood–brain barrier and are then simply filtered at the glomerulus and enter the urine, claims that urinary monoamine assays represent the functional neu- rotransmitter status of the central nervous system, peripheral nervous system, and urine.1 This assertion again is not sup- ported by the relevant science.

 

There is no consistent direct relationship between sero- tonin and dopamine amino acid precursor daily dosing levels and the amount of serotonin and dopamine that appears in the urine on monoamine assays.3–5....

 

Statistical analysis of baseline monoamine assays reveals that these assays do not predict the response to precursor therapy. They differ significantly with subsequent baseline assays undertaken on different days from the same subject, and no significant difference exists with assays performed when amino acid precursors are taken. These findings are contrary to the assertions of the UNT model.6–8,11

 

The UNT model claims that baseline monoamine assays obtained prior to ingestion of supplemental amino acid pre- cursors can identify neurotransmitter imbalance in the central nervous system, peripheral nervous system, and urine.6–8 Due to the statistical difference in baseline monoamine assays in the same subject from day to day, an unlimited number of different neurotransmitter imbalances might theoretically be diagnosed with serial assays performed on many dif- ferent days from the same subject. There is a statistical difference between baseline urinary serotonin and urinary dopamine assays in subjects not harboring a monoamine- secreting tumor. The assertion that baseline monoamine assays can diagnose central nervous system, peripheral nervous system, and urinary neurotransmitter dysfunction is not supported on review of the scientific literature.....

 

The UNT model incorrectly asserts that baseline mono- amine assays can serve as a reference point during treatment to gauge effectiveness of treatment when serotonin and dop- amine amino acid precursors are started.8,10 As noted already, there is a significant statistical difference between values found with baseline monoamine assays and baseline assays performed on a different day in the same subject, leading to a host of different reference points being generated when baseline assays are obtained on multiple days. The baseline assays cannot be used as a reference point to measure treat- ment progress or indicate results of treatment....

Conclusion

The application and interpretation of baseline monoamine assays according to the urinary neurotransmitter testing [UNT] model is not a valid approach because there is a significant statistical difference between baseline monoamine assays and monoamine assays obtained on a different day from the same subject and no significant statistical difference in subsequent monoamine assays performed while taking amino acid precursors. The UNT model has no ability to diagnose central or peripheral nervous system serotonin and dopamine imbalance using baseline monoamine assays in subjects not suffering from monoamine-secreting tumors. Urinary serotonin and urinary dopamine assays are not assays of serotonin and dopamine that have been in the central nervous system. Serotonin and dopamine do not cross the blood–brain barrier. Significant amounts of urinary serotonin and urinary dopamine found on assay have not been in the brain or in the peripheral system. Urinary serotonin and urinary dopamine are filtered at the glomerulus and are then metabolized in the kidneys, with no significant amounts of serotonin or dopamine filtered at the glomerulus being found in the urine. Levels of urinary serotonin and urinary dopamine found on assay are newly synthesized in the kidneys, and are a function of the interaction between the basolateral monoamine trans- porters and apical monoamine transporters of the proximal convoluted renal tubule cells.

 

A simple direct relationship between the daily dosing levels of amino acid precursors and monoamine assays does not exist in most cases. Due to complex renal physiologic interactions between serotonin and dopamine newly synthe- sized by the kidneys, a complex relationship is observed....

 

....Correct interpretation of monoamine assays while taking amino acid precursors is complex, and not a direct linear relationship as predicted by the UNT model.

 


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

Research and Reports in Urology Published Date February 2011 Volume 2011:3 Pages 19 - 24

DOI: http://dx.doi.org/10.2147/RRU.S16637

Urinary neurotransmitter testing: considerations of spot baseline norepinephrine and epinephrine

Marty Hinz, Alvin Stein, Thomas Uncini

 

Abstract and full text at http://www.dovepress.com/urinary-neurotransmitter-testing-considerations-of-spot-baseline-norep-peer-reviewed-article-OAJU

 

Background: The purpose of this paper is to present the results of statistical analysis of spot baseline urinary norepinephrine and epinephrine assays in correlation with spot baseline urinary serotonin and dopamine findings previously published by the authors. Our research indicates a need for physicians and decision-makers to understand the lack of validity of this type of spot baseline monoamine testing when using it in the decision-making process for neurotransmitter deficiency disorders.

 

Methods: Matched-pairs t-tests were performed for a group of subjects for whom spot baseline urinary norepinephrine and epinephrine assays were performed on samples collected on different days then paired by subject.

 

Results: The reported laboratory test results for urinary serotonin, dopamine, norepinephrine, and epinephrine, obtained on different days from the same subjects, differed significantly and were not reproducible.

 

Conclusion: Spot baseline monoamine assays, in subjects not suffering from a monoamine-secreting tumor, such as pheochromocytoma or carcinoid syndrome, are of no value in decision-making due to this day-to-day variability and lack of reproducibility. While there have been attempts to integrate spot baseline urinary monoamine assays into treatment of peripheral or central neurotransmitter-associated disease states, diagnosis of neurotransmitter imbalances, and biomarker applications, significant differences in day-to-day reproducibility make this impossible given the known science as it exists today.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

International Journal of Nephrology and Renovascular Disease Published Date July 2011 Volume 2011:4 Pages 101 - 113 DOI: http://dx.doi.org/10.2147/IJNRD.S22783

Validity of urinary monoamine assay sales under the “spot baseline urinary neurotransmitter testing marketing model”

Hinz M, Stein A, Uncini T

 

Abstract and full text at http://www.dovepress.com/validity-of-urinary-monoamine-assay-sales-under-the-ldquospot-baseline-peer-reviewed-article-IJNRD

 

Spot baseline urinary monoamine assays have been used in medicine for over 50 years as a screening test for monoamine-secreting tumors, such as pheochromocytoma and carcinoid syndrome. In these disease states, when the result of a spot baseline monoamine assay is above the specific value set by the laboratory, it is an indication to obtain a 24-hour urine sample to make a definitive diagnosis. There are no defined applications where spot baseline urinary monoamine assays can be used to diagnose disease or other states directly. No peer-reviewed published original research exists which demonstrates that these assays are valid in the treatment of individual patients in the clinical setting. Since 2001, urinary monoamine assay sales have been promoted for numerous applications under the “spot baseline urinary neurotransmitter testing marketing model”. There is no published peer-reviewed original research that defines the scientific foundation upon which the claims for these assays are made. On the contrary, several articles have been published that discredit various aspects of the model. To fill the void, this manuscript is a comprehensive review of the scientific foundation and claims put forth by laboratories selling urinary monoamine assays under the spot baseline urinary neurotransmitter testing marketing model.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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alexjuice

In the course of some labwork for environmental exposure, a doctor ran a urinalysis purported to measure neurotransmitter levels. It does so only indirectly.

 

I found the results pretty interesting.

 

My GABA and Epinephrine were both within the normal range, though only the 2 quartile. However, my Serotonin, Norepinephrine and Dopamine were all scandalously low.

 

I know the urine tests haven't the best reputation. However, as someone who most recently took a substantial dose of an SNRI (Effexor) and an antipsychotic (Risperdal), my result conforms with what I'd expect from a 'withdrawal syndrome' sample. The GABA is ok as I take 12.5mg of Valium and 2.25mg Klonopin everday. The epinephrine is ok, because it escaped phsrmacological targeting.

 

Just throwing this out there.

 

Alex

 

PS - Also when I have more energy, I'll share my genetic profile/polymorphisms in metabolism pathways. The result is relevant, according to the lab, to how my body is able to metabolize certain drugs (such as diazepam) and I wonder if others who endure withdrawal syndromes have similar dysmorphisms.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Barbarannamated

In the course of some labwork for environmental exposure, a doctor ran a urinalysis purported to measure neurotransmitter levels. It does so only indirectly.

I found the results pretty interesting.

 

My GABA and Epinephrine were both within the normal range, though only the 2 quartile. However, my Serotonin, Norepinephrine and Dopamine were all scandalously low.

 

I know the urine tests haven't the best reputation. However, as someone who most recently took a substantial dose of an SNRI (Effexor) and an antipsychotic (Risperdal), my result conforms with what I'd expect from a 'withdrawal syndrome' sample. The GABA is ok as I take 12.5mg of Valium and 2.25mg Klonopin everday. The epinephrine is ok, because it escaped

PS - Also when I have more energy, I'll share my genetic profile/polymorphisms in metabolism pathways. The result is relevant, according to the lab, to how my body is able to metabolize certain drugs (such as diazepam) and I wonder if others who endure withdrawal syndromes have similar dysmorphisms.

 

Alex,

 

I know next to nothing about NT urine testing aside from unreliability that you mentioned. I find it interesting that your doctor used it. Did he explain how he views or uses the results? What do you mean by "indirect" measure?

 

It makes sense that GABA was in higher range in someone on benzos. Curious how this differs from urine drug screen..? (Just thinking out loud)

 

The latter part of your message is very interesting. I, too, have wondered how genetic and metabolic polymorphisms factor into drug response and withdrawal. I have an MTHFR mutation that effects conversion of B vitamins to folate (or vice versa?). Fairly common.

 

I look forward to learning more.


Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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basildev

That's very interesting Alex.

 

I didnt know such a test was possible. You learn something new every day on this forum!


July 2001 prescribed 20mg citalopram for depression;
On and off meds from 2003-2006.
February 2006 back on 20mg citalopram and stayed on it until my last attempt at tapering in September 2011.
By far the worst withdrawal symptoms ever. Reinstated to 20mg citalopram
October 2012 - found this forum!
Nov 2012 to Feb 2013 did 10% taper, got doen to 11mg - was going great until stressful situation. Cortisol levels hit the roof, hideous insomnia forced me to updose to 20mg.
March 2016 - close to 100% back to normal!



****** I am not a medical practitioner, any advice I give comes from my own experience or reading and is only my perspective ******

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alexjuice

I know next to nothing about NT urine testing aside from unreliability that you mentioned. I find it interesting that your doctor used it. Did he explain how he views or uses the results? What do you mean by "indirect" measure?

 

I think the doctor wanted to me to let him try to "correct the imbalance" with supplements.... I found a different doctor ...but I think that's what he was thinking.

 

I am not sure how the urinalysis works. I think the results are intended to represent the Serotonin (or whatever) levels inside the body and not in the urine. So I think they measure other molecules to (like metabolites and/or precurosrs) to come up with the estimates for the Serotonin, etc.

 

It makes sense that GABA was in higher range in someone on benzos. Curious how this differs from urine drug screen..? (Just thinking out loud)

 

I don't know, to be honest. I think the drug screen measure for benzos (or metabolites) rather than getting to the level of the GABA. But I don't know how drug tests work.

 

The latter part of your message is very interesting. I, too, have wondered how genetic and metabolic polymorphisms factor into drug response and withdrawal. I have an MTHFR mutation that effects conversion of B vitamins to folate (or vice versa?). Fairly common.

 

Yea, I wonder about that. I need to pull out the labs and take a good look. I'll do that soon. I had some interesting abnormalties in the CYP group which affect metabolization [EDIT: whatever, it seemed like a word at the time!]. I need to not be on diazepam, in my opinion. Perhaps it is a factor for why my mercury levels have accumulated? Thinking out loud myself ;-)

 

Alsx


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Altostrata

It's a long way from the bladder to the brain.

 

Sorry, alex, this sounds like the neurotranmitter urine tests that have no validity.

 

Your doctor's intention to balance neurotransmitters confirms this.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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alexjuice

I'm don't advocate for the test for any diagnostic purpose but I find the result personally interesting. I may redo the test in the future, if I am willing to eat the $150, after I am complete benzo taper. I am curious, for my own sake, what the test will say on GABA relative to what it said during daily BZD therapy.

 

Though, I probably will not be willing to eat $150 to satisfy this curiosity.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Nadia

Here is Dr. Weil's answer regarding these tests. (And from what I can tell he has a pretty standard allopathic approach.)

 

QUESTION:

Neurotransmitters: What Tests Work Best?

I recently had my neurotransmitter levels and hormone levels checked through a lab (urine and saliva samples). I've since heard that these tests are suspect. Can you give me any information about them and tell me if they're legitimate?

 

ANSWER (Published 12/15/2009):

Neurotransmitters are chemicals naturally produced in the body that facilitate communication between nerve cells in the brain and between nerve cells and the body. They include acetylcholine, which governs muscle contractions and prompts glands to secrete hormones (a loss of cells that regulate acetylcholine is associated with Alzheimer's disease); gamma-aminobutyric acid (GABA), which helps control muscle activity and is an important part of the visual system; serotonin, which constricts blood vessels and brings on sleep, among other functions; and dopamine, which is involved in mood and control of complex movements.

 

You don't say what neurotransmitters you were tested for or why. I checked with David Perlmutter, M.D., a neurologist colleague in Florida, about the accuracy of urine testing for neurotransmitters. He told me that neurotransmitters and their precursors are produced in abundance throughout the body and to assume that "what is collected in the urine reflects what's going on in the brain is a stretch."

 

You also ask about saliva testing. I do not believe that this is a reliable method for assessing levels of neurotransmitters or hormones. In some circumstances, it may be a good idea to have blood tests to assess certain hormone levels; for example, if you're a woman approaching menopause, your physician can measure levels of follicle stimulating hormone (FSH), which increase as the ovaries stop functioning. Without any need for a lab, you can also get an FDA-approved urine test kit for use at home that can tell you whether your FSH levels have increased. While this is more reliable than any saliva test, it isn't foolproof: according to the FDA, the urine test accurately measures FSH levels only nine times out of 10. (Incidentally, if you use any FDA-approved home test and have any problems with it, report it to the FDA's MedWatch.)

 

I'm aware that saliva tests are widely promoted on the Internet to check levels of a variety of hormones including estrogen, cortisol, progesterone, testosterone, melatonin and DHEA (dehydroepiandrosterone). Results supposedly determine your need for various "anti-aging" supplements, often sold on the same Web sites that promote the analysis. Don't waste your money on such tests.

 

Andrew Weil, M.D.

 

Still, I see why you are curious, Alex. If I had unlimited funds I'd be testing all sorts of stuff just to see if any patterns emerged!


'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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Nadia

Also, here's a scientific article by Marty Hinz, Alvin Stien, George Trachte, et al.

 

ABSTRACT:

 

This paper analyzes the statistical correlation of urinary serotonin and dopamine data in subjects not suffering from monoamine-secreting tumors such as pheochromocytoma or carcinoid syndrome. Peer-reviewed literature and statistical analyses were searched and monoamine (serotonin and dopamine) assays defined in order to facilitate their proper interpretation. Many research findings in the literature are novel. Baseline assays completed with no monoamine precursors differ from baseline assays performed on a different day in the same subject. There is currently no scientific basis, value, or predictability in obtaining baseline monoamine assays. Urinary assays performed while taking precursors can demonstrate a lack of correlation or unexpected correlations such as inverse relationships. The only valid model for interpretation of urinary monoamine assays is the “three-phase model” which leads to predictability between monoamine assays and precursor administration in varied amounts.

Purpose: This paper reviews the basic science of urinary monoamine assays. Results of statistical analysis correlating baseline and nonbaseline assays are reported and provide valid methods for interpretation of urinary serotonin and dopamine results.

Patients and methods: Key scientific claims promoting the validity of the urinary neurotransmitter testing (UNT) model applications are discussed. Many of these claims were not supported by the scientific literature. Matched-pairs t-tests were performed on several groupings. Results of all statistical tests were compared with peer-reviewed literature.

Results: The statistical analysis failed to support the UNT model. Peer-reviewed literature search failed to verify scientific clams made in support of applications of the UNT model in many cases.

 

And here's one that disagrees, but look at the authors... webpage is Neuroscience, Inc. (neurorelief.com). They're selling something.


'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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Nadia

There is also this paper.

 

But hmm... I see Marty Hinz has his own agenda, though...

 

He discredits the monoamine theory, but then seems to be pushing for amino acid supplementation, and has something called the "bundle damage theory" (see this paper).

 

Well, if even he discredits urine neurotransmitter levels as significant indicators, that says a lot.


'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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alexjuice

Wow, Nadia that's some legwork.

 

The urine test struck me as an interesting footnote. It was among a number of preliminary labs I did for a specialist, not something I requested or expected to be actionable.

 

What I found interesting about it is independent of mental states - depression, anxiety. I found it interesting that the test suggested I was within range but low on two of the measures and quite low on the other three. I think the doctor wanted to extrapolate that to my brain, something I did't care to do.

 

Dr. Weil's reports are almost a perfect contrary indicator -- I typically tend to get good results from things he declares bunk and bad results from thinks he recommends. But I'm not an expert on him. Last I checked with him he was adamant about whole grains. I don't harbor a strong opinion though because I haven't kept up with him -- why is he famous? Is he on TV?

In any event, I don't think that means he's wrong about the urine tests.

 

I don't want to be misunderstood about the neuro-test. I don't see a particular diagnostic value for regular folks. I don't think that a drug-naive person who pee'd low in serotonin (and suffered from depressed mood) should use their urinalysis to support starting SSRIs or 5-htp or whatever. In my own case, I find the result interesting, that's all. Right now, my health is in the shitter and neurotrasnmitter urinalysis is not near a priority.

 

I wish I had unlimited money for tests. Actually, I wish I had a job and a working hypothalamus. That I have dedicated my resources towards my health (nearly the entire $10,000 I earned in 2011 went to medical expenses) is possible because of the charity of my family members. On the one hand I am lucky and feel grateful. On the other, I have no car, no place of my own to live, the total worth of possessions, as estimated at my chapter 7 in 2011, totaled $100 (less the car I have since sold). Mixed bag.

 

There are four critical assets needed for anything like a non-dependent life, IMO. They are, in order: HEALTH, TIME, MONEY, RELATIONSHIPS. If one has these four things then they can fin unhappyness by 1st world problems (typically feeling poorly about one's status relative to the status of one's peers) and almost everyone finds unhappyness no matter. But if one is above water on all, their is no reason that person can't live a wonderful life. Necessary but not sufficient. Of course every cancer-ridden, 101 year old, broke, relationshipl-less human has nearly fully-expired assets and their outlook is more dire (based on their asset value) and life holds little chance of sustained wonderfulness. All IMO.

 

Anyway, a ramble ... good homework on the neurotransmitter testing.

 

Alex


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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alexjuice

There is also this paper.

 

But hmm... I see Marty Hinz has his own agenda, though...

 

He discredits the monoamine theory, but then seems to be pushing for amino acid supplementation, and has something called the "bundle damage theory" (see this paper).

 

Well, if even he discredits urine neurotransmitter levels as significant indicators, that says a lot.

 

Yes, but I find the results interesting in light of withdrawal syndrome and I am pretty sure nobody is studying the data from that perspective.

 

Ok, so why is this interesting? It is interesting because if the tests suggests low levels of _Blank_ hormone, that may suggest that w/d syndrome has a component of insufficient manufacture or inefficient use in the aftermath of the drug. Or the test is noise so it's just a fluke -- but I doubt anyone is looking at these tests systematically from the perspective of aftermath cases.

 

Take me. Right now my GABA is normal. If I reduce my valium and klonopin by 50% and I redo the test and find a significant drop in GABA by the test, that may be significant. If i then reduce my valium and klonopin to 0 and redo the test and find a further drop commenserate with my dosage drop, that's potentially useful. I don't see how it can't be useful.

 

Here's on study by Hinz...

 

Background: The purpose of this paper is to present the results of statistical analysis of spot baseline urinary norepinephrine and epinephrine assays in correlation with spot baseline urinary serotonin and dopamine findings previously published by the authors. Our research indicates a need for physicians and decision-makers to understand the lack of validity of this type of spot baseline monoamine testing when using it in the decision-making process for neurotransmitter deficiency disorders.

 

Methods: Matched-pairs t-tests were performed for a group of subjects for whom spot baseline urinary norepinephrine and epinephrine assays were performed on samples collected on different days then paired by subject.

 

Results: The reported laboratory test results for urinary serotonin, dopamine, norepinephrine, and epinephrine, obtained on different days from the same subjects, differed significantly and were not reproducible.

 

Conclusion: Spot baseline monoamine assays, in subjects not suffering from a monoamine-secreting tumor, such as pheochromocytoma or carcinoid syndrome, are of no value in decision-making due to this day-to-day variability and lack of reproducibility. While there have been attempts to integrate spot baseline urinary monoamine assays into treatment of peripheral or central neurotransmitter-associated disease states, diagnosis of neurotransmitter imbalances, and biomarker applications, significant differences in day-to-day reproducibility make this impossible given the known science as it exists today.

 

Okay, great. But the results may be entirely reproducible in ways that are significant to me. For instance, for the result to be meaningless, I'd have to repeat it several times and get results that contradict my expectation. In my test 5-ht, NE, DA were reported low... If I repeat the test multiple times and Dopamine consistenly measured lower than Epinephrine, even if their are fluctuations, it'd be a relevant result. I took drugs which depressed DA but none that specifically targeted epinephrine. If Epinephrine measured low and DA high, even once, then the test is entirely useless from my perspective.

 

I do not need specificity to the degree that a researcher may to find the result useful.

 

I suspect that if I did redo the test, my Dopamine, NE, 5-ht would still be low and GABA would still be higher. I may be wrong, but my suspicion is the test is not pure noise.

 

That's my guess anyway and the reason for my interest.

 

I don't think any shrink or lab doc reviewing these tests is looking at the results in the way I am. If there are studies on neurotransmitter tests in withdrawal subjects, that'd interest me.

 

Again, last time, I am not recommedning or endorsing the urinalysis. I found my results correlated to the hormone systems targeted by the meds I took which was an interesting result to me.


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Brandy

If I've posted about this here, I can't find it.

 

When my hypersomnia was getting worse and worse while on paxil, my doctor ordered neurotransmitter testing (from NeuroScience).

 

My serotonin levels were so low by doctor was scared. He'd been hoping to get me off psych meds since I'd met him years ago (he's an integrative medicine M.D. and doesn't like them), but he was so alarmed he immediately upped me from 15 mg to 20.

 

My hypersomnia promptly increased. Light bulb moment. Tapered off paxil (unwittingly too fast), went into horrific w/d.

 

About six months into w/d, another doctor ordered more neurotransmitter tests (same lab). Serotonin levels sky high.

 

Go figure.

 

I actually came up with an off-the-wall theory that the tests actually measured the levels of serotonin my synapses couldn't use and was blocking. No science on that so my doctor just shrugged, baffled. But he told me he no longer uses those tests (for anyone).

 

Wish I had all that money back. I could use it right now (have a bunch of major lab tests coming up - nothing to do with neurotransmitters needless to say).

 

Just my two cents. (About all that lab left me with lol.)


I was "TryingToGetWell" (aka TTGW) on paxilprogress. I also was one of the original members here on Surviving Antidepressants

 

I had horrific and protracted withdrawal from paxil, but now am back to enjoying life with enthusiasm to the max, some residual physical symptoms continued but largely improve. The horror, severe derealization, anhedonia, akathisia, and so much more, are long over.

 

My signature is a temporary scribble from year 2013. I'll rewrite it when I can.

 

If you want to read it, click on http://survivingantidepressants.org/index.php?/topic/209-brandy-anyone/?p=110343

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compsports

Against my better judgment, I saw an alternative doc last year around the end of June as I was desperate due to having fatigue. But I drew the line when she wanted to do neurotransmitter testing.

 

I asked how it was going to work if the chemical imbalance theory had been disproved in mainstream medicine. She swore up and down that it did work and seemed irritated I was questioning her judgment.

 

I never went back wasted the money I paid for the visit which was quite expensive.

 

CS


Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Altostrata

Generally, alternative practitioners order these tests through Neuroscience, which sells very expensive supplements matched to the test results.

 

I also got caught in this scam.

 

Believe me, alex, it's bunk. Think about it. Neurotransmitters are swimming around all over your body. What comes out in your urine or saliva represents only what happens to be in your urine and saliva that minute. It doesn't correlate to what might be in your bloodstream, much less your nervous system, and even less your brain.

 

So what good is the information? Perhaps your bladder could use some psychotherapy?


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Nadia

I hear you on Dr. Weil, Alex... I often feel that way about the stuff he writes.

 

About the neurotransmitter tests, there probably is a reason certain neurotransmitter levels in your urine are low or high, but it probably depends on very complicated full-body processes. So unless you have unlimited funds, it's like finding a needle in a haystack. I'd be curious, too, though, and your logic might be right on. But how would that info help you?

 

Actually, the more I read about even the standard blood tests, the more it seems like they are pretty random. Markers change wildly throughout the day, and there is so much individual variation. It seems like medicine is really only set up to diagnose disease when your body is extremely broken... riddled with cancer, for example. If we had 24 hour tracking of hormones, neurotransmitters, etc., over time we'd probably see some pretty interesting patterns emerge, but that's an impossibility. It's maddening when you are trying to figure out a solution for yourself. In the end, I think you kind of have to go on gut instinct a lot of the time... like you did for your diet.


'94-'08 On/off ADs. Mostly Zoloft & Wellbutrin, but also Prozac, Celexa, Effexor, etc.
6/08 quit Z & W after tapering, awful anxiety 3 mos. later, reinstated.
11/10 CTed. Severe anxiety 3 mos. later & @ 8 mos. much worse (set off by metronidazole). Anxiety, depression, anhedonia, DP, DR, dizziness, severe insomnia, high serum AM cortisol, flu-like feelings, muscle discomfort.
9/11-9/12 Waves and windows of recovery.
10/12 Awful relapse, DP/DR. Hydrocortisone?
11/12 Improved fairly quickly even though relapse was one of worst waves ever.

1/13 Best I've ever felt.

3/13 A bit of a relapse... then faster and shorter waves and windows.

4/14 Have to watch out for triggers, but feel completely normal about 80% of the time.

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tryingtosurvive

Is there such a thing as a neurotransmittor test ??? then how and where ? read something about checking it from urine - is it really that simple ?
Anyone tried ?
Then thats what one need to do to know what to take- what I lack...


fluoxetine since 13years followed doctors advice tapered 40 mg to 0mg in 4 months july 2015 august crasched in panic attacks etc end of september akatisia , nausea, crying alot no one told me it could be something called withdrawal I read it and also about going back to last dose No one knew if it was worth it. tried reinstate autumn 2014 5 mg prozac then 10mg since 29/11-2014 feel only worse sucidal for real, tried antihistamine 10 mg or oxascand (benso) 5 mg or valerian for anxiousness but sick feeling taking this. 6mg prozac to taper slowly down since 15/2-2014 (30ml out of 100ml water with 20 mg pill) tapered 10-20% per month until June 2015 super anxious depressed tired. Got Buspar may 2015 5mg 10mg 15mg headache etc
June 2015: 10mg buspar plus around 3 mg prozac quit this cold turkey in July 2015. One week later crying spells and suicidal. Tried 5htp.magnesium omega 3 until September. October 2015 tested vit D was 17 . Since October 2015 ONLY Vit D and magnesium . nov 2016 can laungh again! but still too anxious ,depressed or lethargic in waves can't focuS, Crying spells , scared, social fobia, bitterness. .. . Did not reinstate prozac again . Trying to survive ....

july 2016-troathpain /reflux starts...

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Altostrata

Use search in the Symptoms and Self-Care forum http://tinyurl.com/3hq949z


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Abilifyneedhelp88

This is the best information about neurotransmitter testing that I could find.....which describes the pros and cons of urinary neurotransmitter testing...

 

amino-acid-therapy.com/neurotransmitter-testing/

 

Hope this helps clarify.....


med exp since 1985- abilify, latuda, Seroquel, risperadol, zyprexa, Haldol. latuda, saphris, mellaril, thorazine, lithium, tegretol, Depakote, lamictal, Prozac, pamelor, wellbutrin, Ativan, klonipin, etc.

 currently only on remeron: 3/13/14-6/5/14- 15mg

6/20/14 -9.5mg < 0.75-1.5 per week

7/12/14-3.75mg

8/11/14- 0.6mg of Remeron (almost off)

8/16/14--last dose of remeron...now completely drug free....

11/21/14-- 95 DAYS DRUG FREE!!!!

 

I do not give out medical advice only personal experience.

dx: BPI, II, CKD, secondary hyperparathyroidism, Chronic pain, fibro,

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Altostrata

See discussion above.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Wildflower0214

I agree, that this is bunk. Waste of my money. When I got tested my norepinephrine was really really high, and I believe it was due to SNRI, and I'm not surprised it was floating around in me. But, this is not a diagnostic tool.

 

Secondly, I was already in an acute WD when they did this, and the supplements they sold me gave me awful reactions, big surprise. Lol it was like an illicit drug experience. Amino acids are very powerful and I believe too much for those of us that are sensitized.

 

 

The end result of this experience was the loss of a couple hundred dollars, bad and frightening reactions to supplements which lasted for days, and more dr's telling me the same mantra. Only difference is that it wasn't in reference to psych meds but supplements. "It couldn't possibly be the supplement, I've never heard of that before, you are hyper vigilant." Ya, ok.


2005-Zoloft bad reaction.....2006-Lexepro......2012-Upped Lexepro.......2013-Upped Lexepro......2/2014- Attempted Taper Lexepro...2/2014- Updosed Lexepro.......3/2014-Ativan.....5/2014- CT switch from Lexpro to Effexor.....

5/2014-7/2014-Tapered Ativan from 1mg to .25mg.....6/2014-Bad reaction to Effexor........7/2014- Rapid taper Effexor every other day......7/5/2014- Off Effexor.......7/2014-12/2014 - Ativan .25mg.......12/25/2014 -Taper Ativan by 4% due to paradoxical reaction .24mg...11/18/2015-Taper Ativan 1% CURRENTLY ON: .2376mg Ativan taken in 6 .0396mg doses.

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starcontrol2

I know this is an old thread but here is what I have to add:

 

I just had cardio/ion test done, many vials of blood and urine sample.

Someone comes to your house to draw blood, centrifuge it properly, etc.

Co pay for test $249

$65 for home blood draw.

Waste of $$? I don't know, it only recently started getting covered by insurance so considering that ok.

I was/am desperate like many of you, $300+ is money, no doubt but this is my life and anything that can possibly help...

I got results back which i can share here.

Neurotransmitters are only small part of it.

It measures many many other things including cholesterol, testosterone and heavy metals.

A brief summary: testosterone low, mercury high, alum getting there, a lot of ammonia "stuff", metabolic pathways blocked. Detoxification is what the natural dr is preaching. Maybe she has a point. Hence bunch of supplements to detoxify ammonia and some other things. Dr says detoxification causes anxiety, on days i take most of what she recommends i think i do get more anxiety. Maybe ssri threw everything out of whack. She sells supplements, they are same $$ as amazon, I am sure she makes $ on them but doesn't seem to overcharge.

If you would like more details let me know.


10/2012 - Lexapro 10mg

2013/2014 - Started experiencing visual disturbances, like visual processing was slow, feeling drunk all the time

9/2014 - Lexapro 5mg, didn't notice any withdrawal, drunk feeling went away

2015 - Drunk feeling came back

5/2015 - Lexapro 2.5mg - 1.25mg - insomnia started

6/2015 - Lexapro 0.625mg

7/2015 - Severe symptoms started, in desperation on advice of pdoc restarted 5mg Lexapro - total disaster

8/2015 - Lexapro 5mg, disoriented, sleepless zombie

9/2015 - Very reluctantly started transitioning to Zoloft

as of 10/10/2105 - no lexapro, 37.5mg Zoloft

12/14/2015 - 35mg zoloft, 1/16/2016 - 34mg

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Altostrata

Please use search in the Symptoms forum to see our discussions about various tests and treatments.

 

Most of them are not applicable to withdrawal syndrome. In general, "detox" regimens are very stressful on the body and can make you worse.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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compsports

I know this is an old thread but here is what I have to add:

 

I just had cardio/ion test done, many vials of blood and urine sample.

Someone comes to your house to draw blood, centrifuge it properly, etc.

Co pay for test $249

$65 for home blood draw.

Waste of $$? I don't know, it only recently started getting covered by insurance so considering that ok.

I was/am desperate like many of you, $300+ is money, no doubt but this is my life and anything that can possibly help...

I got results back which i can share here.

Neurotransmitters are only small part of it.

It measures many many other things including cholesterol, testosterone and heavy metals.

A brief summary: testosterone low, mercury high, alum getting there, a lot of ammonia "stuff", metabolic pathways blocked. Detoxification is what the natural dr is preaching. Maybe she has a point. Hence bunch of supplements to detoxify ammonia and some other things. Dr says detoxification causes anxiety, on days i take most of what she recommends i think i do get more anxiety. Maybe ssri threw everything out of whack. She sells supplements, they are same $$ as amazon, I am sure she makes $ on them but doesn't seem to overcharge.

If you would like more details let me know.

Starcontrol,

 

I understand the desperation.  Not sure if I mentioned this previously but i am almost decided to see a naturopath out of desperation before I realized I would be making a big mistake.

 

Obviously, it is your life but I honestly feel this doctor is taking you down the wrong path and has nothing to offer you.  Please follow Alto's advice about searching for the discussions on the various tests and treatments.


Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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freespirit123

Hi everyone. I just received my Nero transmitters testing results and I'm shocked. I didn't look into this type of testing before the results. But did wonder how in the world could you test neurotransmitters through saliva in urine and it be accurate? I was completely normal if you will before September when I had a mental break down. Since then I have been on what it seems like all kinds of drugs. Before September I've never taken a drug in my life for my mental health. Anyways, my test results showed that every single neurotransmitter was high. She explained the serotonin was probably high because of the SSRI drugs I'm on but couldn't understand why everything else was high. She explained the serotonin was probably high because of the SSRI drugs I'm on but couldn't understand why everything else was high. I find it ironic that next to every high level was a symptom associated with that level which was insomnia and anxiety, which is what I put on the test papers for my symptoms. So their suggestion is to take the supplements that the lab offers and to get retested in six weeks. Wow that's a lot of money in the labs pocket. I actually felt like I was doing a lot better until I got these results and now I can't stop thinking about them


In 2015- had UTI put on Microbid. Stopped sleeping & had a nervous breakdown! Was put on Seroquil, Trazadone, Klonopin, just to name a few! Got off all drugs except Celexa until May of 2018. 

 

Update as of 1/19- reinstated Celexa 20mg. Drinking wine nightly along with a slew of meds/supplements to try and get to sleep. 

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starcontrol2

Freespirit,

 

I probably did the similar test, see my post above.

All my neurotransmitters are in normal range. Yet, I am in withdrawal and feel very bad to horrible depending on the day with a lot of depression and many other things. Tests measure neurotransmitter turnover not what's in the brain. You can't measure what's in the brain.

My test also measured many other things and while not everything is within normal none of that can account for how horribly I feel.


10/2012 - Lexapro 10mg

2013/2014 - Started experiencing visual disturbances, like visual processing was slow, feeling drunk all the time

9/2014 - Lexapro 5mg, didn't notice any withdrawal, drunk feeling went away

2015 - Drunk feeling came back

5/2015 - Lexapro 2.5mg - 1.25mg - insomnia started

6/2015 - Lexapro 0.625mg

7/2015 - Severe symptoms started, in desperation on advice of pdoc restarted 5mg Lexapro - total disaster

8/2015 - Lexapro 5mg, disoriented, sleepless zombie

9/2015 - Very reluctantly started transitioning to Zoloft

as of 10/10/2105 - no lexapro, 37.5mg Zoloft

12/14/2015 - 35mg zoloft, 1/16/2016 - 34mg

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freespirit123

What do you mean neuro turnover and not in the brain?


In 2015- had UTI put on Microbid. Stopped sleeping & had a nervous breakdown! Was put on Seroquil, Trazadone, Klonopin, just to name a few! Got off all drugs except Celexa until May of 2018. 

 

Update as of 1/19- reinstated Celexa 20mg. Drinking wine nightly along with a slew of meds/supplements to try and get to sleep. 

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freespirit123

I felt like I was doing so much better and my sleep was stabilizing on the new taper and then I got these damn test results and I can't stop thinking about them! I've had to use Klonopin every night since the results (mon) which is making me worried bc I don't want to take that! I just need to hear from people that have done the research on these damn test to reaffirm to me that they are bogus and not accurate! I mean if my Nueros were sky high then wouldn't I feel bad or depressed or something other than feeing normal? My dad and husband thinks I've had the wool pulled over my eyes and the Drs have me where they want me bc I'm gulable. Help!!!!! And I've read all the above and most think it's an inconclusive test but I'm still not letting it go!!!


In 2015- had UTI put on Microbid. Stopped sleeping & had a nervous breakdown! Was put on Seroquil, Trazadone, Klonopin, just to name a few! Got off all drugs except Celexa until May of 2018. 

 

Update as of 1/19- reinstated Celexa 20mg. Drinking wine nightly along with a slew of meds/supplements to try and get to sleep. 

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Altostrata

Stop thinking about the test results. You wasted your money and body fluids.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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freespirit123

Lol thanks. Honestly your response helps. I just had a meeting with some natural homeopathy friends (which is more me than traditional meds) and they said you'll find people that are for it (natural) and then you'll find the govt (big pharm) that will say the test is bogus. So which to believe?!?! Why were they all high?


In 2015- had UTI put on Microbid. Stopped sleeping & had a nervous breakdown! Was put on Seroquil, Trazadone, Klonopin, just to name a few! Got off all drugs except Celexa until May of 2018. 

 

Update as of 1/19- reinstated Celexa 20mg. Drinking wine nightly along with a slew of meds/supplements to try and get to sleep. 

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Altostrata

If there was something to it, I'd be the first to say so. There's a lot of nonsense in alternative medicine, just as there is in conventional medicine.

 

This does not bear further discussion.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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starcontrol2

What do you mean neuro turnover and not in the brain?

Means they measure them on exit from your body and try to gauge by that. I was desperate, i was hopeful, it didn't get me anywhere.


10/2012 - Lexapro 10mg

2013/2014 - Started experiencing visual disturbances, like visual processing was slow, feeling drunk all the time

9/2014 - Lexapro 5mg, didn't notice any withdrawal, drunk feeling went away

2015 - Drunk feeling came back

5/2015 - Lexapro 2.5mg - 1.25mg - insomnia started

6/2015 - Lexapro 0.625mg

7/2015 - Severe symptoms started, in desperation on advice of pdoc restarted 5mg Lexapro - total disaster

8/2015 - Lexapro 5mg, disoriented, sleepless zombie

9/2015 - Very reluctantly started transitioning to Zoloft

as of 10/10/2105 - no lexapro, 37.5mg Zoloft

12/14/2015 - 35mg zoloft, 1/16/2016 - 34mg

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