Posted by SLS on May 20, 2000, at 11:53:24
In reply to Re: Magnesium and depression, posted by Sigolene on May 20, 2000, at 3:35:06
> Hi Scott,
> how do I know that I have a too high turnover in 5-HT and DA you asked :
> It 's because there's too much "metabolites" (residue from metabolism) of DA and 5-HT in my urine. (this can be measured to know wich med to take)
> Sigolene.
This is interesting. I believe this is the first time I have heard of a clinician currently using urinary levels of neurotransmitter metabolites as a an indicator of which drugs to use. I hope it works.Which drugs does your doctor suggest for people with low 5-HT and DA? Which are you taking? How do you feel?
In the past, depression has been associated with *low* levels of urinary metabolites. This is an indicator of low turnover.
Regardless of which is which, it would be very interesting to know how successful your doctor has been using these lab results to determine treatment.
Anyway, I hope you found some of the magnesium/calcium information interesting.
History:Investigations looking for associations between neurotransmitter metabolites in urine, blood, and cerebrospinal fluid (CSF) have not yielded consistent results.
Over the years, studies have often linked low levels of certain neurotransmitter metabolites (products of chemical break-down) with depression. The metabolites most often studied are: MGPG (norepinephrine), 5-HIAA (serotonin / 5-HT), and HVA (dopamine). MHPG seems to be the one that most consistently demonstrates an associated with depression. Some studies observed that when urinary levels of MHPG were low, patients were more likely to respond to an antidepressant known increase norepinephrine activity, tricyclics in particular (NE reuptake inhibition). The low levels of MHPG found in the urine are an indicator of reduced norepinephrine turnover. Low MHPG has also been shown to predominate in melancholic depression and sometimes act as an indicator of severity. The lower the MPHG, the more severe the depression.
Similar associations have been proposed for the serotonin metabolite, 5-HIAA. Some studies suggest that low CSF levels of 5-HIAA (indicating low turnover of serotonin) are associated with an increased risk of suicide. It is also suggested an individual who has low levels of 5-HIAA is more likely to respond to an SSRI. Some suggest that low 5-HIAA is indicative of atypical depression.
Again, the results of the many studies performed have been equivocal. They are inconsistent and often contradict each other.
I included a few abstracts below.I think the first helps put some of the pieces together regarding NE levels in the blood versus the urine. In summary, it suggests that in depressed individuals, NE turnover is reduced while certain NE systems are hyperresponsive (oversensitive). I don't know, but perhaps this is a function of the upregulation of NE receptors that has been observed in depression.
- Scott
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Psychiatry Res 1999 Jul 30;87(1):21-7 Related Articles, Books, LinkOut
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.
PMID: 10512151, UI: 99440702
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Ann N Y Acad Sci 1997 Dec 29;836:158-81 Related Articles, Books, LinkOut
Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies.Asberg M
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. mariea@psyk.ks.se
Studies of neurotransmitter metabolites in cerebrospinal fluid (CSF) were initially focused on depressive illness. Although several studies have demonstrated low concentrations of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), and the dopamine metabolite, homovanillic acid (HVA), in depressed patients, these early studies may have been biased by concomitant administration of antidepressant drugs (which tend to lower CSF 5-HIAA), amount of CSF drawn (there is a concentration gradient for both metabolites), and selection of control subjects. Once these methodological details are controlled for, the differences between depressed patients and controls are unimpressive. However, there is a remarkably consistent association between low concentrations of CSF 5-HIAA and suicidal behavior, as evidenced by over 20 studies. The association is not confined to depressive illness but has also been found in schizophrenia, personality disorder, and certain impulse control disorders (but, interestingly, not in bipolar disorder). A low concentration of CSF 5-HIAA in a suicide attempter is associated with a substantial increase in short-term suicide risk. CSF studies in violent criminals, and in nonhuman primates, suggest that aggression dyscontrol may partly explain the association between suicide and serotonin, which is of considerable theoretical interest. CSF 5-HIAA determinations may also be helpful in the clinical assessment of suicide risk.
Publication Types:
Review
Review, academicPMID: 9616798, UI: 98279770
poster:SLS
thread:34025
URL: http://www.dr-bob.org/babble/20000517/msgs/34122.html