The Whacky, Wild and Misleading World Of Neurotransmitter Testing

I was recently asked to comment on what I thought of urinary testing for neurotransmitter deficiencies.

neurotransmitter_homeBeing the shy and demure sort, naturally I had no opinion…

GOTCHA! -Just checking to see if you’re awake!  :O

Within the last few years, this approach to attempting to quantify what might or might not be deficient neurotransmitter-wise has gained a great deal of popularity among numerous health care providers.  This type of testing can be somewhat costly, as can the “customized cocktails” later prescribed once results have been summarily tabulated and quantified.  It all seems very scientific,  precise and appealing.  After all, isn’t lab testing the way to go?

Welllll…there are several problems with this approach.

First, let me state that I am, in fact, a big fan of lab testing for all sorts of things.  I regularly look at blood chemistries from a detailed functional perspective, salivary hormone panels to measure adrenal functioning (cortisol imbalances) and others,  stool antigen tests for major food sensitivities ( and urinary loading tests for iodine deficiency.  The numbers can be quite a credible wake up call for many and one can repeat the test at a later time to see what results are being gotten from whatever one happens to be doing for the associated issues.  Very cool stuff.  I much prefer lab testing to muscle testing and other approaches by virtue of its broader acceptance, clear tangibility and trackability with clear numbers.

I have considered the urinary testing approach and was even enamored of the concept at first.  Once I looked into the idea more closely, though, it just didn’t add up for me.

As seductive as the urinary hormone testing approach is,  I am sorry to say that it  falls  short of any real accuracy and genuine usefulness for several reasons…

Neurotransmitters are not unique to the brain and, in fact,  act throughout the body and brain in varying capacities and concentrations.  Many people aren’t aware, for instance that 95% of all serotonin production in the body occurs not in the brain, but in the gut!  Within these very separate respective systems, concentrations of neurotransmitters can vary hugely.

For example, within the brain, the amounts of serotonin found in different regions of the brain acting on different things may be completely different.  Also, an isolated measurement does not take into account other variables such as what are called uptake mechanisms, receptor site sensitivity, carrier protein ratios, the type of receptor sites (i.e., D1 or D2 for dopamine), degradation rates, and agonist and antagonistic influences from other messengers (Kharrazian).  In other words, it’s a complicated story.  It seems to me the analogy would be akin to trying to determine what was in some compartment of your refrigerator by looking in  your garbage can.  The correlations seem dubious, at best.

Also, even if you could determine how much of a given neurotransmitter you had based on some form of testing how can you know just how it was being used by the brain and/or body, and where?  This also doesn’t take into account something called functional variables (i.e., brain timing mechanisms) at all either, which in my experience can make a monumental difference.  I, personally, was entirely freed of what had been for me a near lifetime (35 years) of intractable depression as well as anxiety and panic attacks over 12 years ago doing neurofeedback that just hadn’t responded in a sustained way to anything else.  For me the core issue was actually a functional timing dysregulation, and not biochemistry.

Medications manipulate physiology by artificially adjusting things like receptor site sensitivity, synaptic cleft activity and/or reuptake mechanisms.  As such, these compounds can have a profound (albeit temporary) effect on the brain’s responses to neurotransmitters but never really change quantitative laboratory measurements.  In other words, Prozac can’t produce one single molecule of serotonin.  When taking oral neurotransmitter precursors one can and does impact brain levels of neurotransmitters, as well-but (for instance) taking 5-HTP or L-tryptophan increases serotonin in both the central and periperal nervous system.  The central nervous system and the peripheral nervous system function biochemically very separately (it’s this whacky this called “the blood-brain barrier”).  You’re influencing the brain levels of serotonin, but the majority of the conversion actually takes place in the GI tract and are produced for local responses which don’t translate to the brain at all.  As such, a urinary serotonin test is more likely a measurement of the neurotransmitter produced in the gut than serotonin produced in the brain.  Even if you were directly testing cerebro-spinal fluid (CSF) as a means of ascertaining how much neurotransmitter was actually present in the brain (the only way of really accurately determining what is going on on that side of the blood-brain barrier) you still wouldn’t necessarily know what serotonin in the central nervous system (CNS) was specifically doing where.

I have seen the best results evaluating functional aspects of neurotransmitters by symptomatic and a more “holistic assessment”, which seems of course less glamorous, is decidedly less lucrative and may seem less appealing from a left-brained “quantitative” perspective than a “lab test”.   The symptoms I look at when it comes to identifying probable neurotransmitter issues are outlined in much greater detail in my book, Primal Body-Primal Mind (pages 279-284).  This has consistently yielded good to excellent results for my clients when supplementation has been approached in a careful, systematic results-oriented manner.

Most people also tend to digest poorly and may have sub-optimal levels of hydrochloric acid, leading to poor protein digestion which can subsequently lead to sub-optimal levels of amino acids/neurotransmitter precursors.  As such,  I tend to additionally address digestive issues with people who seem to exhibit signs of amino acid deficiency.

I have been using amino acids now to adress issues of mood, health and cognitive functioning for over 20 years.  I have never used anything other than mood/symptomatic screening to guide amino acid supplementation.  Results tend to be uniformly good to excellent.  The sheer overwhelming complexity of amino acid/neurotransmitter activity in the human body/brain-and the compartmentalized nature of the biochemistry of each seems to best lend itself to a more functional and symptom-related evaluation.  Lab testing simply falls short of the mark here.

Save yourself some dough and aggravation.  Next time you’re wondering what neurotransmitters you may be short of, just take an internal inventory of how you’re feeling instead (oh-and get my book!).   Relief may be closer and much less expensive than you think!

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  1. says

    I want you to know, your piece goes to the essence of the topic. Your clarity leaves me wanting to know more. I am going to immediately grab your feed to keep up to date with your blog. Saying thanks is simply my little way of saying bravo for a fantastic resource. Take On my dearest wishes for your next post.

  2. says

    Dear Sir,
    I read your words with interest. I came to your site after a Google search. I have been troubled by anxiety all my life its developement partly caused by others discrimination towards me. I feel so frustrated by doctors attitude towards my illness in this country (uk) because they will not prescribe benzos. I am a trained psychiatric nurse who knows the basics of how the brain works but they will not listen. I believe I have a problem with my GABA levels and to back this up alcohol works in calming my brain. All I am given is SSRI’s which don’t really help but because they are not addictive like benzos they are somehow self commended for prescribing them. I see where you are coming from in your critique but I would hope you would welcome more research into testing neurotransmitters so that your efforts in restoring balance for people like me can be achieved.

  3. Mary Beth Vogt says

    Hello, I see your comments are dated April 2009. Do you have any updates? My 7 year old son’s holistic health practitioner is recommending a neurotransmitter test. My spouse is not so sure it is cost effective or beneficial. Thank you!

  4. Laurie says

    I’m in the same position as Mary Beth who posted recently. I notice your blog info was posted in 2009 and I wondered if you have more recent info. My 9 yr old son has Spectrum Disorders and ADHD so we are doing a urine & saliva test. There are just as many websites claiming to be pro-testing as there are blogs like yours saying it isn’t worth it. It’s not invasive so I don’t see the harm in testing and gaining further insight into his body chemistry.
    Would be interested in your reply.

  5. Steven B. says

    To Mary Beth Vogt and Laurie: I have had my urine neurotransmitter levels tested many times over the last six years with somewhat limited results. However, two books I would highly recommend on these subjects are: The Ultramind Solution, by Mark Hyman,M.D., and What your Doctor May Not Tell You About Depression, by Michael Schachter, M.D.

  6. Julie Ditmarsen says

    So what do you recommend in my case:

    I do not know what kind of doctor to seek or what type of testing to ask for. I believe we need testing to determine neurotransmitter levels.

    1. My daughter stutters terribly and we have been told brain chemical imbalance, esp Dopamine, is most likely the cause.

    2. I suffer extreme anxiety and extreme insomnia related to menopause. My doctor just keeps giving me different meds for depression which do not help and different sleeping pills which some had no effect and another made me sleep 18.5 hours.

    What kind of doctor and testing should I seek to find the CAUSE of this?

    Please do not suggest I read a book. Have been having sleep problems for the past 3 years, have not slept well in 23 of the past 45 nights. I would not be able to comprehend a book.

    Thank you for your help.

  7. meri gray says


    There is a piece on right now about balancing dopamine and serotonin using food and amino acid supplements. It’s more carb heavy than most primal experts talk about but healing protocols often are radically different from what joe/jane on the street needs to do. I’ve got my husband on the balancing protocol now and am already seeing improvement. I’m a little surprised because we’re not using pill supplements at all, just foods high in what he needs.

  8. Catherine says

    Benzos like klonopin (clonazepam) are meant for anxiety but are no longer under patent by pharmaceuticals, so they made a big push for SSRIs, changed the definition of addiction so that SSRIs would not be called addictive, and convinced doctors that benzos are harmful and that SSRIs work for everyone, even though recent studies have shown they make about 10%? of adolescents suicidal. In any case, there are still some doctors that will prescribe them in the U.S., but not necessarily the first you try. There was a study that I think said clonazepam was good for agoraphobia. You might want to look on the internet to see if I’ve got that right, and approach a doctor with that in mind.

  9. Lynne Wood says

    I had a urine neurotransmitter sleep panel test done in February, 2013 showing that my transmitters were all high. My practitioner said my “brain was on fire”. My new doctor wants to test me again with an expanded panel. I am not in favor as it seems to me so many other factors are involved. I have a complicated health picture which includes years of anxiety, depression, childhood trauma.
    What do you do with HIGH levels?

  10. Heather says

    I had a urine neurotransmitter test and my doctors recommendation for me gave me relief within two days from 40 years of depression and anxiety. I also eat pretty well, so maybe there was less to adjust. I understand the complexities of the body/brain, hormones, metabolism, stress, etc., and that go into the test and making sense of things we may not fully understand and my doc made no assumption it was an easy fix. In fact, I have had several visits to tune myself even more, which has made me more aware of what is happening to me throughout my day. And granted, the real question is why my body has trouble with creating the right level, and using the right level of NT’s, which can be many things as well, including toxins, detoxifying, mutations in genetic expressions, diet, cognitive processes, and all of the above and more. Still, to have such immediate and effective relief that was well worth the small cost of the test and supplements each month, and a great platform to give me focus and a relaxed mind to look for a deeper cause, meanwhile, feeling pretty good about life. In fact, my daughter has done the test and is on her way to resolving her years of anxiety after just a few days on her individually targeted regimen. Regardless of where the NT’s come from, they can be an indirect indicator that says much more than not having the test done at all. There is a connection, even if it is once or twice removed. My brain may have its own ebb and flow, my gut its own, too. And when I feel down, or anxious it is not just a message from my gut nor just from my brain, but from my whole bodies nervous system, and my senses, and more.

    It is like Quantum physics and the model of the atom. We can’t see exactly what it is, but we can see what it does. We can respond to what it does and because we are not responding directly to what the atom actually is and may be wrong in our thinking of what is really happening and what the model of the atom really looks like, it doesn’t really matter because the actions are still equally as effective.

  11. Natasha says

    Heather, please advise me as well the name of your doctor and the type of test or company/lab used to test your urine for neurotransmitters. I just took my home urine Metabolic Panel AKA Organic Acids test this morning and dropped it off at FedEx to be sent to Genova. My integrative doctor, Dr. Martin Dayton, will meet with me to go over the results when he gets them. I recently found out I am homozygous for MTHFR and VDR Taq and hetero for ACAT 1-02, MTRR A66G, MTRR H595Y, MTRR K350A, and MTRR A664A. My whole life I’ve been thin and healthy but have shown high cholesterol and low Vitamin D in my blood labs and had never felt the need to seek psychological help until recently. After undergoing plastic surgery under general anesthesia this past March I experienced some nerve damage. My doctor recommended super high doses of B12 and B6 in the attempt to regenerate the nerves. By doing so, it catapulted me into uber anxiety mode, panic episodes, and insomnia- AND worsened my tingling nerves. I began psychotherapy and was prescribed klonopin at a very low dose about 4 months ago. I also cut out all supplements but the D and Omega Fatty Acid. Throughout the last 5 months, Ive been to numerous doctors and no one could figure out the source of my small fiber neuropathy until I had myself genetically tested and connected the dots. I’ve always felt foggy in the brain, moody, a little irritable, low energy, experienced horrible PMS, and have a strong family history of cancers, diabetes, mood disorders, and anxiety. I tried taking the l-methylfolate and some amino acids on my own but made myself feel worse. I’m hopeful that neurotransmitter testing can help me figure things out and get my life back on track.

  12. brendasue says

    The urine test for neurotransmitters for my chronically depressed, anxious and at times, hair-trigger angry, teenage son showed him low in serotonin and GABA. Within a week of supplementation he was like a different kid. I’m a believer. He kept being prescribed pharmaceuticals by MDs which he didn’t want to continue to take due to side effects. He is now happily taking his amino acid formula, vitamin D and Omega-3. I hope such “treatment” is the future of mental health care for everyone. Go natural.

  13. says

    There is something which has bothered me for quite awhile, with regard to chemical imbalances. Why have laboratory baseline and periodic measurements NEVER been undertaken on me? A GOOGLE search lists numerous testing facilities. I’ve been treated by numerous psychiatrists for decades, and when I ask questions such as this, I am the recipient of obfuscation, not information, and given a prescription for medications. My records indicate that I have been prescribed approximately 75 different psychotropic drugs over the past three decades. I have been improperly diagnosed as suffering from bipolarity (although self testing scales consistently indicated no mania); it literally took me years to persuade a psychiatrist that I was clinically depressed, as well as experiencing PTSD, GAD, et al. I am currently being prescribed Cymbalta for clinical depression. Are there any practitioners which might be recommended in the Scottsdale, Arizona, area?

  14. Kimberly says

    (Dr.) Sandy Kramer are you a doctor yourself? I wasn’t sure why you have Dr in parenthesis. If so, what type of doctor? Are you able to order tests for yourself? I’m just surprised that if you’re a doctor too, why wouldn’t these other doctors listen to your concerns? I took Cymbalta too between 2007-2009, and I feel it is a big part of the reason for the imbalances that I now have along with other health issues. I will never take another synthetic prescription drug again.

  15. Kimberly says

    P.S. I don’t think any prescription medication should ever be given without thorough testing of the patient first. Too many doctors hand out samples before even writing a prescription or doing any testing of any kind. Do you know how many people, thanks to the over-saturation of advertising for pharmaceutical drugs, can walk into a dr’s office and lie about their symptoms or make things up and walk out with free samples or a prescription for something they shouldn’t even be taking? There’s too many doctors as it is but none of them have time to do the proper testing. It’s ridiculous and disgusting what the healthcare system has become.

  16. Cami says

    At Brandisue who made a comment above regarding your son . Please provide me with the name of practitioner that you have taken your son to.
    My teenage son has been suffering from something , whether it’s anxiety or depression I am not sure. He has been seeing a marriage and family therapist , however he needs serious help . His therapist just suggested to see a physiatrist to do a neurotransmitter testing and prescribe drugs, however I am not comfortable with synthetic pills. He is suffering and I am feel hopeless. I have come to this site by accident . Please , please contact me back and let me know the name of your practitioner . I hope you read this comment and help me out . I am a mother just like you and I feel helpless . Please .

  17. Cami says

    I apologize, I spelled the commentators name wrong. My previous comment was addressed to brendasue who commented September 11, 2014. Thank you .

  18. karma says

    I suggest your son to do an “Elimination diet”. It may really help him.

  19. Lynn says

    My daughter has been dealing with anxiety/depression since she was 11. She has seen pyschologists, psychiatrists, therapists etc. She was on zoloft for 5 months which turned her into a zombie that always wanted to sleep & when she stopped taking them she went through a vicious withdrawls, sick & throwing up for 6 days. She has been diagnosed with GAD, OCD, depression. I also think maybe bipolar too. She is 17 & she wakes up everyday saying she wants to die. She has checked herself into the hospital once for a day which helped 0%, she vomitted every morning for 3 mos & she started going to a acupuncturist which helped. Her anxiety/OCD is so bad she cant get out of bed till 11 or later. She has missed so much school, which causes her more anxiety because she is very smart but a perfectionist. She is again waiting to see a pychiatrist to get diagnosed. My daughter is in so much pain & I worry constantly & there is no help anywhere! She hates taking pills, any suggestions or what she should be taking natural? Thanks

  20. Laura says

    I don’t think this thread is read or updated anymore. I hope you and your daughter find a better psychiatrist for her. Perhaps she was given the wrong dose of zoloft, because it has helped so many people. And it is really dangerous to go off it cold turkey. For more natural methods, I hear amino acids can be great but there is the challenge of finding the right doc to prescribe the right ones in the right amounts and monitor her closely. Plus they are expensive. Best of luck to you.

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