Webinar Review: The Nuts & Bolts of Neurotransmitter Testing

ZRT's senior research scientist Dr. Kate Placzek presented a webinar about the neurotransmitter testing ZRT began offering last year.

Neurotransmitter testing is a natural progression of the wellness testing options that ZRT has developed and offered over the years, and in some ways encompasses many aspects of the testing in other areas such as steroid hormone and metabolite testing, adrenal and thyroid health assessment, cardio-metabolic parameters, and heavy metals.

She addresses these questions that are commonly asked by health care providers who call in to enquire about this testing.

How do I know if neurotransmitter testing is right for my patients?

Dr. Placzek presents these assessment tools: our patient quiz, which helps with assessment of patients' mental wellbeing; and the ZRT requisition form on which patients report symptoms along with their test samples. Some are very pertinent to possible neurotransmitter imbalances, including those that don't immediately appear to relate directly to brain health.

Which panel should I choose?

The NeuroBasic profile has 7 tests – serotonin, GABA, glutamate, phenylethylamine (PEA), dopamine, norepinephrine, and epinephrine, forming a good basic screening test.

The NeuroIntermediate profile has the above 7 tests plus glycine and histamine, useful for assessing patients with problems such as migraine, allergies, and/or low libido.

The NeuroAdvanced profile provides a comprehensive functional assessment that can be used to tailor treatments.

The NeuroAdvanced profile has all of the above plus the major metabolites of the main players in the neurotransmitter rainbow: 5HIAA (serotonin metabolite), DOPAC and HVA (dopamine metabolites), NMN (norepinephrine metabolite), and VMA (norepinephrine and epinephrine metabolite). This therefore provides a comprehensive functional assessment that can be used to tailor treatments. It is particularly useful for patients with suspected methylation issues affecting neurotransmitter metabolism, or those with unusual symptoms.

Optional add-ons to testing are diurnal cortisol, diurnal melatonin, and diurnal norepinephrine and epinephrine. These are possible because patients collect 4 urine samples on filter cards during the day at specified time points that are tested individually, allowing a diurnal pattern to be assessed. Assessment of diurnal cortisol, melatonin, norepinephrine and epinephrine are useful in identifying an individual’s response to stress, particularly when the patient is affected by circumstances or conditions that affect sleep.

Dr. Placzek outlines how patients should prepare for the test for best results; e.g., avoiding some foods that have a large effect on urine NT levels (bananas, nuts, pineapple, and avocado), excessive exercise, and some medications that can affect results (e.g., acetaminophen and vitamin C). She also explains what happens to the sample when it arrives at ZRT, and the importance of the testing method for these small molecules, which require highly accurate and sensitive liquid chromatography/tandem mass spectrometry (LC-MS/MS) analysis by our well-trained lab professionals.

How do I interpret the results and use the report to navigate appropriate treatments?

Dr. Placzek explains some general considerations when interpreting NT test results, and these comprise:

  1. The balance between inhibitory and excitatory NTs.
  2. How different patterns emerge, and how they relate to one another.

She presents a test report and explains the different sections of the report and how to read it effectively to use all the information the patient provided as well as the test results.

She explains how the reference ranges for each analyte were determined at ZRT and why it's important to consider the optimal range when interpreting results.

The report also includes the main neurotransmitter metabolic pathways to help with interpretation of what is happening to the neurotransmitters in the body and what impacts their levels, such as factors that affect their metabolism. Dr. Placzek explains how to use these pathways to see what is happening in a patient in light of their results, and what supplements might help influence the pathway to bring the neurotransmitter picture more into balance.

How do urine neurotransmitter levels relate to brain function?

The webinar outlines neurotransmitter production in the body and explains how the peripheral neurotransmitter production and metabolism relates to that in the central nervous system. Urinary neurotransmitters typically come from peripheral tissues since most do not normally cross the blood-brain barrier. Ninety percent of serotonin, for example, is produced in the gut, and most of the dopamine in the urine is produced in the kidney. However, research in this area is very active and studies show how peripheral levels of neurotransmitters and their metabolites reflect the overall homeostasis of the neurotransmitter production in both the brain and the peripheral tissues. 

Case studies

Dr. Placzek presents three case studies highlighting a range of typical patients: a "burned-out male," a premenopausal woman with suspected HPA axis dysfunction, and a child with an ADHD diagnosis. She gives detailed interpretations of their test reports and how these relate to their symptoms, and includes recommended treatment considerations, including a detailed rationale for these, in each case.

Finally, she summarizes some general treatment considerations for both overall low and overall high neurotransmitter levels, emphasizing that each patient is different and must be assessed on a case by case basis. She also explains the importance of considering the potential interaction of the neurotransmitter system with a patient’s overall hormone picture, including steroid and thyroid hormone balance, heavy metal exposure, and diurnal cortisol patterns to assess stress burden.