Neurotransmitter Testing in Charleston and Mt. Pleasant, SC

In research, the sample thought to best reflect the brain is cerebrospinal fluid, the fluid around the brain and spinal cord, because it is in contact with brain tissue.[3] Looking across brain scans, genetic tests and blood measures, a 2023 review in World Psychiatry concluded that the overwhelming majority of candidate psychiatric biomarkers have not proven reliable, valid and useful enough for clinical use.[4] None of the few promising candidates it named for further testing was a urine panel.

Autism is a useful example. Raised blood serotonin was first described in autism in 1961, and it shows up in more than a quarter of autistic people. Six decades later, that review noted that no prospective study had yet tested whether it predicts autism risk.[4]

What the serotonin research really says

You may have heard that depression is a “chemical imbalance” of low serotonin. In 2022, an umbrella review in Molecular Psychiatry pulled together 17 systematic reviews, meta-analyses and large studies to test that idea.[3] It concluded that the main areas of serotonin research give no consistent evidence of an association between serotonin and depression, and no support for the idea that depression is caused by lowered serotonin activity or levels.[3]

Studies of 5-HIAA, the serotonin breakdown product many panels measure, showed no association with depression.[3] Studies of serotonin in blood plasma showed no relationship with depression either, and lower levels were linked to antidepressant use.[3] So a low serotonin result can reflect a medication someone already takes, not a cause of their mood.

Here is what the review did not say. It examined whether depression is linked to low serotonin. It did not study whether antidepressants help people, so it cannot be read as evidence that they do not work. The Task Force lists both talk therapy and medication among evidence-based treatments for anxiety.[6] If you take a medication for mood or anxiety, please do not change it based on this page or on any lab number. Talk with the clinician who prescribes it.

For the same reasons, a urine serotonin number is not a sound basis for choosing an antidepressant or a supplement, and no lab test has been validated for individualizing psychiatric treatment.[3][4]

How mood, anxiety, ADHD and autism are actually diagnosed

The US Preventive Services Task Force recommends screening adults for depression, including pregnant and postpartum people and adults 65 and older, using short questionnaires such as the PHQ.[5] A positive screen leads to a fuller assessment to confirm the diagnosis and gauge severity.[5] For anxiety, the Task Force recommends screening adults 64 and younger with tools such as the GAD-7, and found the evidence insufficient to recommend for or against it at 65 and older.[6] People who screen positive should be evaluated further and offered, or referred to, evidence-based care.[6]

A good evaluation also looks for physical causes. The National Institute of Mental Health notes that thyroid disorders, some viruses and certain medications can cause the same symptoms as depression, and that a provider can rule them out with an exam, an interview and lab tests. This is where blood work genuinely earns its place, through tests like thyroid levels, iron and B12, chosen for a reason.

ADHD and autism are diagnosed by looking at behavior, not blood or urine. The CDC states plainly that there is no single test to diagnose ADHD, and that sleep problems, anxiety and depression can look like it. The CDC describes gathering information from parents and teachers about behavior at home, at school and with peers. Autism, like all psychiatric diagnoses, is defined by shared behavioral features, and the biomarker review above found no lab measure ready to diagnose it.[4]

If you are in crisis or thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline. It is free, confidential and available around the clock.

Feeling low, on edge, or foggy, and not sure where to start? Begin with a conversation rather than a urine cup. Call 843-981-0870 to book a visit in Mount Pleasant or downtown Charleston, where we look at your mood, sleep, thyroid, iron and hormones together and decide on next steps with you.

Where catecholamine testing earns its place, and how we use results

One version of this testing is well validated, and it shows what a good test looks like. Pheochromocytoma and paraganglioma are tumors that grow from adrenaline-making cells, inside the adrenal gland or elsewhere in the body, and they commonly produce catecholamines.[7] The Endocrine Society recommends that initial testing use plasma free metanephrines or urinary fractionated metanephrines, a strong recommendation backed by high-quality evidence.[7] That test answers one specific question about one kind of disease.

A neurotransmitter panel ordered for low mood has none of those features. It has not been shown to be reliable, valid and useful for diagnosing or treating a psychiatric condition, and it cannot separate what the brain is doing from what the gut and kidney are doing.[1][2][4]

So how do we approach it? If you already have results, bring them, and we will explain what each number does and does not mean. If you want the test, we can order it, knowing it will not diagnose a mood disorder or guide medication. Either way, the visit centers on your mood and sleep history, a validated questionnaire, and labs aimed at real causes such as thyroid function, iron, B12 and hormones. When symptoms point to a mental health condition, we talk through evidence-based options, including referral to a mental health specialist when that is the better fit.

Ashley Harwyn, PA-C, is board certified in anti-aging and functional medicine (A4M) and holds ABAAHP certification, and she sees patients in our Mount Pleasant office at 496 Bramson Ct, Suite 120, and downtown at The Longevity Club, 163 Rutledge Ave, Suite 202, in Charleston. If gut symptoms are part of your picture, our gut health page covers how we evaluate them. If you have been told you have “adrenal fatigue,” our adrenal fatigue page explains what the evidence shows.