Lab GURUS: what tests for anxiety

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    Lab GURUS: what tests for anxiety


    What lab tests would you run if you had chronic anxiety for no apparent reason? I have already tested the basics, need more suggestions!


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    Why don't you make an appointment to see your Doctor instead of trying to self-diagnose and treat yourself via an internet message board.

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    Quote Originally Posted by T-Bone View Post
    Why don't you make an appointment to see your Doctor instead of trying to self-diagnose and treat yourself via an internet message board.
    Been there, done that, not interested in xanax.

    •   
       

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    Quote Originally Posted by LeanGuy View Post
    Been there, done that, not interested in xanax.
    I would start with thyroid and adrenals, including saliva cortisol and urine catecholamines.

    I don't know if you've tried Busbar or any of the SSRIs (e.g. Paxil). Many have good fortune with them. Others have good luck with anti-seizure meds (e.g. neurontin) and atypical anti-psychotics (e.g. serzone, lamictal).

    There are neurotransmitter tests, though I am not aware of any that are believed to be reliable, at least by any consensus. I've read that for it to be reliable, it would need to come from the brain, rather than blood, urine or saliva.

    I'm sure Jan can recommend some labs.

    Good luck.

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    Quote Originally Posted by LeanGuy View Post
    Been there, done that, not interested in xanax.
    Starting with above premise;

    Quest:
    Estradiol, Free, LC/MS/MS (36169X)
    Testosterone, Free, Bio/Total (LC/MS/MS)

    Genova:
    Comprehensive Thyroid Assessment
    Metabolic Analysis Profile

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    Quote Originally Posted by jinxie View Post
    I would start with thyroid and adrenals, including saliva cortisol and urine catecholamines.
    12/07 Saliva Cortisol 8am: 7 ng/ml [13-24] LOW
    12/07 Saliva Cortisol 12pm: 5 ng/ml [5-10] LOW-NORMAL
    12/07 Saliva Cortisol 4pm: 3 ng/ml [3-8] LOW-NORMAL
    12/07 Saliva Cortisol 12am: 8 ng/ml [1-4] HIGH

    2/07 Saliva Cortisol AM: 5.2 ng/ml [3.7-9.5]
    2/07 Saliva Cortisol PM: 0.3 ng/ml [0.4-1.0] LOW

    Urine Epinephrine 6.3 ug/gCr [day:8-12, night:1-3]
    Urine Norepinephrine 31.4 ug/gCr [day:35-50, night:20-30]
    Urine Dopamine 124.9 ug/gCr [day:110-175, night:80-120]
    Urine Serotonin 75.1 ug/gCr [day:150-200, night:100-175] LOW
    Urine GABA 1.6 umol/gCr [day:1.5-4.0, night:1-3] LOW
    Urine Glutamine 400.8 umol/gCr [day:150-400, night:100-350]
    Urine Glutamate 26.9 umol/gCr [day:10-35, night:8-20]
    Urine PEA 236.6 nmol/gCr [day:175-450, night:125-300]
    Urine Histamine 19.6 ug/gCr [day:10-20, night:5-15] HIGH-NORMAL

    Serum DHEA-S 361 ug/dL [35-430] WAS LOW BEFORE SUPP
    Serum TSH 1.740 uIU/mL [0.3-5.6]
    Serum Free T3 3.4 pg/mL [2.0-4.2]
    Serum Free T4 1.12 ng/dL [0.87-1.56]
    Serum Reverse T3 351 pg/mL [90-350]
    Serum Thyroglobulin AB <80 IU/mL [normal]
    Serum Thyroid Peroxidase AB <20 IU/mL [normal]
    Serum ACTH test [normal]

    Quote Originally Posted by JanSz View Post
    Quest:
    Estradiol, Free, LC/MS/MS (36169X)
    Testosterone, Free, Bio/Total (LC/MS/MS)

    Genova:
    Comprehensive Thyroid Assessment
    Metabolic Analysis Profile
    Serum Testosterone-Total 594 ng/dL [280-1100] WAS LOW BEFORE CLOMID
    Serum Testosterone-Free 18.59 ng/dL [5-21] WAS LOW BEFORE CLOMID
    Estradiol 28.5 pg/mL [0-56]

    Thanks guys. As you can see, I have done much of this. I really do not want an SSRI, IMO its only masking the problem, and adds a bunch of new sides. I want to know the reason why I feel the way I do. My doctors are out of ideas for tests. My endo is useless, checked TSH, ACTH, said they're normal and I should just take xanax. My ND tells me to take tryptophan/5-HTP for low serotonin which I agree, helps some w/ sleep but not anxiety yet. Cortisol runs low, I don't see how that could cause anxiety, unless it's spiking up.

    I will look into the metabolic analysis. What about some kind of amino/vitamin/mineral deficiency (NutrEval)? What about aldosterone causing some kind of elecrolyte imbalance? What about homocysteine to check methylation issues? Anything else, I am trying to cover all bases.

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    Quote Originally Posted by LeanGuy View Post
    12/07 Saliva Cortisol 8am: 7 ng/ml [13-24] LOW
    12/07 Saliva Cortisol 12pm: 5 ng/ml [5-10] LOW-NORMAL
    12/07 Saliva Cortisol 4pm: 3 ng/ml [3-8] LOW-NORMAL
    12/07 Saliva Cortisol 12am: 8 ng/ml [1-4] HIGH

    2/07 Saliva Cortisol AM: 5.2 ng/ml [3.7-9.5]
    2/07 Saliva Cortisol PM: 0.3 ng/ml [0.4-1.0] LOW

    Urine Epinephrine 6.3 ug/gCr [day:8-12, night:1-3]
    Urine Norepinephrine 31.4 ug/gCr [day:35-50, night:20-30]
    Urine Dopamine 124.9 ug/gCr [day:110-175, night:80-120]
    Urine Serotonin 75.1 ug/gCr [day:150-200, night:100-175] LOW
    Urine GABA 1.6 umol/gCr [day:1.5-4.0, night:1-3] LOW
    Urine Glutamine 400.8 umol/gCr [day:150-400, night:100-350]
    Urine Glutamate 26.9 umol/gCr [day:10-35, night:8-20]
    Urine PEA 236.6 nmol/gCr [day:175-450, night:125-300]
    Urine Histamine 19.6 ug/gCr [day:10-20, night:5-15] HIGH-NORMAL

    Serum DHEA-S 361 ug/dL [35-430] WAS LOW BEFORE SUPP
    Serum TSH 1.740 uIU/mL [0.3-5.6]
    Serum Free T3 3.4 pg/mL [2.0-4.2]
    Serum Free T4 1.12 ng/dL [0.87-1.56]
    Serum Reverse T3 351 pg/mL [90-350]
    Serum Thyroglobulin AB <80 IU/mL [normal]
    Serum Thyroid Peroxidase AB <20 IU/mL [normal]
    Serum ACTH test [normal]



    Serum Testosterone-Total 594 ng/dL [280-1100] WAS LOW BEFORE CLOMID
    Serum Testosterone-Free 18.59 ng/dL [5-21] WAS LOW BEFORE CLOMID
    Estradiol 28.5 pg/mL [0-56]

    Thanks guys. As you can see, I have done much of this. I really do not want an SSRI, IMO its only masking the problem, and adds a bunch of new sides. I want to know the reason why I feel the way I do. My doctors are out of ideas for tests. My endo is useless, checked TSH, ACTH, said they're normal and I should just take xanax. My ND tells me to take tryptophan/5-HTP for low serotonin which I agree, helps some w/ sleep but not anxiety yet. Cortisol runs low, I don't see how that could cause anxiety, unless it's spiking up.

    I will look into the metabolic analysis. What about some kind of amino/vitamin/mineral deficiency (NutrEval)? What about aldosterone causing some kind of elecrolyte imbalance? What about homocysteine to check methylation issues? Anything else, I am trying to cover all bases.
    Genova:

    Metabolic Analysis Profile

    You will get a list of supplements to take,
    name, daily dose, additional advice.

    No need to involve your doctor in making basic guesses.
    Unless your doc is top notch researcher,
    results of the test will give you better advice that given by your doctor.

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    Quote Originally Posted by JanSz View Post
    Genova:

    Metabolic Analysis Profile

    You will get a list of supplements to take,
    name, daily dose, additional advice.

    No need to involve your doctor in making basic guesses.
    Unless your doc is top notch researcher,
    results of the test will give you better advice that given by your doctor.
    Gotcha. Now I need to convince my doctor to order the test. Any idea about non-insured cost?

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    Quote Originally Posted by LeanGuy View Post
    12/07 Saliva Cortisol 8am: 7 ng/ml [13-24] LOW
    12/07 Saliva Cortisol 12pm: 5 ng/ml [5-10] LOW-NORMAL
    12/07 Saliva Cortisol 4pm: 3 ng/ml [3-8] LOW-NORMAL
    12/07 Saliva Cortisol 12am: 8 ng/ml [1-4] HIGH

    2/07 Saliva Cortisol AM: 5.2 ng/ml [3.7-9.5]
    2/07 Saliva Cortisol PM: 0.3 ng/ml [0.4-1.0] LOW

    Urine Epinephrine 6.3 ug/gCr [day:8-12, night:1-3]
    Urine Norepinephrine 31.4 ug/gCr [day:35-50, night:20-30]
    Urine Dopamine 124.9 ug/gCr [day:110-175, night:80-120]
    Urine Serotonin 75.1 ug/gCr [day:150-200, night:100-175] LOW
    Urine GABA 1.6 umol/gCr [day:1.5-4.0, night:1-3] LOW
    Urine Glutamine 400.8 umol/gCr [day:150-400, night:100-350]
    Urine Glutamate 26.9 umol/gCr [day:10-35, night:8-20]
    Urine PEA 236.6 nmol/gCr [day:175-450, night:125-300]
    Urine Histamine 19.6 ug/gCr [day:10-20, night:5-15] HIGH-NORMAL

    Serum DHEA-S 361 ug/dL [35-430] WAS LOW BEFORE SUPP
    Serum TSH 1.740 uIU/mL [0.3-5.6]
    Serum Free T3 3.4 pg/mL [2.0-4.2]
    Serum Free T4 1.12 ng/dL [0.87-1.56]
    Serum Reverse T3 351 pg/mL [90-350]
    Serum Thyroglobulin AB <80 IU/mL [normal]
    Serum Thyroid Peroxidase AB <20 IU/mL [normal]
    Serum ACTH test [normal]



    Serum Testosterone-Total 594 ng/dL [280-1100] WAS LOW BEFORE CLOMID
    Serum Testosterone-Free 18.59 ng/dL [5-21] WAS LOW BEFORE CLOMID
    Estradiol 28.5 pg/mL [0-56]

    Thanks guys. As you can see, I have done much of this. I really do not want an SSRI, IMO its only masking the problem, and adds a bunch of new sides. I want to know the reason why I feel the way I do. My doctors are out of ideas for tests. My endo is useless, checked TSH, ACTH, said they're normal and I should just take xanax. My ND tells me to take tryptophan/5-HTP for low serotonin which I agree, helps some w/ sleep but not anxiety yet. Cortisol runs low, I don't see how that could cause anxiety, unless it's spiking up.

    I will look into the metabolic analysis. What about some kind of amino/vitamin/mineral deficiency (NutrEval)? What about aldosterone causing some kind of elecrolyte imbalance? What about homocysteine to check methylation issues? Anything else, I am trying to cover all bases.
    No offense intended here, but have you considered long-term psychotherapy. Regardless of the cause, you need to get in touch with your triggers.

    While I understand your feeling that SSRIs are bandaids, it may be your only resort. While it's possible that hormonal rebalancing will quell some of your anxiety, I would remain open minded. I think you may be well served by trying hCG rather than clomid, which may serve to increase dopamine. I haven't heard many good things about clomid monotherapy. That said, your free-T is pretty good.

    I don't have that much confidence in L-tryp and 5HTP. They may help you sleep, but they are usually not that affective for managing day-time anxiety.

    Good luck and hang in there.

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    Quote Originally Posted by jinxie View Post
    No offense intended here, but have you considered long-term psychotherapy. Regardless of the cause, you need to get in touch with your triggers.

    While I understand your feeling that SSRIs are bandaids, it may be your only resort. While it's possible that hormonal rebalancing will quell some of your anxiety, I would remain open minded. I think you may be well served by trying hCG rather than clomid, which may serve to increase dopamine. I haven't heard many good things about clomid monotherapy. That said, your free-T is pretty good.

    I don't have that much confidence in L-tryp and 5HTP. They may help you sleep, but they are usually not that affective for managing day-time anxiety.

    Good luck and hang in there.
    No offense taken. But SSRI's will be a very last resort for me. IMO there is a physiological reason for anxiety/insomnia, not all in the head. I think I'd rather live with the symptoms than add sexual sides etc. from a SSRI. That would bring on depression

    All that being said, I do occasionally take 25mg trazodone when I really need some help sleeping... works great with no sides except stuffy nose... it is not an SSRI... libido actually increases on it.

    As far as clomid, it has brought my total T from 260 to 600, and free T from 6 to 18 in 2 weeks. I am not opposed to HCG in the future, but why take something suppressive before at least trying a SERM like clomid which may jump-start the HPTA.

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    Quote Originally Posted by LeanGuy View Post
    Gotcha. Now I need to convince my doctor to order the test. Any idea about non-insured cost?
    Metabolic Analysis Profile was my first Genova test.
    I posted its report here:
    JanSz-Metabolic Analysis and Cellular Energy

    I do not remember its (nominal) cost.
    Cost to me was $0.00 after insurance.

    Latter I did ONE.
    ONE consist of:


    GDX ONE - Optimal Nutrition Evaluation
    The ONE - Optimal Nutrition Evaluation - (Cost $472.01) bill dec/10/2007 consists of:
    Metabolic Analysis
    Amino Acid Analysis
    Oxidative Stress Analysis

    Out of pocked was minimal.

    I posted ONE resport on the above link.
    .
    .
    Look at thos reports, specially look for the advice on corrective action,
    first discussion, then detailed list of supplements, daily dose and additional testing if any.
    .
    All in all I paid about $50 for all the Genova tests I did to date.
    .
    One of the reasons for insurance payments is Genova's instructions to doctors on how to fill up proper justifications for the test. I wish Quest made such an effort. I am sure 50% of insurance non-coverage is just wrong paperwork. Another words, complicated bureocracy, not real reluctance to pay.
    .
    .

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    Quote Originally Posted by JanSz View Post
    The ONE - Optimal Nutrition Evaluation - (Cost $472.01) bill dec/10/2007 consists of:
    Metabolic Analysis
    Amino Acid Analysis
    Oxidative Stress Analysis
    I might do "The ONE" for $472... that's not bad for all you get.

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    In the meantime, try a little lemon balm and/or oat seed extract with your tryptophan doses. These have a nice, mild anti-anxiety effect with no other negative side effects (at least for me and most people). Lemon balm also re-establishes and enhances your sleep cycle.

    Other super-simple things to add in just to ensure your body is getting what it needs to produce enough serotonin..folic acid upwards of 1-3 mgs per day, chromium 50 mg, and selenium. These all act as co-factors in nuerotranmitter function and production and from my experience, they can help a lot if you are low on them. All fairly cheap to boot.

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    Quote Originally Posted by LeanGuy View Post
    I might do "The ONE" for $472... that's not bad for all you get.
    I smell that you may spring for few extra $$ and get the real McCoy.

    NutrEval (old Style)

    There is also

    NutrEval(new) ( my second choice).

    Listen to podcast here (about ONE)
    Genova Diagnostics

    GDX Nutritional Laboratory Assessments

    If you get ONE (like I did), right away you will find out that you are definitely want to add Essential & Metabolic Fatty Acid and Elemental analysis.

    That was my way.
    You be better of doing the NutrEval right away and be done with it.

    GDX NutrEval Profile
    .
    .

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    Quote Originally Posted by bioman View Post
    In the meantime, try a little lemon balm and/or oat seed extract with your tryptophan doses. These have a nice, mild anti-anxiety effect with no other negative side effects (at least for me and most people). Lemon balm also re-establishes and enhances your sleep cycle.

    Other super-simple things to add in just to ensure your body is getting what it needs to produce enough serotonin..folic acid upwards of 1-3 mgs per day, chromium 50 mg, and selenium. These all act as co-factors in nuerotranmitter function and production and from my experience, they can help a lot if you are low on them. All fairly cheap to boot.
    Thanks bioman, will do.

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    Quote Originally Posted by LeanGuy View Post
    No offense taken. But SSRI's will be a very last resort for me. IMO there is a physiological reason for anxiety/insomnia, not all in the head. I think I'd rather live with the symptoms than add sexual sides etc. from a SSRI. That would bring on depression

    All that being said, I do occasionally take 25mg trazodone when I really need some help sleeping... works great with no sides except stuffy nose... it is not an SSRI... libido actually increases on it.

    As far as clomid, it has brought my total T from 260 to 600, and free T from 6 to 18 in 2 weeks. I am not opposed to HCG in the future, but why take something suppressive before at least trying a SERM like clomid which may jump-start the HPTA.

    Plenty of anxiety IS of psychological/emotional origin. I used to have episodes of anxiety that would last for weeks, where I worried constantly, had difficulty eating and sleeping and felt like I was ready to jump out of my skin. I managed to keep myself distracted from it by being manically active and overworking, but eventually, coping in that way was beginning to really wear me out.

    I went into psychotherapy and began to feel better in a matter of weeks - no pills, no lab tests, just talk therapy. The psychtherapy extended for nearly two years, but, having gone through it, I never have anxiety of that kind any more.


    I understand that not everybody has the time, patience and coin for psychotherapy (I paid for it out of pocket), but keep it in mind as an option.

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    Quote Originally Posted by cpeil2 View Post
    Plenty of anxiety IS of psychological/emotional origin. I used to have episodes of anxiety that would last for weeks, where I worried constantly, had difficulty eating and sleeping and felt like I was ready to jump out of my skin. I managed to keep myself distracted from it by being manically active and overworking, but eventually, coping in that way was beginning to really wear me out.
    I'm not discounting therapy... I'm sure it has helped a lot of people. In my case, I am not worried about anything, I just feel like I've had a few cups of espresso all the time. Wired and tired... like they say for adrenal fatigue, accelerator and brake on at the same time. Like the body is saying "hey something is wrong, find it". If I exhaust all physical tests, then only the mind is left.

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    Here is a good list of anxiety causes and remedies:

    http://www.diagnose-me.com/cond/C58563.html

    Some of you will be happy, it includes therapy as a remedy

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    Quote Originally Posted by LeanGuy View Post
    No offense taken. But SSRI's will be a very last resort for me. IMO there is a physiological reason for anxiety/insomnia, not all in the head. I think I'd rather live with the symptoms than add sexual sides etc. from a SSRI. That would bring on depression

    All that being said, I do occasionally take 25mg trazodone when I really need some help sleeping... works great with no sides except stuffy nose... it is not an SSRI... libido actually increases on it.

    As far as clomid, it has brought my total T from 260 to 600, and free T from 6 to 18 in 2 weeks. I am not opposed to HCG in the future, but why take something suppressive before at least trying a SERM like clomid which may jump-start the HPTA.
    Higher T can act as a buffer for stress. It promotes dopamine production, the happiness neurohormone. hCG is anecdotally said to give a sense of wellbeing, for many. I think I would give hCG a chance. Unless you have an issue with injections (it's just an insulin pin), I dont see the big deal if you are going to take medicine (Clomid) in any event. And I think hCG has a cleaner side effect profile.

    Good luck -- and get going with the talk therapy.

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    Cool news, my doc agreed to order the Genova Metabolic test. Not sure about the pocketbook damage yet. JanSz, I'll post results when I get 'em.

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    You've done most of the tests, what are you taking? You def. need cortisol and possibly florinef as well. That and get the thyroid up and cranking. those two are huge as well as test.

    until those 3 are straigthened out for at least 3 months, id hold off on anything else unless you just need a bandaid to get by.

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    Quote Originally Posted by Scottyo View Post
    You've done most of the tests, what are you taking? You def. need cortisol and possibly florinef as well. That and get the thyroid up and cranking. those two are huge as well as test.

    until those 3 are straigthened out for at least 3 months, id hold off on anything else unless you just need a bandaid to get by.

    I'm taking isocort for cortisol. I thought my thyroid looked ok...

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    Isn't the high rT3 a problem? I'm still learning but I thought I read that somewhere.

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    Quote Originally Posted by LeanGuy View Post
    I'm taking isocort for cortisol. I thought my thyroid looked ok...
    Isocort is **** for your values. Its far too short acting, and kind of worthless for many of us 'far along'. Im guessing that is your crux of the problem. If the thyroid just pools in the blood, you'll still feel depressed (not in cells) but also feel hyper and thus anxious as well. Get on better cortisol support if you can.

    2 cents.

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    Quote Originally Posted by Shootist View Post
    Isn't the high rT3 a problem? I'm still learning but I thought I read that somewhere.
    Two docs I've seen said no.

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    Quote Originally Posted by LeanGuy View Post
    Been there, done that, not interested in xanax.
    Yeah no crap...I suffer from anxiety/restless nerves and they wanted to put me on that as well. Not saying that's a stupid idea by any means but I am not interested either...too many mood fluctuations xanax can cause and I don't really care to become chemically addicted to a drug either...went with Atarax instead...

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    Quote Originally Posted by LeanGuy View Post
    No offense taken. But SSRI's will be a very last resort for me. IMO there is a physiological reason for anxiety/insomnia, not all in the head. I think I'd rather live with the symptoms than add sexual sides etc. from a SSRI. That would bring on depression
    SSRIs made my anxiety WORSE...I know everyone is different but one of the possible side effects of SSRIs is increased anxiety...and I found myself jumping over anything and everything...but other than that made me not give too shyts about anything...I wasn't happy, nor sad...just neutral about life. Some people actually dose an SSRI every other day to every other 3 days so not have the full sexual suppression but still had some benefits from the drug...some even do this to be able to last longer haha

    And NO, I'll never take an SSRI again...

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    Quote Originally Posted by maynehood171 View Post
    SSRIs made my anxiety WORSE...I know everyone is different but one of the possible side effects of SSRIs is increased anxiety...and I found myself jumping over anything and everything...but other than that made me not give too shyts about anything...I wasn't happy, nor sad...just neutral about life. Some people actually dose an SSRI every other day to every other 3 days so not have the full sexual suppression but still had some benefits from the drug...some even do this to be able to last longer haha

    And NO, I'll never take an SSRI again...

    Exactly, SSRI's are for depression, not anxiety. I have been taking my 25mg trazodone at night, and the anti-anxiety effect seems to last into the next day. It is a good script with few sides. This works for me until I get my metabolic testing done.

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    Quote Originally Posted by LeanGuy View Post
    Exactly, SSRI's are for depression, not anxiety. I have been taking my 25mg trazodone at night, and the anti-anxiety effect seems to last into the next day. It is a good script with few sides. This works for me until I get my metabolic testing done.
    ...I probably should have stated that I took it for depression but made my anxiety worse...

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    UPDATE: Just found out that I have a gluten sensitivity, and it can cause neurological symptoms and low serotonin... going gluten-free for awhile to see how I feel.

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    Yeah, gluten/celiac can really mess you up. I tried to help a gal friend of mine for over a year and nothing worked until we found out she was celiac. Now she's golden.

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