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What tests should be done to check the levels of serotonin and norepinephrine chemicals?

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Practicing since : 2003
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Question for Dr. Gyanshankar XXXXXXX
please guide how to proceed to check effectiveness for usage of Venlafexin -co Venlafexin xr 37.5 mg, means that what tests should be done to check the levels of Serotonin and Norepinephrine chemicals,these chemical are released by this medicine in brain etc.
Definitely excess presence of these chemicals must have side effects.There can be some dependable test which can be done for these chemicals.
Sleep specialist are in just in routine mood that to continue this medicine which is having some doubts keeping in view the present advancements of lab testings.
Posted Thu, 17 Jan 2013 in Lung and Chest disorders
Answered by Dr. Gyanshankar Mishra 17 hours later
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. Normally laboratory tests are not indicated in cases of patients on venlafexin.

2. It is from SSRI group of antidepressent medications.

3. Serotonin toxicity is one of the side effects of this drug though not so common and at present there is no lab test for its confirmation. It depends on the clinical symptoms which are based on presence of the following:

Spontaneous clonus, or
Inducible clonus plus agitation or diaphoresis, or
Ocular clonus plus agitation or diaphoresis, or
Tremor plus hyperreflexia, or
Hypertonism plus temperature > 38 °C (100 °F) plus ocular clonus or inducible clonus.

4. If the clinical adverse effects are not developing then you are probably on a safe dose and physician has titrated your dose correctly.

5. In academic research direct serum levels of the drug are measured at tertiary care advanced laboratories but these are mostly for research purposes.The therapeutic plasma/serum concentration of venlafaxine is approximately 0.2 mg/L.

6. Remember a golden rule in clinical medicine "treat the patint and not the reports". Thus if you have any symptoms then you need to report it to your doctor rather then trying to base treatment on mere investigations.

7. Also most of these neurotransmitter changes occur in the CNS and can be picked up by functional scans at higher centers.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.


Dr. Gyanshankar Mishra
Consultant Pulmonologist
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