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Troubleshooting Elevations in Serotonin and Dopamine
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By Heather Hydzik, ND | May 28, 2025
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When interpreting neurotransmitter reports, finding a solution for low levels can seem simple, but elevations in serotonin and dopamine may be surprising and trickier to treat, especially since we see this result less often. After a review of the signs and symptoms of this pattern, the potential causes, and considerations to address this imbalance, providers can be more prepared to respond to these results.
Elevated serotonin may present with anxiety, agitation, and even diarrhea. High serotonin can occur in conditions like schizophrenia and autism. Altered mental status, hyperreflexia, and autonomic instability should raise suspicion of serotonin syndrome.
Potential causes of high serotonin include:
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Supplementation with melatonin, tryptophan, 5-HTP
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Certain pharmaceuticals, especially when combined: anti-depressant medications, trazadone, triptans, dextromethorphan, opioids, antiemetics, lithium, linezolid, ritonavir, recent illicit drug use.
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Low protein/high carbohydrate meals, high insulin
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Exercise and bright outdoor light exposure increase serotonin levels
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Decreased monoamine oxidase (MAO) activity
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Gut dysbiosis can alter production and metabolism of serotonin
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Clostridia, staphylococcus, bifidobacterium and Enterococcus species can produce serotonin
Dopamine elevation may occur with symptoms and conditions like worry, distrust, social withdrawal, ADHD, OCD, acute stress, schizophrenia, manic states, pregnancy, and anticipation of a reward such as in drug addiction or gambling. Rare conditions associated with dopamine excess (which are beyond the scope of this article) include: in children – neuroblastoma, Costello syndrome, leukemia, pheochromocytoma, Menke’s disease, and rhabdosarcoma of the bladder; in adults – carcinoid tumor and pheochromocytoma.
Potential causes of dopamine elevation include:
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Supplementation with phenylalanine, tyrosine or Mucuna pruriens
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Pharmaceuticals such as NDRIs, SNRIs, Parkinson's medications (note: in these cases, elevated dopamine is the desired effect), dopamine agonists (as in the treatment of prolactinoma), MAOIs, recent illicit drug use
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Decreased catechol-O-methyltransferase (COMT) and or MAO activity
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Gut dysbiosis as certain bacteria can alter production, metabolism or conversion
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Staphylococcus, Bacillus, Proteus, Serratia, and Escherichia Clostridia overgrowth may slow the conversion of dopamine to norepinephrine.
A Comprehensive Neurotransmitter Profile can demonstrate if slower function of the COMT or MAO enzymes that break down serotonin and dopamine are contributing to elevations. Hormone imbalance involving lower testosterone and/or estrogen dominance is a common underlying cause of decreased function of both of these enzymes.
The following also decrease MAO function:
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Tobacco
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Caffeine
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Deficient iron, B2, B3
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Herbs: bilberry, curcumin, echinacea, evening primrose, licorice, rhodiola, St. John’s wort
These contribute to decreased COMT function
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Psychosocial stress, oxidative stress, toxins (metals, plastics, etc.), polypharmacy, insomnia, processed food, high sucrose diet, artificial sweeteners, leptin and insulin resistance
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Deficiency of magnesium, methylfolate, methylcobalamin, or methionine
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Genetic variant for COMT or MTHFR
Therapeutic considerations for elevated dopamine depend on the cause. Be sure to investigate and address the causes discussed here. Below are considerations to support the COMT and MAO enzyme.
COMT support:
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SAMe: 100-500 mg
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Mg: 150-500 mg
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MTHF: 400-5000 mcg
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Methylcobalamin:1000-5000 mcg
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Foods/herbs: cruciferous vegetables, soy foods (ex. genistein), resveratrol, citrus, rooibos, dandelion, rosemary, curcumin
MAO support:
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Vitamin B2: 50 mg (ideally riboflavin 5 phosphate)
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Vitamin B3: 100 mg
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Iron: if deficiency is confirmed via serum testing, 25-50 mg
Additional testing to consider when serotonin and or dopamine are elevated:
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- Salivary estradiol, progesterone, testosterone, and diurnal cortisol
- Test for genetic SNPs and function (DNA testing or functional methylation assessment)
- GI360 especially if digestive symptoms or poor diet are present or if there is lack of response to initial treatment
- Significant dopamine or serotonin elevations along with concerning signs or symptoms may warrant further workup, for example:
- Testing for pheochromocytoma
- Signs include episodic headache, sweating and tachycardia, hypertension or paroxysmal hypertension (although bp can be normal)
- Testing: If there is a low index of suspicion, 24-hour urinary fractionated catecholamines and metanephrines; if high index of suspicion - plasma fractionated metanephrines (drawn supine with an indwelling cannula for 30 minutes)
- Testing for carcinoid tumor
- Signs: Chronic flushing and/or diarrhea
- Test: 24-hour urine 5-HIAA
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Mildly elevated serotonin or dopamine in the absence of specific signs and symptoms should not be cause for concern. First, review medications and supplements; assess nutrition, digestion and stress. Then consider salivary hormone testing (Comprehensive Hormone Profile), stool microbiome profiling (GI360), and testing for genetic SNPs (DNA methylation). This will allow the provider to treat the underlying etiology to rebalance these neurotransmitters in order to address the patient’s concerns.
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References
1. Chen Y, Xu J, Chen Y. Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. 2021;13(6):2099. Published 2021 Jun 19. doi:10.3390/nu13062099
2. Potter, K., Gayle, E.J. & Deb, S. Effect of gut microbiome on serotonin metabolism: a personalized treatment approach. Naunyn-Schmiedeberg's Arch Pharmacol 397, 2589–2602 (2024). https://doi.org/10.1007/s00210-023-02762-5
3. Gutman E, Litvak Y. Gut dopamine kick: How gut microbes turn on host receptors to fight pathogens. Cell Host Microbe. 2024;32(5):623-624. doi:10.1016/j.chom.2024.04.011
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Precision Cardiometabolic Lab Markers for Prevention and Longevity
Presented by Heather Hydzik, ND | June 4, 2025 at 12 PM Pacific
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Cardiovascular disease is the leading cause of death worldwide yet is often preventable, emphasizing a need for better early screening measures. Major modifiable risk factors such as obesity, metabolic syndrome, hyperlipidemia, hypertension, poor nutrition and sedentary lifestyle are on the rise. While routine laboratory testing like fasting glucose and the lipid panel can fail to identify individuals at high risk of atherosclerosis and insulin resistance, advanced lipid testing and more modern metabolic and inflammatory lab markers can more precisely distinguish high risk patients for whom lifestyle changes and medications could increase lifespan and enhance the proportion of time spent in good health.
Through patient cases, we will discover how assessing levels of oxidized LDL-C, small dense LDL-C, non-HDL-C and apolipoprotein B provides a clearer representation of cardiovascular health than standard markers like LDL-C. Find early evidence of adverse metabolic health with leptin and 1,5-anhydroglucitol. Lastly, we will uncover how fad diets like ketogenic truly impact health. Learn to interpret precision cardiometabolic biomarkers and help patients gain control of their health today.
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Learning Objectives:
- Recognize the limitations of standard lipid panels and routine labs, and integrate advanced biomarkers to enhance early detection of cardiometabolic risk and guide personalized treatment strategies.
- Appreciate the contribution of nutrition and lifestyle to the balance between atherogenic and anti-atherogenic lipoproteins, to enable counsel on effective therapies including behavior change, supplementation, and medication.
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Mapping Risk: Leveraging the HuMap™ for Breast Cancer Insights
Presented by Ruth Hobson, ND | June 13, 2025 at 11:05 AM Pacific
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Join us for Fullscript Forward, a free, live, virtual event featuring industry leaders driving the future of healthcare and the field of whole person care.
This presentation explores the pathophysiology of breast cancer risk in menopause and introduces the HuMap™, a non-invasive tool for assessing urinary hormones and their metabolites. This presentation will explore phase I and phase II estrogen metabolism, emphasizing the significance of urinary hormone and metabolite testing for uncovering an individual's unique metabolic function. Assessing estrogen metabolite imbalance is a reasonable first step to developing an effective risk reduction strategy for these patients.
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Disclaimer: All information given about health conditions, treatment, products, and dosages are for educational purposes only and do not constitute medical advice.
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800.323.2784 (US and Canada)
+1.630.377.8139 (Global)
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