question: How is the level of serotonin measured in a depressed patient?
comment: They don’t measure it for depressed people in a clinical setting- I’m not sure if it would even be possible. The idea that depression is caused by chemical imbalances actually evolved from the fact that meds that affect the concentration of those chemicals can also act as anti-depressants. Basically we accidentally found some meds that work and came up with an explanation for why. Depression is complicated and we don’t understand it.
passages: The neurons of the raphe nuclei are the principal source of 5-HT release in the brain.
  
  There are nine raphe nuclei, designated B1-B9, which contain the majority of serotonin-containing neurons (some scientists chose to group the "nuclei raphes lineares" into one nucleus), all of which are located along the midline of the brainstem, and centered on the reticular formation.
   There is no specific test for diagnose serotonin syndrome. Diagnosis is by symptom observation and investigation of the person's history. Several criteria have been proposed. The first evaluated criteria were introduced in 1991 by Harvey Sternbach. Researchers later developed the Hunter Toxicity Criteria Decision Rules, which have better sensitivity and specificity, 84% and 97%, respectively, when compared with the gold standard of diagnosis by a medical toxicologist. As of 2007, Sternbach's criteria were still the most commonly used.
   The most widely recognized example of serotonin syndrome was the death of Libby Zion in 1984. Zion was a freshman at Bennington College at her death on March 5, 1984, at age 18. She died within 8 hours of her emergency admission to the New York Hospital Cornell Medical Center. She had an ongoing history of depression, and came to the Manhattan hospital on the evening of March 4, 1984, with a fever, agitation and "strange jerking motions" of her body. She also seemed disoriented at times. The emergency room physicians were unable to diagnose her condition definitively but admitted her for hydration and observation. Her death was caused by a combination of pethidine and phenelzine. A medical intern prescribed the pethidine. The case influenced graduate medical education and residency work hours. Limits were set on working hours for medical postgraduates, commonly referred to as interns or residents, in hospital training programs, and they also now require closer senior physician supervision.
   Initial treatment consists of discontinuing medications which may be contributing. In those who are agitated, benzodiazepines may be used. If this is not sufficient, a serotonin antagonist such as cyproheptadine may be used. In those with a high body temperature active cooling measures may be needed. The number of cases of serotonin syndrome that occur each year is unclear. With appropriate treatment the risk of death is less than one percent. The high-profile case of Libby Zion, who is generally accepted to have died from serotonin syndrome, resulted in changes to graduate medical education in New York State.
   The most common used method of measuring depression for many studies on Chinese elderly is the Geriatric Depression Scale (GDS) by Yesavage & Brink. The Chinese version of the GDS was translated by Chu Lee Hing of the Chinese University of Hong Kong. A study in Hong Kong found its "[brief] and simple response format [to be] particularly favourable for use among the elderly" and was found to be "satisfactory" for screening depression in elderly Chinese.
   In level one, patients received the selective serotonin reuptake inhibitor (SSRI) citalopram for up to 14 weeks, with adjustment of the dose being managed by their own physicians. If patients achieved remission or response during that time period, they could enter a 12-month naturalistic follow-up, during which time the researchers did not have any influence over the treatment plan. Non-remitters were encouraged to enter level two.
   Section::::Pathophysiology.:Spectrum concept.
  
  A postulated "spectrum concept" of serotonin toxicity emphasises the role that progressively increasing serotonin levels play in mediating the clinical picture as side effects merge into toxicity. The dose-effect relationship is the effects of progressive elevation of serotonin, either by raising the dose of one drug, or combining it with another serotonergic drug which may produce large elevations in serotonin levels. Some experts prefer the terms serotonin toxicity or serotonin toxidrome, to more accurately reflect that it is a form of poisoning.
  
  Section::::Diagnosis.
   The Primary Care Evaluation of Mental Disorders (PRIME-MD) is completed by the patient and a researcher. This depression rating scale includes a 27-item screening questionnaire and follow-up clinician interview designed to facilitate the diagnosis of common mental disorders in primary care. Its lengthy administration time has limited its clinical usefulness; it has been replaced by the Patient Health Questionnaire.
  
  Section::::Usefulness.
   Serotonin (novel)
  
  Serotonin () is a novel by French writer Michel Houellebecq, published in January 2019.
  
  Section::::Plot.
  
  The book is a first-person narrative. A depressed agricultural scientist, Florent-Claude Labrouste, is living in a brutalist Parisian apartment block (the Tour Totem) but commuting to Normandy to help promote French cheese. He is sympathetic to the plight of local farmers but powerless to help them retain their traditional methods:
   The DASB image from a human PET scan shows high binding in the midbrain, thalamus and striatum, moderate binding in the medial temporal lobe and anterior cingulate, and low binding in neocortex.
  
  The cerebellum is often regarded as a region with no specific serotonin transporter binding and the brain region is used as a reference in some studies.
  
  Since the serotonin transporter is the target of SSRIs used in the treatment of major depression it has been natural to examine DASB binding in depressed patients.
  
  Several such research studies have been performed.
   Carlat has argued that psychiatry has been inconclusive about how and why it works: "We don't have any direct evidence that depression or anxiety or any psychiatric disorder is due to a deficiency in serotonin because it's very hard to actually measure serotonin from a living brain. Any efforts that have been made to measure serotonin indirectly — such as measuring it in the spinal fluid or doing post-mortem studies — have been inconclusive. They have not shown conclusively that there is either too little or too much serotonin in the fluids. So that's where we are with psychiatry. ... In cardiology, we have a good understanding of how the heart pumps, what electrical signals generate electricity in the heart. And due to that understanding, we can then target specific cardiac medications to treat problems like heart failure or heart attacks... not perfect, but pretty well worked out."
   The most important symptoms for diagnosing serotonin syndrome are tremor, extreme aggressiveness, akathisia, or clonus (spontaneous, inducible and ocular). Physical examination of the patient should include assessment of deep-tendon reflexes and muscle rigidity, the dryness of the mucosa of the mouth, the size and reactivity of the pupils, the intensity of bowel sounds, skin color, and the presence or absence of sweating. The patient's history also plays an important role in diagnosis, investigations should include inquiries about the use of prescription and over-the-counter drugs, illicit substances, and dietary supplements, as all these agents have been implicated in the development of serotonin syndrome. To fulfill the Hunter Criteria, a patient must have taken a serotonergic agent and meet one of the following conditions:
   BULLET::::- Clinically Useful Psychiatric Scales: HAM-D (Hamilton Depression Rating Scale). Accessed March 6, 2009.
  
  BULLET::::- Hamilton Depression Rating Scale - Original scientific paper published in 1960 "in" Psychiatry out of Print website. Accessed June 27, 2008.
  
  BULLET::::- Commentary on the HRSD by Max Hamilton, July 10, 1981, "in" "This Week's Citation Classic", Current Contents 33: 325 (August 17, 1981), "in" website of Eugene Garfield, Ph.D.. Accessed June 27, 2008.
   Section::::Perception of resource availability.:Outside the nervous system.:Bone metabolism.
   Section::::Scales completed by patients.
  
  Some depression rating scales are completed by patients. The Beck Depression Inventory, for example, is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex, and feelings of guilt, hopelessness or fear of being punished. The scale is completed by patients to identify the presence and severity of symptoms consistent with the DSM-IV diagnostic criteria. The Beck Depression Inventory was originally designed by psychiatrist Aaron T. Beck in 1961.
   Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects. In practice, such toxic levels are essentially impossible to reach through an overdose of a single antidepressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI. The intensity of the symptoms of serotonin syndrome vary over a wide spectrum, and the milder forms are seen even at nontoxic levels.
  
  Section::::Pharmacology.:Antiemetics.
   BULLET::::- In 2016 a study criticized the effects of the FDA Black Box suicide warning inclusion in the prescription. The authors discussed the suicide rates might increase also as a consequence of the warning.
  
  Section::::Side effects.:Pregnancy and breastfeeding.
   Serotonin is one compound of the poison contained in stinging nettles ("Urtica dioica"), where it causes pain on injection in the same manner as its presence in insect venoms (see below). It is also naturally found in "Paramuricea clavata", or the Red Sea Fan.
  
  Serotonin and tryptophan have been found in chocolate with varying cocoa contents. The highest serotonin content (2.93 µg/g) was found in chocolate with 85% cocoa, and the highest tryptophan content (13.27–13.34 µg/g) was found in 70–85% cocoa. The intermediate in the synthesis from tryptophan to serotonin, 5-hydroxytryptophan, was not found.
  
  Section::::Comparative biology and evolution.:Invertebrates.
   BULLET::::- Elevated serotonin transporter binding in major depressive disorder assessed using positron emission tomography and [11C]DASB; comparison with bipolar disorder. Cannon DM, Ichise M, Rollis D, Klaver JM, Gandhi SK, Charney DS, Manji HK, Drevets WC. Biological Psychiatry. 2007 Oct 15;62(8):870-7. Epub 2007 Aug 2.
   Studies of serotonin's primary metabolite 5-HIAA have been inconsistent, although limited evidence points towards reduced central serotonin signaling in a subgroup of aggressive or suicidal patients. Studies assessing the binding potential of the serotonin transporter or serotonin receptors have also been inconsistent, but generally point towards abnormal serotonin signalling. One study reported both increased SERT binding in the insula, mPFC, ACC and thalamus, and decreased SERT binding in the raphe nuclei in acutely depressed bipolar. Serotonin may play a role in mania by increasing the salience of stimuli related to reward.
   Serotonin levels in the human brain is measured indirectly by sampling cerebrospinal fluid for its main metabolite, 5-hydroxyindole-acetic acid, or by measuring the serotonin precursor, tryptophan. In one placebo controlled study funded by the National Institute of Health, tryptophan depletion was achieved, but they did not observe the anticipated depressive response. Similar studies aimed at increasing serotonin levels did not relieve symptoms of depression. At this time, decreased serotonin levels in the brain and symptoms of depression have not been linked
   Unlike many other similar instruments, the MDI is available free of charge and can be downloaded from the internet with a full manual and scoring instructions. This makes it an attractive option in epidemiological population surveys. It has also been translated into seven languages.
  
  Section::::Scoring.
  
  To measure treatment outcome the sum of the ten items is used. A higher score signifies deeper depression.
  
  When using the scale to diagnose depression according to ICD-10, there are the following possibilities:
   Serotonin is used by a variety of single-cell organisms for various purposes. SSRIs have been found to be toxic to algae. The gastrointestinal parasite "Entamoeba histolytica" secretes serotonin, causing a sustained secretory diarrhea in some people. Patients infected with "E. histolytica" have been found to have highly elevated serum serotonin levels, which returned to normal following resolution of the infection. "E. histolytica" also responds to the presence of serotonin by becoming more virulent. This means serotonin secretion not only serves to increase the spread of enteamoebas by giving the host diarrhea but also serves to coordinate their behaviour according to their population density, a phenomenon known as quorum sensing. Outside the gut of a host, there is nothing that the entoamoebas provoke to release serotonin, hence the serotonin concentration is very low. Low serotonin signals to the entoamoebas they are outside a host and they become less virulent to conserve energy. When they enter a new host, they multiply in the gut, and become more virulent as the enterochromaffine cells get provoked by them and the serotonin concentration increases.
   One study could see no difference in serotonin transporter availability between long/long and short/short homozygotes subjects among 96 subjects scanned with SPECT using the iodine-123 β-CIT radioligand.
  
  Using the PET radioligand carbon-11-labeled McN 5652 another research team could neither find any difference in serotonin transporter binding between genotype groups.
  
  Newer studies have used the radioligand carbon-11-labeled DASB 
  
  with one study finding higher serotonin transporter binding in the putamen of L homozygotes compared to other genotypes.
  
  Another study with similar radioligand and genotype comparison found higher binding in the midbrain.
   Section::::Management.:Agitation.
  
presuppositions: The level of serotonin in a depressed patient is measured. You can measure serotonin levels.
corrections: The level of serotonin in a depressed patient is not measured. You can not measure serotonin levels.
raw_presuppositions: The level of serotonin in a depressed patient is measured. You can measure serotonin levels.
raw_corrections: The level of serotonin in a depressed patient is not measured. You can not measure serotonin levels.