We’re midway through mentoring 2020 and we’ve temporarily shifted gear out of case presentations and into dedicated time for answering praccies toughest questions…and oh man, I love these opportunities!  This year in our Mental Health Primer Group, there are clinicians whose questioning…nEVeR sTOps. [insert: excited squeal] and that means I have an excuse to dig deeper, go further, read more research and ensure I can provide answers confident of their comprehensiveness and that they reflect all the contemporary information to date. So amongst stiff competition – here’s my favourite from the gIAnT piLE on my desk right now…

“We often hear that the bulk of our body’s serotonin is in our platelets – so do platelets (counts, activity etc) have a role in mental health?”

Well, I’m so glad you asked! Yes, 99% of your body’s serotonin is found inside your platelets.  Where did this come from?  From the plasma. How did it get there? Using the identical transporter mechanisms that your neurons do.  Sounds like all the pieces fit right…oooooh so low platelets might drive low serotonin and poor mood and and and…

No. 
You may get excited when you get a box of jigsaw pieces but you must first complete the puzzle and ensure everything is in its rightful place.

Platelets are linked to depression but not as a cause but as a consequence.  Because their transporter systems & receptors for serotonin are virtually identical to those in the CNS, they suffer from the same serotonin deficit…in spite of a relative abundance in the plasma they’re floating in.   So really platelets are of interest in mental health as a more accessible way of studying and understanding neurochemical regulation in the brains of those affected.  Did she just say neurochemicalS…as in, plural.  I sure did.  Because healthy platelets contain a whole plethora of substances, even a relatively large quantity BDNF, the concentration of which also becomes  severely compromised in the platelets of depressed individuals.  So it seems like its tough-talkin’ Tuesday and just to bust a few more moves myths while we’re here…

Your platelets get their 5HT from the plasma
Your neurons make it themselves
Platelet numbers are not indicative of your 5HT producing capacity…anywhere
Therefore treatment objectives that speak to platelet numbers or platelet activity are clearly non-sensical
A bit like measuring serotonin derivatives in your urine…and imagining that reflects the <1% from your CNS….hey?

Yes.  That’s what I said.  Want to learn more?  Please do. A great review paper by Marlene Williams, from the World Journal of Psychiatry, for starters, anyone? 🙂

If this last point is news to you…sounds like you really Need to Start  Here!  Accurate Pathology Interpretation

Don’t be fooled by the false promises of functional tests.  Make sure all the pieces of the puzzle fit to actually make something sensible, accurate, reproducible and meaningful. Mainstream pathology results actually offer a goldmine of information and insight about your patients However to realise their full value and make the most accurate interpretations we need to first learn more about ‘lab language’, upskill in finding our way around reports which are packed with a surprising amount of hidden extras, demystify reference ranges and then develop a logical critical process we can apply to every result of any patient to get the real take-home. Packaged with numerous specifically developed resources to aid in your application of these skills this is a foundational offering that changes practices.

%d bloggers like this: