Serotonin/serotonergic system metabolism

Serotonin and catecholamine functions in the central nervous system are both diverse and complex, and direct assessment of central neurotransmitters by cfinical laboratory methods is currently limited. The effects, however, of central serotonergic, dopaminergic, and serotonergic systems on metabolic and hormonal function are routinely measured in the clinical laboratory, and many of the therapeutic and illicit drugs that modulate central monoamine neurotransmission are monitored by laboratory techniques in a wide range of clinical settings. 

Selective serotonin reuptake inhibitors. Currently available selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram. At present, expert opinion does not support the usefulness of these serotonergic compounds in the treatment of core ADHD symptoms (National Institute of Mental Health, 1996). Nevertheless, because of the high rates of comorbidity in ADHD, these compounds are frequently combined with effective anti-ADHD agents (see Combined Pharmacotherapy, below). Since many psychotropics are metabolized by the cytochrome P450 system (Nemeroff et ah, 1996), which in turn can be inhibited by the SSRIs, caution should be exercised when combining agents, such as the TCAs, with SSRIs. 

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