An award largely forgotten after the glutamate debacle, when some restaurants decided you can’t have too much of a good thing. Serotonin may be too old for the game after half a century of tri-cyclic and SNRI usage, and quite frankly has put on an embarrassing amount of weight. Bad press due to misbehavior by lookalike pregabalin is likely to rule out GABA. AcetylCholine is a bit too vague-as to set hearts racing, but quietly achieves reduced inflammatory cytokines. Norepinephrine (common misspelling of Noradrenaline) has been fighting for sympathetic following with its edgy, flighty manner and dopamine will need more vigilance if it’s to retain the award. The thoughtful amongst you always expected this winner, but dopamine addicts can unclench your jaw and relax now. Smoko, perhaps?

Besides aiding concentration, dopamine’s supporting role aka Prolactin Inhibitory Hormone breaks the pathway from leptin to inflammatory cytokine. Prolactin measures correlate with a bad prognosis in chronic Heart Failure, if the European Society of Cardiology is to be believed. Typical IL-6 levels in fibromites correspond to typical levels in New York Heart Association’s class II functionally limited. Diastolic HF in Chronic Fatigue is of concern to Miwa&Fujita, where ejection fraction is preserved but the ventricle muscle rebound is insufficient. The article in Healthcare for Women International where Leonard Jason found 20% of death certificates of CFS sufferers reported heart failure – at an age of 24 years less than the US national average will surely send chills, given the frequent syndrome coincidence of orthostatic intolerance with FM. And certainly a concern to fibromites, whose augmented prolactin response to Riedel’s or Malt & Ursin et al’s challenge test will send them to their prescribers for dopamine reuptake inhibitors (DRI). Pointless request however, they’re psycho-stimulants and perceived as likely to be abused – though you could have an opioid for pain instead! This reluctance is despite fatigue and concentration improvements from double-blind randomized clinical trials of the DRI methylphenidate for Chronic Fatigue Syndrome (Blockmans, van Houdenhove & Bobbaers or  Usón and Alecha). Pharmacotherapy solutions are actually quite a concern (doesn’t the MBBS degree cover iatrogenic issues at all?), for example amitriptyline. Despite already depleted CoQ10, fibromites are prescribed Endep which Prof Cordero has found exacerbates the problem*. CoQ10 is vital for heart muscle condition, and note that we haven’t yet considered CardioVascular Disease for which more unpleasant news was presented by Dana March of the CFInitiative this year. You’d have a coronary just thinking about it. All this risk in order to boost serotonin – neural levels of which can’t be ascertained, and serum levels don’t seem worth measuring!

Reader’s choice award for neurotranny of 2014 through your comments is eagerly awaited. But bear in mind that meddling via meds is dangerous.

*Oral treatment with amitriptyline induces coenzyme Q deficiency and oxidative stress in psychiatric patients