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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on April 4, 2003, at 15:49:11
Of course I have no real proof,
but you kind of get this feeling.My only breakthrough mania happens
durring stressfull times (school
exams) My brain must be just squirting
the stuff out.Does anyone know when that cortisol
antagonist is coming out ??
Linkadge
Posted by Ron Hill on April 4, 2003, at 16:40:18
In reply to cortisol is the source of my problems, posted by linkadge on April 4, 2003, at 15:49:11
> Of course I have no real proof,
> but you kind of get this feeling.
Linkadge,Read the cortisol/DHEA articles linked in the following post provided by JLx:
http://www.dr-bob.org/babble/20030402/msgs/216217.html
If you want, you can get a saliva cortisol/DHEA test and you will know the answer.
-- Ron
Posted by worrier on April 4, 2003, at 19:25:58
In reply to cortisol is the source of my problems, posted by linkadge on April 4, 2003, at 15:49:11
> Of course I have no real proof,
> but you kind of get this feeling.
>
> My only breakthrough mania happens
> durring stressfull times (school
> exams) My brain must be just squirting
> the stuff out.
>
> Does anyone know when that cortisol
> antagonist is coming out ??
>
>
> Linkadge
>>Just want to say a big amen to your comments about cortisol. Recently had tests for blood and 24 hr urine cortisol levels...they were both elevated, my GP repeated the 24hr urine cortisol test during a period that my anxiety level was really high and suprise...the levels were even higher than the first time. I knew they would be because of my physical symptoms. Have an appointment with an endocrinologist the end of this month.Maybe she'll find something more concrete or at least have some suggestions for reducing this excess cortisol. My pdoc thinks the anxiety causes the elevated cortisol, not the other way around, but I have my doubts as the anxiety seems totally unrelated to actual life events. Anyway, to make a long story even longer I feel as you do that cortisol is the source of my problem. Good luck.
Posted by Frog on April 5, 2003, at 2:21:02
In reply to cortisol is the source of my problems, posted by linkadge on April 4, 2003, at 15:49:11
> Of course I have no real proof,
> but you kind of get this feeling.
>
> My only breakthrough mania happens
> durring stressfull times (school
> exams) My brain must be just squirting
> the stuff out.
>
> Does anyone know when that cortisol
> antagonist is coming out ??
>
>
> LinkadgeFor myself, I suffer from a major depression . Few months ago , I was advised to see an endocrinologist to get a full analysis of my metabolism to see if there was something wrong with it. Result showed that everything was fine except one thing : my cortisol rate was really high during a whole day (analysis was based on 24hr urine cortisol test)
He prescribed me another test(I had to take a special pill named "dectancyl" before that test ) to see if the problem was organic or functional , result showed that problem of cortisol being really high was due to surrenal gland dysfunction and not organic dysfunction.
He told me that high cortisol is representative of high stress and in my case it is a consequence . So he said it was useless to try meds that could lower my cortisol rate since it is the cause of my problem which needs to be fixed first, and the cause of my problem is major depression...
So , cortisol test (either 24h urine or blood) will show if high cortisol rate is due to functional or organic dysfunction of surrenal gland. If dysfunction is organic ,there are some drug that can fix that easily , if dysfunction is functional , it is not that easy...
Frog
Posted by Pfinstegg on April 5, 2003, at 17:24:25
In reply to Re: cortisol is the consequence of my problems, posted by Frog on April 5, 2003, at 2:21:02
Hi Frog..I think it's great to have gone to an endocrinologist, but I was a bit disappointed by the answers he gave you. Because of stress/depression, you now have HPA axis dysregulation, with overactive CRF production by your hypothalamus, excessive ACTH production by your pituitary, and excessive cortisol production by your adrenal glands. Your adrenals may have become excessively large because of chronic over-stimulation by ACTH, and, in turn, they are now producing too much cortisol, which is preventing the normal daily birth of new cells in your hippocampus, is damaging the neuroreceptors there, and making the hippocampus unable to tell your hypothalamus to turn everything down.
It's true that it's not easy at all. But there are lots of things which will turn down parts of this cycle, and if you do several of them, you may be able to at least partially reverse the HPA axis dysregulation. A few suggestions- and I hope others on the board will add to these-
1. Take all the vitamins and supplements which are thought to be neuroprotective, such as fish oil, B vitamins, alpha lipoic acid, phosphadatyl serine and 7-keto DHEA
2. Consider AD's which are thought to have neuroprotective qualities, such as lithium- perhaps in low doses. Tianeptine, available in Europe,has been shown to protect rat and tree shrew hippocampuses from damage caused by cortisol. In animal studiers, it prevents neuron loss, and allows the daily creation of new neurons to continue even when cortisol levels are high. Some neuroscientists are thinking that it is the daily birth of new neurons in the hippocampus which prevents depression from occurring.
Currently, a lot of the "regular" AD's are being evaluated for their neuroprotective effects, and we should soon know more about which ones do a good job.3. Look up the studies currently being done at Stanford and NIH on the use of mefipristone in depression associated with high cortisol levels. They have reported very dramatic results. It is a short-term treatment- I think it's 7-10 days, and I don't know how they manage long-term treatment. Still, these studies are considered very promising- they are "fast-tracked" by the FDA- and they would seem to meet your situation.
4. Get familiar with what ECT and TMS can do. They have the same effect of increasing neurogenesis, calming HPA over-activity, and increasing blood flow to the left hippocampus and frontal lobe.
5. Don't forget psychotherapy! A good therapist can help you learn gradually how to prevent the hyperrousal which gets all these unwanted physiological reactions going.
Good luck! And be sure to let us know what you decide upon- and what you think works.
Pfinstegg
Posted by Edgefield on April 5, 2003, at 18:49:44
In reply to Re: cortisol is the source of my problems, posted by worrier on April 4, 2003, at 19:25:58
Since all of this is new to me...could you please tell me what if anything can be done by the endocrinologist to lessen the cortisol levels?
God Bless
Edgefields
> > Of course I have no real proof,
> > but you kind of get this feeling.
> >
> > My only breakthrough mania happens
> > durring stressfull times (school
> > exams) My brain must be just squirting
> > the stuff out.
> >
> > Does anyone know when that cortisol
> > antagonist is coming out ??
> >
> >
> > Linkadge
> >
>
> >Just want to say a big amen to your comments about cortisol. Recently had tests for blood and 24 hr urine cortisol levels...they were both elevated, my GP repeated the 24hr urine cortisol test during a period that my anxiety level was really high and suprise...the levels were even higher than the first time. I knew they would be because of my physical symptoms. Have an appointment with an endocrinologist the end of this month.Maybe she'll find something more concrete or at least have some suggestions for reducing this excess cortisol. My pdoc thinks the anxiety causes the elevated cortisol, not the other way around, but I have my doubts as the anxiety seems totally unrelated to actual life events. Anyway, to make a long story even longer I feel as you do that cortisol is the source of my problem. Good luck.
Posted by Edgefield on April 5, 2003, at 18:58:35
In reply to Re: cortisol is the consequence of my problems, posted by Frog on April 5, 2003, at 2:21:02
Thanks for this information. So I need to check with my endocrinologist to find out if the dyfunction is organic or functional.....
God Bless
Edgefield
> > Of course I have no real proof,
> > but you kind of get this feeling.
> >
> > My only breakthrough mania happens
> > durring stressfull times (school
> > exams) My brain must be just squirting
> > the stuff out.
> >
> > Does anyone know when that cortisol
> > antagonist is coming out ??
> >
> >
> > Linkadge
>
> For myself, I suffer from a major depression . Few months ago , I was advised to see an endocrinologist to get a full analysis of my metabolism to see if there was something wrong with it. Result showed that everything was fine except one thing : my cortisol rate was really high during a whole day (analysis was based on 24hr urine cortisol test)
>
> He prescribed me another test(I had to take a special pill named "dectancyl" before that test ) to see if the problem was organic or functional , result showed that problem of cortisol being really high was due to surrenal gland dysfunction and not organic dysfunction.
>
> He told me that high cortisol is representative of high stress and in my case it is a consequence . So he said it was useless to try meds that could lower my cortisol rate since it is the cause of my problem which needs to be fixed first, and the cause of my problem is major depression...
>
> So , cortisol test (either 24h urine or blood) will show if high cortisol rate is due to functional or organic dysfunction of surrenal gland. If dysfunction is organic ,there are some drug that can fix that easily , if dysfunction is functional , it is not that easy...
>
> Frog
>
Posted by Pfinstegg on April 5, 2003, at 19:14:34
In reply to Re: cortisol is the source of my problems » worrier, posted by Edgefield on April 5, 2003, at 18:49:44
The two things that I know of that an andocrinologist can do is to prescribe ketanozodole or mefipristone. Ketanozodole is effective, but can be dangerous to your liver. I think mefipristone is much safer. It is also known as RU-485- the abortion drug. It has been given safely (although briefly) for this purpose for a number of years. In order to give it for another use, such as excessive cortisol due to HPA axis dysregulation(i.e. depression), your endocrinologist has to apply directly to Danco Laboratories, and receive permission to obtain the drug from them. It is still under investigation at Stanford and NIH for this use, and doctors in private practice may want to await the results of these studies before using it. If you are interested in mifepristone, you could contact the principle investigators of the studies to get as much information as possible. You might want to join one of the studies, which are not lengthy. Of course, one never knows whether drugs in these studies actually pan out, but mefipristone is the only antidepressant which the FDA has ever fast-tracked, so there is a lot of hope for it for people with depression associated with high 24-hour cortisols. I think it is in Phase 3 now- the last step before approval.
Pfinstegg
Posted by Pfinstegg on April 5, 2003, at 19:32:43
In reply to Re: cortisol is the consequence of my problems » Frog, posted by Edgefield on April 5, 2003, at 18:58:35
That way of thinking- that something is either organic or functional- really isn't useful in psychiatry. We all have mood disorders which began with a psychological cause, but over time, the effect on our brains is physical, with various disabling psychological symptoms- depression, anxiety, panic etc. When scientists begin to look closely, they find the physical abnormalities underlying these psychological symptoms- a small left hippocampus, decreased blood flow in the left frontal and hippocampal regions, an absence of new nerve cell formation in the hippocampus (as normally occurs throughout life), damaged receptors in the hippocampus, elevated 24-hour cortisols, and DST non-suppression.
However, the endocrinologists are probably making a distinction between the clinical picture I just described, which they consider "functional", and cortisol abnormalities brought on by something like adrenal cancer, which they would label "organic".
But from your point of view, you have an illness with psychological and physical components, both aspects of which should be treated.
Pfinstegg
Posted by glenn on April 6, 2003, at 8:47:01
In reply to Re: cortisol is the consequence of my problems » Edgefield, posted by Pfinstegg on April 5, 2003, at 19:32:43
As is normally the case I can but agree with the wisdom of the marvellous pfinstegg!
In my case I would say that I always did have a sensitive switch, or more precisely a slow and poor cortisol shutdown mechanism which responded strongly to stress.
However there is ia big difference when it totally breaks down, at that point having lots of horrible cortisol stimulation becomes the norm, like your thermostat having been permanently pushed up 20 degrees, or at least that's how it feels for me!
I can only add that seriphos is a cheaper and possibly more efficient anti cortisol than phosphatidylserine anmd that some form of relaxation/ meditation has been shown to help over the longer term and I do notice a definite difference over a few weeks.
You could look at the Centrepointe programme which I am currently doing, but be warned for once their hype may be correct, it beats straight meditation hands down from what I can see but may " bring up uncomfortable stuff" not terrible but certainly not what you might expect.Good Luck
ps If pfinstegg reads this I hope your husband is still doing well.
Glenn xxx
Posted by Edgefield on April 6, 2003, at 12:50:50
In reply to Re: cortisol is the consequence of my problems, posted by glenn on April 6, 2003, at 8:47:01
Thanks for the information everyone. May I ask if pfinstegg is a doctor? I'm new here.
God Bless
Edgefield
> As is normally the case I can but agree with the wisdom of the marvellous pfinstegg!
> In my case I would say that I always did have a sensitive switch, or more precisely a slow and poor cortisol shutdown mechanism which responded strongly to stress.
> However there is ia big difference when it totally breaks down, at that point having lots of horrible cortisol stimulation becomes the norm, like your thermostat having been permanently pushed up 20 degrees, or at least that's how it feels for me!
> I can only add that seriphos is a cheaper and possibly more efficient anti cortisol than phosphatidylserine anmd that some form of relaxation/ meditation has been shown to help over the longer term and I do notice a definite difference over a few weeks.
> You could look at the Centrepointe programme which I am currently doing, but be warned for once their hype may be correct, it beats straight meditation hands down from what I can see but may " bring up uncomfortable stuff" not terrible but certainly not what you might expect.
>
> Good Luck
>
> ps If pfinstegg reads this I hope your husband is still doing well.
>
> Glenn xxx
Posted by JLx on April 6, 2003, at 13:52:29
In reply to cortisol is the source of my problems, posted by linkadge on April 4, 2003, at 15:49:11
I suggest the new book "The Cortisol Connection" by Shawn Talbott, for a lot of practical suggestions other than drugs, such as phytosterols, epimedium, and magnolia bark to lower cortisol levels. I got mine from the library but I can see it's a good book to own. Here's his website:
http://www.cortisolconnection.com/index.php
One of the other things he recommends is sleep, especially before midnight, and explains why in terms of the diurnal cortisol fluctuations. I've always been a nightowl, but am now trying very hard to get to sleep at 10 PM.
Here's a good, succinct article on stress, cortisol, and diet from a UK newspaper with commentary from a nutrition center in London:
http://www.thefooddoctor.com/displayarticle_HV.htm?ArticleID=149
Are you getting enough Vit C, B's, and magnesium? Is your diet too acidic? Are you eating sugar, caffeine, too much salt?
This is another interesting article, this time more specifically on hypoglycemia and the cortisol connection:
http://www.hyperemesis.org/misc_reference_info.htm
I recently started supplementing with magnesium glycinate and felt so much better in one day that I quit my meds (Zoloft,Provigil) and since then have made changes to my diet that I could never have imagined making so painlessly before. And I now feel better than I have since I was a kid. :)
As hard as it would have been for me to admit in the past, I think now that many if not all of our mental problems are diet related.
Posted by Frog on April 6, 2003, at 16:38:44
In reply to Re: cortisol is the consequence of my problems » Frog, posted by Pfinstegg on April 5, 2003, at 17:24:25
Hello Pfinstegg,
Thank you very much for your advice , I am taking note of it.
I am going to tell a bit about myself so that you can see exactly my situation. I suffer from major depression since at least 5 years(at the beginning the depression was not so major)and this is only recently (november 2002) that I was daignosed with this disease. The main symptoms I have are : Extreme fatigue 24/7 (I am perfectly able to distinguish mental fatigue from physical fatigue) , unable to concentrate, loss of interest in everything I used to enjoy in the past...
Since then , I have been on various antidepressant (Prozac, Effexor, Anafranil , Seroxat , Ixel) but noone has worked for me , I only got various side effect..
Now regarding suggestions you have mentionned :> 1. Take all the vitamins and supplements which are thought to be neuroprotective, such as fish oil, B vitamins, alpha lipoic acid, phosphadatyl serine and 7-keto DHEA
>Ok , I think it would be interesting to look in that way . I also remember seeing that “ketoconazole” could have antidepressant effect by lowering cortisol levels. I read that in the book of Andrew Solomon “The noonday demon”
> 2. Consider AD's which are thought to have neuroprotective qualities, such as lithium- perhaps in low doses. Tianeptine, available in Europe,has been shown to protect rat and tree shrew hippocampuses from damage caused by cortisol. In animal studiers, it prevents neuron loss, and allows the daily creation of new neurons to continue even when cortisol levels are high. Some neuroscientists are thinking that it is the daily birth of new neurons in the hippocampus which prevents depression from occurring.
> Currently, a lot of the "regular" AD's are being evaluated for their neuroprotective effects, and we should soon know more about which ones do a good job.
>Tianeptine is known as Stablon here , and I did know until you mentionned it that could have good effect in lowering cortisol . Therefore, I will definately give a go to this drug if my current antidepressant fails.
> 3. Look up the studies currently being done at Stanford and NIH on the use of mefipristone in depression associated with high cortisol levels. They have reported very dramatic results. It is a short-term treatment- I think it's 7-10 days, and I don't know how they manage long-term treatment. Still, these studies are considered very promising- they are "fast-tracked" by the FDA- and they would seem to meet your situation.
>Those studies seems to be very promising if it has an antidepressant effect and can also deal with high cortisol levels , I hope that this drug would also get approval in Europe too since I am european.
> 4. Get familiar with what ECT and TMS can do. They have the same effect of increasing neurogenesis, calming HPA over-activity, and increasing blood flow to the left hippocampus and frontal lobe.
>Regarding TMS , I read in a book that it was effective but mainly for low/mild depression . About ECT , it is said to be very fast and powerful for major/atypical depression. Before trying such therapy , I really hope that I could find a solution among drug available before.
> 5. Don't forget psychotherapy! A good therapist can help you learn gradually how to prevent the hyperrousal which gets all these unwanted physiological reactions going.
>
> Good luck! And be sure to let us know what you decide upon- and what you think works.
>Thank you very much for your support Pfinstegg , at the moment I am on Marsilid(50mg/day) since 4 days and I really hope this drug will be the right one for me.
Frog
Posted by Pfinstegg on April 6, 2003, at 16:48:00
In reply to Re: cortisol is the consequence of my problems » glenn, posted by Edgefield on April 6, 2003, at 12:50:50
Glenn (you darling!)- nice to hear from you! And thank you for your kind and generous words. I did forget to mention meditation, but it should definitely be included in the list of things to help lower cortisol. I'm not familiar with Seraphos, but it's true that phosphadatylserine is expensive, especially if you're going to take it for an extended period. The Centrepointe programme is also unfamiliar- can you tell us a little about it?
You are so kind to remember about my husband- he has another month of radiation to undergo for locally recurrent prostate cancer, but has a hopeful prognosis and is doing the whole thing in good style.
Edgefield.. I am a doctor, but until I got onto PB, and began reading what others had learned about depression and anxiety, and then began looking up the references on Medscape, Medline and PubMed, I was just like everyone else here, being given one AD after another, none of which ever got me close to a remission, having some awful side effects, and not understanding anything about what PTSD had done to my brain. I feel that I have learned almost a lifetime of information from six months on this board, and am so grateful to all the wonderful people who contribute here. I never learned ANY of this in medical school or residency training- the playing field is truly level!
JLx..the book and articles you recommended all look very valuable; I just ordered "The Cortisol Connection", which I have seen mentioned here several times. Just the concept that we can all do some things to help us take control of our cortisol levels is so encouraging. I was particularly interested in what a good response you have had to magnesium glycinate. I am taking it, too, and think it is very helpful- but forgot to mention it! I find I am also doing much better off the regular AD's, and taking fish oil, B vitamins, 7-keto DHEA, alpha-lipoic acid, phosphadadylserine, magnesium,Cytomel- and the oddball AD tianeptine. I had TMS also, in January- it really got me into a real remission for the first time in many years.
It's wonderful to hear from all of you!
Pfinstegg
Posted by Pfinstegg on April 6, 2003, at 17:26:12
In reply to Re: cortisol is the consequence of my problems, posted by Frog on April 6, 2003, at 16:38:44
Dear Frog - thank you for your reply, and for giving us more information about yourself. I hope the Marsilid will prove to be helpful. I believe that, like other MAOI's, it increases the levels of all three neurotransmitters- serotonin, norepinephrine and dopamine- so it may work well.
I am under the impression that mefipristone is much more readily available in Europe than it is here- and has been used more often for Cushing's Disease. You could be said to have "pseudo-Cushing's Syndrome". Even though the cause is not a tumor, the drug treatment would be the same. I would really try to choose that one over ketanozodole, as you always have to worry about your liver function with ketanozodole, and mefipristone has such a good safety profile.
I do wish you the very best in getting into a full remission- and hope you will keep us informed about what treatments you decide upon.
Pfinstegg
Posted by Edgefield on April 6, 2003, at 17:45:04
In reply to Re: in reply: Glenn, Edgefield and JLx, posted by Pfinstegg on April 6, 2003, at 16:48:00
Thank you for replying. As I've said before I'm new to all of this...what is TMS?
Thanks!
God Bless
Edgefield
> Glenn (you darling!)- nice to hear from you! And thank you for your kind and generous words. I did forget to mention meditation, but it should definitely be included in the list of things to help lower cortisol. I'm not familiar with Seraphos, but it's true that phosphadatylserine is expensive, especially if you're going to take it for an extended period. The Centrepointe programme is also unfamiliar- can you tell us a little about it?
>
> You are so kind to remember about my husband- he has another month of radiation to undergo for locally recurrent prostate cancer, but has a hopeful prognosis and is doing the whole thing in good style.
>
> Edgefield.. I am a doctor, but until I got onto PB, and began reading what others had learned about depression and anxiety, and then began looking up the references on Medscape, Medline and PubMed, I was just like everyone else here, being given one AD after another, none of which ever got me close to a remission, having some awful side effects, and not understanding anything about what PTSD had done to my brain. I feel that I have learned almost a lifetime of information from six months on this board, and am so grateful to all the wonderful people who contribute here. I never learned ANY of this in medical school or residency training- the playing field is truly level!
>
> JLx..the book and articles you recommended all look very valuable; I just ordered "The Cortisol Connection", which I have seen mentioned here several times. Just the concept that we can all do some things to help us take control of our cortisol levels is so encouraging. I was particularly interested in what a good response you have had to magnesium glycinate. I am taking it, too, and think it is very helpful- but forgot to mention it! I find I am also doing much better off the regular AD's, and taking fish oil, B vitamins, 7-keto DHEA, alpha-lipoic acid, phosphadadylserine, magnesium,Cytomel- and the oddball AD tianeptine. I had TMS also, in January- it really got me into a real remission for the first time in many years.
>
> It's wonderful to hear from all of you!
>
> Pfinstegg
Posted by Pfinstegg on April 6, 2003, at 18:01:16
In reply to Re: in reply: Glenn, Edgefield and JLx » Pfinstegg, posted by Edgefield on April 6, 2003, at 17:45:04
TMS is short for Transcranial Magnetic Stimulation. It is similiar to ECT, except that an electromagnetic wave rather than an electrical current is used. It is about equivalent in effectiveness to ECT, but has the advantage of not requiring anesthesia, not causing a seizure, and not causing short-term memory loss. It is not yet FDA-approved, but there are a few doctors in the US who give it in their private practices. We had quite an extensive discussion about it approximately a week ago on PB, so you could look that up for further information- it's a bit above these entries.
Pfinstegg
Posted by Pfinstegg on April 6, 2003, at 18:32:50
In reply to Re: in reply: Glenn, Edgefield and JLx » Pfinstegg, posted by Edgefield on April 6, 2003, at 17:45:04
The thread I was referring to is "rTMS available non-experimentally?" posted by Dave1 March 28,2003 at 14:50:49
Pfinstegg
Posted by Frog on April 7, 2003, at 12:28:41
In reply to Re: cortisol is the consequence of my problems » Frog, posted by Pfinstegg on April 6, 2003, at 17:26:12
Dear Pfinstegg ,
Regarding Marsilid , yes it increases the levels of all three neurotransmitters- serotonin, norepinephrine and dopamine.
The good thing at the moment is that I don't have any side effect at all , with my past experience with other antidepressant suchs as Prozac, Effexor, Seroxat, Ixel, Anafranil : I was always having at least one side effect.>I am under the impression that Mifepristone is much more readily available in Europe than it is here- and has been used more often for Cushing's >Disease.
In your previous message , I thought you were saying that a new antidepressant will be released based on Mifepristone molecule , but I just realised that is in fact mefipristone itself that has been used as an antidepressant and have shown dramatical result. And yes , I can confirm that this pill is available here(France), this pill is also known as RU-486 or "abortion pill".
> You could be said to have "pseudo-Cushing's Syndrome". Even though the cause is not a tumor, the drug treatment would be the same. I would >really try to choose that one over ketanozodole, as you always have to worry about your liver function with ketanozodole, and mefipristone has >such a good safety profile.
Regarding Cushin's Syndrome , I thought of that idea when I see I got high levels of cortisol (after 24h urine test).I am about to do another cortisol test on Wednesday at 08:00 am (cortisol reaches its peak at this time) but result could not be so exact since I am on Marsilid.
About mifepristone pill , I am really interested in this pill but I am also sceptic for my situation , I read that depressed people who tried Mifepristone had to follow this treatment with conventional antidepressant(after Mifepristone relieves depression) for having a consolidation of their state.
So , if I have well understand , Mifepristone can lower dramatically cortisol levels and it because those cortisol levels are lowered(and therefore become normal)that conventionnal antidepressant can make positive effect.
Would it mean that all antidepressant that I took in the past could work well on me after having a Mifepristone treatment ?>I do wish you the very best in getting into a full remission- and hope you will keep us informed about what treatments you decide upon.
Thanks for your support , as I said above , it is today my 5th day on Marsilid 50mg , no side effect at all , Maoi Diet is fine too , well I just need to wait....
Frog.
Posted by Pfinstegg on April 7, 2003, at 16:03:37
In reply to Mifepristone question » Pfinstegg, posted by Frog on April 7, 2003, at 12:28:41
Dear Frog..it's good to hear that you are not having any side effects from the Marsilid. Although we here in the US have the MAOIs Parnate and Nardil, we are not familiar with Marsilid. I do not have any personal experience with the MAOIs, but have you noticed how many favorable reports there are about them here on Psychobabble? I hope you also have a very good and successful experience.
My understanding of mifepristone is that it is an excellent 7-10 day treatment to bring people out of a severe depression by lowering their 24-hour cortisols to normal, and it's in accord with what you say- that people afterwards need maintenance treatment with an anti-depressant. Your endocrinologist will know for sure, but I think a course of mifepristone, which is a form of sex hormone, could safely be followed by Marsilid.
As you know, there are two ways to study cortisol levels: the first is the 24-hour cortisol; when this is elevated, which happens only in a small percentage of depressed people, it means that the depression is quite severe. The second way is the Dexamethasone Suppression test. You take a baseline 8 AM serum cortisol, then, that night, you take 1 mg. of Dexamethasone. The following morning you take another 8 AM serum cortisol. A normal reading on the second morning would be 5 or less. If it is greater than 5, and especially if it is just the same as it was on the first morning, you have Dexamethasone non-suppression which is the hallmark of over-reactivity of your Hypothalamic-Pituitary-Adrenal Axis, and the most common endocrine finding in depression. If you just have DST non-suppression, Marsilid alone may be enough to give you a remission. But if you have elevated 24-hour cortisols in addition, it would be very worthwhile to consider a 7-day course of mifepristone followed by the Marsilid.
Keep letting us know how you are doing.
Pfinstegg
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