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Re: Pfinstegg going on even more- Linkadge and Seamus » Pfinstegg

Posted by SLS on October 21, 2002, at 1:18:12

In reply to Pfinstegg going on even more- Linkadge and Seamus, posted by Pfinstegg on October 20, 2002, at 23:30:34

Dear Pfinstegg,

For what it's worth - I agree with almost everything you have written. Cortisol is a MF. Reregulation of the HPA-axis during the course of an affective episode might be resistant to direct pharmacological targeting.

Ketoconazole?

Regarding antidepressants: That you specified "when they work" is most insightful and crucial. There are such smart people here (myself excluded). By comparison, lithium and Depakote reverse hippocampal shrinkage independent of therapeutic activity, albeit via mechanisms independant of cortisol. It involves a decrease in the production of neurotoxins and an increase in the production of neuroprotectants and neurotrophins.


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Lithium Augmentation Increases the ACTH and Cortisol Response in the Combined DEX/CRH Test in Unipolar Major Depression

Tom Bschor, M.D.1, Mazda Adli, M.D.2, Christopher Baethge, M.D.2, Uta Eichmann2, Marcus Ising, Ph.D.3, Manfred Uhr, M.D.3, Sieglinde Modell, M.D.3, Heike Künzel, M.D.3, Bruno Müller-Oerlinghausen, M.D.2, Michael Bauer, Ph.D., M.D.4

1 Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
2 Department of Psychiatry, Freie Universität Berlin, Berlin, Germany
3 Max-Planck Institute of Psychiatry, Munich, Germany
4 Neuropsychiatric Institute & Hospital, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles (UCLA), Los Angeles, California, USA


"Response to lithium augmentation was measured by weekly ratings on the Hamilton Depression Rating Scale (HDRS 17-item version). Response was defined as a DHDRS of ³ 50% and an endpoint score of < 10. Patients had a significantly higher ACTH and cortisol response to CRH stimulation during lithium augmentation compared to the values at baseline. There was no difference in ACTH and cortisol reaction between responders and non-responders to lithium augmentation. This increase is in contrast to the known normalization of HPA-axis overdrive after treatment with a tricyclic antidepressant like amitriptyline. Because the effect was independent of response status we suggest that this increase reflects an effect of lithium that is independent from the psychopathological state or its change. This effect might be explained by the serotonergic effects of lithium."

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I am almost convinced that my severe depression is very much due to an overproduction of cortisol in childhood and adolescence as a result of protracted psychosocial stress. I am also convinced that the severity of my condition - particularly cognitive deterioration (dementia) - is due to period lasting about a year of mammoth stress and trauma at age 20 when my fiancé dumped me and my life fell apart.

My hippocampus must look like decaying almond, and my prefrontal cortex a ring of dehydrated tripe.

I have no doubt that cortisol and HPA dysregulation are fundamental to the induction, and possibly the perpetuation, of affective illness.


Sincerely,
Scott

 

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