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Re: Cortisol testing bozeman

Posted by Pfinstegg on January 16, 2003, at 0:26:12

In reply to Re: Cortisol testing Dinah, posted by bozeman on January 15, 2003, at 22:27:06

There are some things one can do about cortisol abnormalities, although not as many as one would like. There are two things to discover about cortisol; first, do you have non-suppression on the Dexamethasone Suppression Test? This involves taking one mg. of Dexamethasone in the evening and then having an 8 AM serum cortisol drawn. Normally, your reading should be 5. Not suppressing at all is associated with about half of the cases of both major depression and bipolar disorder. Another test, the 24-hour urinary cortisol, is associated with very severe depressive disorders- the kind which may have psychotic features- it's not as common as the DST non-suppression.

Having DST non-suppression means that cortisol and other hormones have gone into over-drive, and have decreased the number of receptor cells in the hippocampus. So you are losing the feedback mechanism which tells your hypothalamus to shut off its production of CRH- you have HPA axis dysregulation- too much cortisol too much of the time. People who have this show smaller left dorsolateral prefrontal cortexes, and smaller left hippocampuses on MRI; if you have a SPECT scan to study blood flow, it will be lower than it should be in these areas.

So far, the most effective treatments for HPA axis dysregulation, and the resulting brain changes I mentioned above are either ECT or TMS. However, successful drug treatment, with all the different classes of ADs and mood stabilizers, can also reverse these changes. So far, I have not been able to find much research showing that this happens, but there are isolated reports in the literature of this occurring. It probably happens quite a bit with successful drug treatment, but isn't documented.

Other things which one can consider are taking adequate fish oil and B vitamins in fairly high doses, so as to make sure your brain metabolism is as healthy and efficient as possible. Phosphadatylserine is thought to lower cortisol, and can be helpful in going to sleep easily, if taken at bedtime. Going out on a limb here, I take tianeptine, not because it is a good anti-depressant, but because research in a number of centers, on tree shrews, shows that stressed baby animals do not develop shrunken prefrontal lobes or hippocampuses, or a decrease in the number of receptors, if they are given tianeptine during the time they are stressed. It is thought to put a barrier between your brain and the excessive cortisol. I don't know of any similiar studies in human beings, but, knowing it's a safe drug, I decided to do an experiment on myself!

In a few years, we will have CRH antagonists which will probably prevent the axis dysregulation from occuring. Mefipristone is now being fast-tracked in studies as an AD which can rapidly return cortisol metabolism to normal.

Don't forget, thyroid abnormalities usually occur simultaneously with the cortisol abnormalities. Even if your TSH, etc. is normal, you can obtain an antidepressant effect by making sure that the TSH is at the lowest range by taking supplemental T3 and T4 in low doses.





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