Posted by mattdds on April 9, 2003, at 13:04:46
In reply to Re: IMHO, Don't sweat the hypercortisolemia!, posted by glenn on April 9, 2003, at 4:37:31
Hi Everyone,
I certainly didn't mean to sound unsupportive, I was just stating the opinion that has impressed me about this cortisol problem.
Obviously, there is something awry with the HPA axis in depression and anxiety. My argument was never that "it is all in your head" or anything like that. Obviously, there are true biological disturbances going on here.
However, the HPA axis does not exist in a vacuum. It is definitely not some autonomous organ that simply squirts out evil chemicals as it pleases. It receives inputs from many higher cortical centers. Most neurophysiologists subscribe to the so-called "James-Lange" theory of fear and anxiety conditioning. This theory holds that higher cortical areas (the parts from which conscious-level negative thoughts would arise) are the inputs that activate the HPA axis. Why would it have been evolutionarily advantageous to have a randomly firing HPA axis? I think eons of evolution have this organ more fine tuned than we think, much like the renal osmotic regulatory systems that we all possess.
The other (much less accepted) theory of HPA and ANS hyperarousal is the Cannon-Bard theory, which holds that sympathetic discharge preceeds cortical (higher awareness) perception of fear. But to me, this makes no sense whatsoever! Again, what primordial conditions would have favored animals with randomly-firing HPA axes?
To me the former theory makes much more sense from an evolutionary standpoint. First the potential threat information is gathered from the environment, and filtered through neural networks. If the belief systems (which arise from neural networks) calculate that a threat is present, then the animal's ANS and HPA axis would become activated. So the more things that we perceive to be threatening, based on our individual threat beliefs, the more the HPA axis is aroused.
So, the "stream", so to speak, in my opinion begins at the higher cortical centers, where beliefs originate. This seems pretty common sense to me. Many people (myself included) perceive so many things to be threatening (e.g. exams, projects at work, social situations, and so on), that their HPA axis is in a constant state of arousal! This becomes a vicious cycle, where the HPA axis becomes increasingly sensitive to any threat stimuli. It is a sick, viscious cycle!
I feel this is why my extreme (2 psychiatrists diagnosed me as TRD, as I failed EVERY class of antidepressants) depression responded so well to cognitive behavioral therapy. Because I, over the period of a year, have begun to "rewire" all those threat related beliefs, so I no longer perceive them to be harmful. This took a great deal of work! Slowly, I imagine, my HPA is beginning to calm down. This is certainly my subjective experience, as I FEEL much calmer and much less depressed. I would imagine that I would have by now converted to a DST supressor, and that my 24hr cortisols would be normal, corresponding with how I now feel. However, who knows? I haven't cared to check them, but it might be interesting.
So it is in this sense that I feel most pharmacological treatments (including the much awaited CRF antagonists in the pipeline) are "downstream" treatments. This is not to say they are not worthwhile and not helpful! They may quite possibly be quite helpful, perhaps miraculously so. Only time will tell. I am hoping they will be. I am for anything that helps, be it psychotherapy, ECT, pharmacology or otherwise. But I think without good psychotherapy, these treatments will be insufficient for many, and may be ignoring the underlying cause (negatively skewed perceptions of the world, at the cortical level...or beliefs). But again, this is all just my own speculation, and certainly open to criticism.
Please feel free to comment! I am not married to any of these ideas. Sorry it takes me so long to make a point, but I feel these are complicated problems.
Thanks again for the great discussion!
Matt
poster:mattdds
thread:217414
URL: http://www.dr-bob.org/babble/20030407/msgs/217835.html