Posted by Elroy on May 25, 2005, at 17:57:01
Okay.... looking for any potential answers.
Have had severe anxiety for almost a year now. Started in June of 2004. Prior to that had milder anxiety (treated with talk therapy and Ambien sleep aid only) from July 2002 until Feb 2004. Then things seemed very much better ("cured") until relapse of June 2004.
Immediately following onset of severe anxiety (within 2-3 weeks) came down with a number of concurrent physical symptoms (constant tinnitus, hypogonadism, tingling/stinging pains in feet and lower legs and hands / lower arms, periodic cold hands but constantly cold / icy cold feet, really bad insomnia, itchy / stinging / flushing patches across torso - especially upper chest and upper back, mild burning / stinging sensation in mouth, and a burning urethra type pain).
Due to physical symptoms, a number of tests have been conducted. Was discovered in Sept 2004 that I had ultra high levels of cortisol (several advanced tests have ruled out Cushings Disease), also discovered a tumor in left adrenal gland (more super advanced tests ruled out both Cushings Syndrome and a "Pheo" tumor... tumor appears to be both benign AND "biologically inactive").
My "educated guess" is that stress occurring to LPHA Axis with combination of elevated stress from 1996 through 2002 and then the mild-to-moderate clinical anxiety from Jul 2002 to Feb 2004 caused a continual excessive secretion of cortisol and that the complete dysfunction of the LPHA Axis then occurred in June of 2004, causing a severe secretion of cortisol (levels in Sept were almost six times the normal max range).
Around late Sept 2004 my pdoc put me on Ativan (1mg x 3 daily). That seemed to be doing nothing so around early Dec 2004 that was changed to Xanax XR (1mg x 2 daily). In addition, I am on meds of AndroGel and Neurontin (300mg x 3 daily).
Also am doing EMDR therapy through psychiatrist office (actually that is an amazing therapy, but it seems like I keep taking 10 stesp forward and then 9 steps backwards... feel extremely well following sessions but seems to quickly fade, another reason why I think biological aspects are in play).
Another interesting aspect is that my adernaline hormone/neurotransmitter levels (the one time that they were tested) came back as low. Dopamine slightly low, epinephrine noticeably low, and norepinephrine extremely low. That seems to be somewhat "strange" for a primarily anxiety situation (I believe that what depression that I have is simply what has developed over the last several months due to my ongoing condition). Even more strangely, anything that tends to elevate those adrenaline levels (dopamine, epinephrine or NE) causes very noticeable flare-ups in both anxiety levels and in my various physical symptoms!
That includes Effexor (was only on it for a few days as it caused an immediate and extreme increase in those "burning urethra" type pains, similar to, but not quite like, prostatitis), Cymbalta (same increase in burning urethra type pain and severe anxiety, just not as immediate nor quite as severe), and even things like low doses Selegiline (I can tolerate 2.5 mg daily but that's it), DLPA and even medium doses of tyrosine! One would think that being able to gradually raise those adrenaline base line levels would be a positive factor.
Also had no luck with SSRIs, well, Lexapro anyway. Aside from extreme nausea which simply wouldn't get better, just simply felt "dead" emotionally with the Lexapro and could feel appetite increasing quite a bit... plus then have since read where Prozac (and other SSRIs???) actually increase cortisol. Many depressives (and people with PTSD) are low in cortisol, so this is probably a very good feature for them as it would "normalize" their cortisol levels... but is the last thing that I need right now. (BTW, tried Lexapro two different occasions)
My question is if anyone out there has any ideas?
I believe that the cortisol levels are directly tied in to whatever is going on. As to the "chicken or the egg" question, I personally believe that the chronic stress and (milder) anxiety led to the breakdown of the LHPA Axis initially, but that the elevated cortisol which exists because of that LHPA Axis breakdown is now keeping the anxiety levels elevated (and likely responsible for many of the physical symptoms - as most are listed for Cushings patients who likewise have elevated cortisol).
Just not sure where to go to from here. Don't believe that SSRIs are the answer and SSNRIs (like Effexor) seem to make the situation worse.
I am currently thinking about discussing with my pdoc about having my Xanax XR switched over to Klonopin. No real reason other than that I've been on the Xanax XR for about six months now and felt that switching around to different benzos might be of benefit???
Also have read some information about Remeron both reducing cortisol AND "re-setting" the HPA Axis. Anyone have any direct experience or more detailed info regarding that data (BTW, I could see where - if that is true - that Remeron might NOT be a VG choice for depressed persons - or PTSD - who were depressed due to LOW cortisol levels, I wonder if it could actually make situation worse?). Anyway, would be looking at Remeron - if applicable - for the specific purpose of lowering the cortisol and "re-setting" the LHPA Axis, so feel that a low dose and moderate-term usage might be effective (???).
Also has been some tantalizing trial data out there concerning the SHORT-TERM use of RU486 to both lower cortisol and to "re-set" the HPA Axis, specifically in cases of non Cushings persons with depression or "psychotic depression" (anxiety) and elevated levels of cortisol. Trial data that I read dealt with therapy regimens of anywhere from 4 to 7 days!
Any and all reasonable suggestions and comments or ideas would be appreciated....
Elroy
poster:Elroy
thread:502852
URL: http://www.dr-bob.org/babble/20050521/msgs/502852.html