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Re: Severe Anxiety, Moderate Depression High Corti » Pfinstegg

Posted by Elroy on May 27, 2005, at 22:26:04

In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by Pfinstegg on May 26, 2005, at 0:40:28

So far have not been able to locate such a study (at least one that I could get into). I have researched a lot (I mean a LOT) of info on the RU486 therapy and have found it to be very interesting.

In my case, there is very definitely extreme HPA Axis hyperactivity and that obviously fuels the interest.

I believe the initial trials covered "psychotic depression" simply because that is one of the most severe types (in its full form version anyway) and also more treatment-resistant types of depression (one could note that many of the characteristics of "psychotic depression" also fit the definitions for "severe anxiety"). Anyway, I have read where some current testing is now being done in bipolar depression conditions (again, somewhat more severe version of depresion and again often more treatment-resistant ). Kind of like they are looking for the "worse case scenarios" to address initially in their trials?

Obviously this type of therapy is not a "Cure-All" as some forms of depression are caused by too LOW of cortisol levels (or at least are characterized by too low cortisol being present).

I know that many have questioned which ciame first, the chicken or the egg (i.e., does elevated cortisol cause the anxiety / depression or is the anxiety / depression causing the elevated cortisol)?

In Cushing's patients, it's obvious that the elevated cortisol is causing the anxiety / depression as said anxiety / depression disappears almost overnight with surgical correction of the problem (removal of tumor causing cortisol levels to be elevated). In severely depressed (to include anxiety) persons - WITH HIGH CORTISOL - they, however, do not have such an offending tumor.... but they still do have elevated cortisol levels (often at levels as high as many Cushing's patients).

I believe that the theory of these studies is that the HPA Axis has become dysfunctional and that is what is causing the elevated cortisol. Very likely chronic stress, chronic lower level anxiety, an acute life trauma, etc., originally caused the HPA Axis to "break down", but (IMHO) once the HPA Axis became dysfunctional that the elevated cortisol is now "running the show" and causing the continuation (and escalation) of the anxiety and / or depression.

I believe that is why many depressions (to include anxiety situations) are treatment resistant... and why some studies have shown that HPA Axis dysfunction problems are strongpredictors of relapes from successful treatment.

Now, my pdoc has been reading all of the material (that I have provided) in regard this RU486 therapy and finds it very encouraging and is supportive of giving it a try... but is reluctant to provide it herself as this med is still in clinical trials phases for "psychiatric treatments".

Now my endo has every right to prescribe this medication as it is an FDA approved anti-cortisol medication (RU486 was first developed many years ago as an anti-cortisol treatment for Cushings patients), but is extremely wary about the "severe side effects" of RU486 and any other anti-cortisol medication... as he confuses the normal Cushing's therapy of long-term medication with the very short-term therapy for purposes of "re-setting" the HPA Axis in depression / anxiety situations.

As to follow-up treatment, I don't believe that there is any (other than isolated cases of relapse). It seemed to my interpretation that the "re-setting" of the HPA Axis in fact "cured" the depression / anxiety (as that WAS the cause... just like in Cushing's patients: once the offending tumor is removed and the cortisol faucet turned down, the anxiety / depression simply went away... in most cases almost overnight to within a couple of weeks). So obviously there are known cases of where it was the elevated cortisol causing the the depression / anxiety.

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Elroy

> My first choice, in your situation, would be to try to get into a Mefipristone (RU486) trial. That's the best one to lower your HPA axis overactivity. They are doing it at Stanford, and undoubtedly other places, and the FDA has "fast-tracked" it. I read a year or two ago that they were then focussing mainly on psychotic depression, which is quite extreme and unusual. I'm not sure whether that is still the focus. It's such a short treatment (a week, maximum) that I wonder what they are thinking of for follow-up treatment. I mean, I wonder if they repeat it if it's needed.
>
> From what I've read, if you can get your HPA axis down to normal, you will be able to prevent the "downstream" events in your left frontal and hippocampal areas which lead to major depression. This would be such an improvement over trying to fix things up "downstream' when damage has already occurred- what we do now with the SSRIs, SNRIs, mood-stabilizers, etc.
>
> If this really interests you, i think you could receive it "off-label" if you can find a doctor to do it. After all, it does have another quite common use...
>
>


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URL: http://www.dr-bob.org/babble/20050527/msgs/503955.html