Posted by Elroy on July 4, 2005, at 11:47:24
In reply to Re: To Elroy, posted by Denise1966 on July 4, 2005, at 11:24:00
OK, for both of the last posts....
The first test that you want to have done is two, preferably three "24-hour Urinary Free Cortisol" tests (called 24-hr UFCs). Those tests are to determine if you have elevated cortisol levels or not. You do NOT want to rely on a salivary test (even if its the type where you take a sample four different times during the day - like at 8 AM and then at 2 PM and then at 8 PM and then again at midnight or whatever). You do NOT want to rely on a serum (blood) test. The problem is that both of those tests just give a "snapshot" of what your cortisol was like at that particular moment... and cortisol secretion is in cycles, not a steady secretion.
So you want the 24-hour UFCs to determine if you have elevated cortisol levels to start with.
Then there's a number of other tests done to start determining the cause... is it Cushing's Disease where the elevated cortisol is caused by a pituitary tumor? Is it Cushing's Syndrome where the elevated cortisol is caused by an adrenal gland tumor (or, less likely, an ACTH-secreting cancer)? Or is it Pseudo Cushing's w- which can be caused by a number of things but one of those being mood disorders such as long-term stress, chronic low-level anxiety and / or depression, etc.
The CRH Test is not really considered that reliable. The Dex Suppression test (especially the high-dose version) has some better reliability but the combined DEX/CRH Test has a very high reliability.
But the "gold standard test" to separate Pseudo Cushings away from the other "regular" forms (I hate saying it that way)... is the "Late Night Salivary Cortisol Test". With regular Cushings patients their daily cycle of cortisol secretion gets completely out of kilter and their late night levels will be significantly elevated while the Pseudo Cushing patient will (about 98+% of the time) have NON elevated levels at that time frame (i.e., 11 PM to Midnite). Again, want to have two or three separate tests done (spread out over a week or two)...
So actually two simple tests determine where you are at.... one consists of simply peeing in a plastic jug for the 24-hour time period and the other consists of spitting into provided test vials.
Remeron seems to be one of those meds that either definitely works for you - or definitely doesn't... which may have a lot to do with the fact that it has those anti-cortisol properties.
The only side effect that I have had from it was that when I was on 15 mg I had extreme sedation (sleeping like 16 - 18 hours a day... which actually felt great at the time as I had insomnia for so long that it felt really greatto sleep like that) and also at 30mg (not so bad, but still sleeping like 10 - 12 hours). At 45mg it seems that the sedation effect is passing significantly (slept about 6.5 hours last night). Still undecided on taking dosage to 60mg or not.
Anyway, Remeron is one of those few meds where the side effects are actually much stronger at the LOWER dosage levels, so if you give it a re-try, start at 30 mg and go to 45 or 60 would be my recommendation.
I have noted to noticeable increase in "hunger pangs", "cravings", or "weight gain" (in fact, I lost about 8 lbs the first two weeks on Remeron). I have also not noted in problems with "anger".
I have my next round of cortisol testing in about three weeks so will be able to see if Remeron has had any effect on reducing cortisol levels....
Elroy
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> Hi Elroy,
>
> Just wondering what checks your endoctrinologist gave you. Also did you pass or fail the Dememethasone Suppression test?
>
> How do you find Remeron anyway? When I took it I got a lot of anxiety at 15mg and also felt a bit zombie like on it, really numb. On the other hand Zyprexa really helped me.
>
>
> Denise
poster:Elroy
thread:515432
URL: http://www.dr-bob.org/babble/20050702/msgs/523277.html