Posted by Elroy on August 2, 2005, at 22:14:29
OK, has been awhile since been on the Board, but I started the Remeron protocol on June 7th.
I have had a strong hypercortisolism problem since the onset of severe anxiety around last June (possibly late May). The various involved docs (endo ,psych doc, PCP, etc.) have concluded - once they determined that it was not "regular" Cushing's (the endo says that it is Pseudo Cushings) - that a few years of strong stress and mild anxiety led to eventual dysfunction of the HPA Axis which then led to malfunctioning of the HPA Axis and hypercortisolism... which caused the severe anxiety (along with a number of other symptoms including things like hypogonadism and tinnitus, etc., etc.).
While this is an anti-depressent med (and we were hoping for some anti-depressent effects as I also had some mild depression - primary problem was severe anxiety, severe insomnia and some other physical effects), our primary purpose in utilizing Remeron was due to its reported anti-cortisol effects.
I started 15 mg for first week - was supposed to be two weeks but had to move up earlier as sedation was just too great. I was sleeping like 14 - 16 hours a day!
On one hand that was really great, as in good... You have to understand that I had insomnia, severe insomnia since this whole mess started and suddenly being able to sleep so deeply and long was just amazing.
Anyway, went to 30 mg for a week, and then 45 mg for a week. I have been on 60 mg since then.
At 30 mg I was sleeping like 12 - 14 hrs (occasionally more), and at 45 mg about the same.
At 60 mg I started out with sleeping at like 10 - 12 hours but that has gradually reduced to around 8 - 9 hrs (with an occasional 10 hrs).
Personally I never had any of the side effects related to "severe hunger pangs" (even at the lower doses). I did have a slight increase in appetite - but seeing as how I had no appetite before, that itself wasn't bad.
Over that time period I probably gained 10 - 15 lbs... mostly early on and not from over-eating or carb craving, etc., but simply from being so sedated and lowered metabolism (Remeron has an anti-histamine effect which is more noticeable at lower levels).
Energy levels were low also early on, kind of like just being fatigued mildly, but that too has been lessening. In the last two weeks I have started exercising regularly which has happened since this all started. Am hoping that energy levels continue to increase and working out will get the weight back off.
The key here is that (IMHO), I don't believe that Remeron is necessarily a good med choice if you do NOT have elevated cortisol. Maybe I'm wrong, but I don't think so.
So to the key question....
Yes, it did.
My 24-hr UFC test showed my cortisol levels in April were 241 (in a reference range of 20 - 100). Not surprising... ALL of my 24-hr UFC tests have shown highly elevated levels since I started testing last September. The first two were over five times the normal maximum. Most of them have been in the range of mid 200s to low 300s.
I then had one done on July 19th. The test result from that one came back Friday and I was a 93.9 - just barely inside the "normal range", but a huge improvement for me with my prior one at 241!
As to how I feel, the anxiety is much lessened from where it was three months ago. The depression is still slightly noticeable but not anywhere near as bad as it was three months ago (again the depression was always much lesser than the anxiety). Aside from indirect action via lowering the cortisol, the Remeron also has some reported direct anti-anxiety actions.
Some of my physical symptoms have also lessened quite a bit.
My belief is that the cortisol needs to continue to be driven downward yet more. There's a "normal range" and then there's an "optimal range". I believe that optimal range is like around 40 - 65, but obviously varies between individuals.
I might (barely) be in the normal range, but my belief is that for the HPA Axis to be able to re-set it is going to need levels not only in the "optimal range", but to be there for a few weeks to a few months.
My goal at this point is to continue my Remeron protocol until the next scheduled round of cortisol testing (mid October) and see what my levels are at that time. If thelevels are in the mid ranges (40 - 65 range for example), then I want to come off of the Remeron and get tested again in one month (rather than waiting for another full three months like we are currently doing). Doing this step will also depend quite a bit on how I feel. I may want to do another full three months on the Remeron to help the HPA Axis along before taking this step.
If cortisol levels are back to elevated levels at that post-one month test, then I'll know that the HPA Axis has not re-set and that I'll need to go back on the Remeron for a while longer... or possibly go through the process of a compassionate use waiver in order to give RU486 short-term protocol a chance.
If cortisol levels remain in mid range, then I'll know that HPA Axis has re-set.
Elroy
poster:Elroy
thread:536897
URL: http://www.dr-bob.org/babble/20050728/msgs/536897.html