Posted by Elroy on September 13, 2005, at 20:46:57
In reply to Re: Remeron Protocol, posted by Tenifer on September 13, 2005, at 9:13:46
Well, Dave, this might end up getting re-directed but here goes.....
First of all, my anxiety has been helped quite a bit by the Remeron. Remeron is an unusual antidepressant. Aside from being one of the few (maybe two?) that directly reduce cortisol levels, it is also very sedating (while some ADs obviously are sedating, most tend to be "energizing", no?) and it also has a degree of direct acting antianxiety properties. In fact, in my case I have found its AD effects to be minimal while I have noticed a degree of AA effects. My routine AA medication has been 1 mg of Xanax XR twice daily (AM and PM dose). I have found with the Remeron that I have been able to "skip" the PM dose probably 1/3 to 1/2 of the time. Remeron is also unusual in that the more noticeable side effects tend to be more obvious at lower doses (with me it has been easily the sedation factor).
To update on the Remeron protocol, I should be getting next tested for cortisol levels next month (hoping for early part of the month). The key will be whether or not the cortisol is still going down - and if it is lower, whether or not the continued lower levels of cortisol will allow the HPA Axis to re-set and cortisol secretion to normalize. The next key step will be in November when I re-test for cortisol and STOP taking the Remeron about two weeks before testing. If the cortisol levels have been lowered further and then STAY lower after stopping the Remeron then one can assume that the HPA Axis has been re-set.
I think it important to also point out that hypercortisolism that is NOT related to a cause that would lead to a diagnosis of Cushing's Disease or Cushing's Syndrome or Exogenous Cushing's (i.e., in other words one would be talking technically about "Pseudo Cushing's") still requires that the causation be addressed.
To give a quick example... there are multiple causes for Pseudo Cushing's, one of those being acute, chronic alcoholism. One might take Remeron to lower cortisol levels (or possibly an aggressive campaign of OTC supplements), but unless the underlying cause of acute alcoholism is addressed, the HPA Axis will remain dysfunctional and the cortisol levels will simply shoot right back up when the medication is halted - or possibly even one will face a situation where the causation eventually "overpowers" the medication and the cortisol levels gradually increase again over time.
So... the point is that if one has a psychological condition of anxiety / depression that has resulted in a dysfunctional HPA Axis, it is important that the "stressors" that led to the original condition be addressed. Possibly that already has and the dysfunctional HPA Axis has kept the anxiety / depression going, but one should just keep that in mind. In taking a holistic approach to addressing my situation I have been going through EMDR therapy also (it has been quite, well, interesting to say the least, but that's another topic).
Before getting into OTC choices, I would ask this... do you know for sure that you have welevated cortisol levels? And, if so, how was that determined? If the cortisol testing was by means of any test other than a 24-hr Urinary Free Cortisol test, then forget it. You did NOT get an accurate cortisol reading. Even the salivary testing that is done four times a day (every six hours) is NOT sufficiently accurate to determine if you in fact have elevated cortisol. I stress this as I am completely shocked by the number of people who contact me who simply assume that they have high cortisol - or use one of the online salivary test or even has their doctor do a morning serum test (which is when cortisol is at the highest level of the day, BTW). As one example, an individual told me that he had a morning serum test where his cortisol was a 15 in a reference range of 8 - 22 so he had "high cortisol". He had no idea of any such thing. A serum test or saliva test simply is like taking a "snapshot" of what your cortisol levels are right at that exact moment... and since one's cortisol secretion varies up and down during the day it doesn't give one any real idea of what their daily cortisol level are at. In addition, one's morning levels are generally when cortisol levels is the highest (say 8 AM to Noon as just an example), so I would expect one to be at least that high in a serum test and be completely normal.
As for OTC type supplements, my research ahs shown me that the following have been identified as having some degree of cortisol inhibition:
Phosphatidylserine
Magnolia bark (main ingredient in Relora)
Epimedium
Rhodiola rosea
Ashwagandha
Holy Basil
Melatonin
Beta-sitosterol
Gingko Biloba
Siberian ginseng
Theanine
Passionflower
7-KETO DHEA
Gerovital-H3
Tongkat aliI personally took the top nine. Not necessarily all nine each day (in fact, I mixed them around, going real strong on a couple for a week or two then switching over to a couple others, etc.). I would prefer to not get into doses (as we are all very different individually), but let us say that I researched the various ones and took "maximum doses" according to the research that I did. I would point out that research has shown (for example) that Phosphatidylserine appears to be most effective in actually reducing cortisol when taken at doses of 400 - 800 mg daily (you'll see the shock of that when you pay more than $25 for a bottle of 120 caps of 100 mg PS... so a daily dose of 800 mg means that said bottle will last you only two weeks - but fortunately that's easily the most expensive). I also found an online store that provides a lot of stuff like this in bulk powder form.
I would also point out that when I conducted my aggressive OTC supp approach, I was able to get my cortisol levels down to a 108 (in a reference range of 20 - 100)... but that when I stopped the supplementation (2 weeks before the next testing), my levels shot right back up there - up to a 214. So obviously the HPA Axis was still dysfunctional. Would another three months or six months (etc.) have ended up being the difference? Maybe. In my case I had run across the info on the Remeron in the meantime and decided to pursue that approach.
As you found out, some ADs (most?) clearly tend to make anxiety situations worse. And there's a number that actually increase cortisol levels. As the field of neuropsychiatry is finding more and more that elevated cortisol (and dysfunctional HPA Axis situations) is implicated in a significant number of psychological disorders, the idea of arbitrarily prescribing a med that could increase cortisol levels is amazing. Now there are also cases of (primarily depression) psychological disorders that involve LOW cortisol levels, so those meds might do well in low cortisol situations.... (just to increase the thought-process a little bit more, I recently read where studies have shown that elevated cortisol levels can cause a decrease in not only serotonin and dopamine, but also the adrenaline hormones (epinephrine and norepinephrine).
Elroy
> Elroy,
>
> Your thesis makes perfect sense to me.
> Thanks for taking the time to post your
> experience so far.
>
> I was also looking at OTC cortisol-lowering
> agents as a means of getting my HPA axis to
> reset so things could get back to normal.
>
> I'd hate to burden you further, but if you
> have the time could you share the OTC protocols
> you tried (brand, dosages, time taken, with
> food?, etc.)
>
> I would really like to go that route before I
> resort to meds (again). Interestingly, I was
> first put on Paxil and that made me nuts and
> significantly worsened my condition. It wasn't
> until recently that I learned that SSRI's
> actually increase cortisol secretions. Crazy
> stuff huh?
>
> By the way, how have your anxiety levels been?
> Judging from the lowered arousal of your HPA
> axis as evidenced by your UFC cortisol levels
> I'd hope that it was substantially reduced or
> eliminated. I hope that is the case. :)
>
> Thanks again for keeping all of us up to date
> on your progress Elroy. I really wish you
> the best and continued success.
>
> May God be with you,
>
> David
poster:Elroy
thread:536897
URL: http://www.dr-bob.org/babble/20050909/msgs/554818.html