Posted by Elroy on November 19, 2005, at 12:05:50
In reply to Re: Remeron and Cortisol, posted by 4WD on November 18, 2005, at 22:12:08
Yes, that's what my Endo has called my adrenal gland tumor also, an "incidentaloma" (but my psyc doc and regular GP both find it too "coincidental" and believe that it has to be up to "something"). I give my Endo credit that he recognized that a couple of test results were borderline - and a coupe of others downrigth pointed towards a definite connection that he pushedfor the acceptance to NIH for the adrenal gland tumor study.
Basically I did have cortisol levels checked before stopping the Remeron - just not immediately before. I started the Remeron in early June and tested in July and then again in early October - and stopped the Remeron on November 1st per NIH. So a cortisol test was done about three weeks before stopping the Remeron. And of course much cortisol testing will get done while at NIH (again not immediately after stopping the Remeron but fairly soon after).
The cortisol levels at both the July testing and the October testing were down to "high normal range". The Test in April showed cortisol levels at 214 (range 20 - 100), or 214% times normal max. July test was 97 (range 20 - 100), or 97% times normal max. October test was a 52 (however reference range was changed as using a different Lab process and new range was 4 - 60), so were talking about 87% of normal max.
Big question of course has been whether cortisol levels have continued downward sicne coming off of the Remeron, have they stabilized sicne coming off the Remeron, or have they started going back up since coming off the Remeron???
And in either case, does it really mean that much if anxiety levels and all those various symptoms continue?
As it stands right now, NIH wants as few meds as possible being used - and especially anything that would have a drastic impact on inhibiting cortisol secretion or causing its rapid metabalizing from the body as it would throw the results of their various tests off (and I definitely don't want that at this point).
The idea with the significant increase of Benzos (i.e., Xanax) seems interesting. Basically is the anxiety causing the hypercortisolism rather than the other way around. I believe that there's a lot of merit in that question... especially when looking at how this whole situation first started. You see, I tend to agree with my Endo and believe that this is more a situation where the severe anxiety did in fact cause the cortisol elevations to skyrocket - and that possibly the adrenal gland tumor is actually simply another symptom of the severe anxiety (in other words that the tumor is a result of all the ongonig severe stress - like a scar - rather than a CAUSE of it). Hopefully that will be something that NIH finds out one way or the other.
The main point (that many miss) is simply that if the severe anxiety caused hypercortisolism and the hypercortisolism caused the HPA Axis to become dysfunctional, one now has a dual problem. In effect a vicious, Catch-22 problem has been created. The anxiety causes elevated cortisol which has thrown off the HPA Axis and the dysfunctional HPA Axis keeps ordering higher production of cortisol (as it is not accurately reading the feedback loop that there's already plenty of cortisol present) and the highly elevated cortisol actually manufactures anxiety symptoms. That last part is a tough one to get a handle on, but hypercortisolism can effect just about any and every system in the body, including neurotransmitters (reduces levels of serotonin and eventualy depletes the adrenaline hormones) and the CNS in a way that actuall "manufactures" anxiety symptoms.
So - if that is the situation one is experiencing - simply taking more and more Benzos could be like having a leak in your basement and bailing it out with a bucket while the leak kept on pouring out water. Another interesting possibility is that it could possibly be the anti-cortisol effects of sufficient Xanax that caused the reduction in cortisol. A lot of people (including psych docs) aren't aware that Xanax decreases cortisol level and increases DHEA levels...
See posting at:
Is it possible that taking sufficient benzos to fully stop the anxiety might just break the cycle and - if taken long enough - give the HPA Axis a chance to normalize. I know that if one has a depression and / or anxiety problem involving a dysfunctional HPA Axis, that if the HPA Axis is not "re-set" that there is a tremendous statistical chance for relapse.
Actually, here's a pretty good explanation of the process involving stress and the HPA Axis:
QUOTE: When the brain becomes overactive and the emotions of fear (and/or anger, etc.) appear, the body goes on alert, and a state of vigilance develops. For short periods this can be normal.
But, if this is a chronic (or severe) condition, there is constant stimulation of the HPA Axis (the hypothalamic-pituitary-adrenal axis), resulting in the release of the chemicals of fight and flight. (These chemicals being cortisol and the various adrenaline hormones) A vicious cycle is created, with the stress chemicals keeping the brain overactive (anxiety) and the overactive brain (anxiety) stimulating release of the yet more chemicals. A condition of acute, chronic stress (anxiety / depression) develops. END QUOTE
> I've been thinking about you too, Elroy. Seems like it might have been a good idea to test the cortisol levels immediately before or immediately after you stopped the Remeron (instead of letting the anxiety increase again before testing).
> It would be interesting as well to see what happened if you took enough of a benzo to completely stop anxiety for a couple of months. If your cortisol levels were low at the end of that time, seems like you could surmise that lowering anxiety lowered the cortisol and not vice versa.
> Anyway, good luck and good thoughts.
> p.s. my endo calls my pituitary tumor an "incidentaloma."