Posted by Racer on July 25, 2004, at 13:18:13
In reply to Re: Stress Hormones? Anyone Heard of This? » Somatization, posted by Larry Hoover on July 25, 2004, at 8:57:02
The stress hormone usually involved in this sort of speculation is cortisol, which is a product of the hypothalamus-pituitary-adrenal axis. It's generally described as the body's response to unrelenting stress that can be neither fought nor fled from. And it's almost certainly involved in depression.
In fact, one feature of successful treatment with anti-depressant medication (or ECT, for that matter -- the only thing the two seem to have in common) is that there is a reduction in corticotropin-releasing factor in the cerebrospinal fluid. In other words, anti-depressants reduce the levels of cortisol -- the CSF shows that the amount crossing the blood-brain barrier is also reduced.
The gold standard of tests for cortisol involvement is the dexamethasone suppression test. The DST involves taking a single dose of dexamethasone, which binds to some of the same receptors as cortisol. I can't quite remember the details, but if cortisol is involved, you'd expect a significant reduction in its levels after the dexamethasone is administered. The DST is used to diagnose Cushing's syndrome, and is sometimes used to diagnose endogenous depression, as well. (In fact, some studies have shown that cortisol levels in many depressed individuals are raised into the Cushing's range, which probably accounts for a lot of the symptoms.)
OK, now that I've spun your brain with my half-acquired knowledge about all this, what to do about it? Dunno. That's the short answer, but there are some things to think about:
1. Biofeedback has been shown to be helpful for some people.
1.a. Relaxation techniques are also helpful for some people.
2. There are some drugs that can block cortisol production, but they tend to have some significant side effects -- and some are just too dangerous to take for long periods. On the other hand, a short course of dexamethasone itself has shown good results in a couple of small studies. Dexamethasone is a corticosteroid, so it's not some new miracle drug by any means -- way too dangerous for long term use, truly -- but it has been shown to be an effective jump start agent when taken at mid-range doses for very short periods (the studies I saw were using 4mg for 4 days -- ONLY), which minimizes the risks while still providing good benefits.
3. RU-486 has shown some good signs that it might be helpful with this.
4. Periactin -- an old anti-histimine which is helpful for some patients with elevated cortisol levels, but not all; and varies in its effectiveness between patients who've tried it.
5. Exercise -- yeah, I know, if only it were that easy to do, but it really can be quite helpful.
6. Spending some time in therapy specifically on the questions of recognizing impending stressors and diverting them somehow so that you reduce your response.
Those last two are probably the lease effective, though. Aside from the role of cortisol in depression, it has some pretty vital roles in normal functioning, too. Normally, there is a daily surge of cortisol starting about 5AM that gives your body the signal to start preparing to wake up and get moving again. That cycle is pretty close to universal -- including for people who work swing shifts or graveyard shifts -- and it's related to why a lot of people suddenly get very cold about 4, 4:30 AM if they're still awake for some reason.
As for the problems eating later in the day, that's likely also related to your normal diurnal rhythms -- it's generally later in the evening, about 9:30, 10PM -- your gastrointestinal tract starts shutting down for the night. (That's why some of us get nightmares or disturbed dreams if we eat too late.)
Basically, sleep science is involved in most of these things, and can be very interesting if you've got the curiosity.
Cortisol is a very powerful hormone, and it can indeed account for all those symptoms. Some of it is natural and you won't want to interfere with it because it is such an integral part of the sleep-wake cycle, but reducing the excess cortisol production is a very good idea. (Excessive cortisol production is associated with a lot of health problems -- it's hepatotoxic, immunotoxic, etc.)
Best I can recommend, though, outside of getting the Big Guns out with an MD, is probably some form of biofeedback. It won't be a perfect solution, but it is supposed to be pretty helpful, and there is a fair amount of hard science to back it up.
OK, hope that helps, and hope it's not too boring.
poster:Racer
thread:370112
URL: http://www.dr-bob.org/babble/psycho/20040723/msgs/370321.html