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next steps - Anna Laura

Posted by pfinstegg on December 16, 2002, at 1:03:59

In reply to Re: NO HOPE to Pfinstegg, posted by Anna Laura on December 14, 2002, at 6:16:19

Thanks for the information and the reference by Nemeroff et al. from Emory. He is such a highly respected scientist in brain-based depression research. I have that article in my file, but was not aware that you fall into the category of hypo-cortisolemic patients.

Just to be sure of what you said, I wasn't clear whether you have a high-normal or low-normal TSH. As you know, the range is about 0.4 to 5.5. If you have a normal free T4 (range .8-1.5) and a normal T3 (range 60-181) but a high-normal TSH, this can mean a relative blunting of the thyroid feedback system ("Serum TSH Concentration as an index of the Severity of Major Depression", Payan, Berlin, Corruble, Puech, Int. J. Neuropsychopharmacol 1999;2 (2); 105-110. Because of this research, plus the information about using T3 in depression (New England Journal of Medicine, 1999, cited earlier on PB, my endocrinologist said that he wanted my TSH down around 0.5, and wanted to get it there using a combination of T4 and T3 (synthroid and Cytomel). Have you done that? I think it helped me quite a lot in having higher energy levels.

Second, do you know what your 24-hour urinary cortisols are (range 12-103)? Do you know whether you suppress or not on the DST or CRH-DST tests? It's possible to be a non- or partial non-suppressor and still have very low 24-hour cortisols.

What you say about CFS and atypical depression is very insightful and knowledgeable- you know much more about this area than most of us. I have four articles, two written by NIH researchers, about the under-reactivity, or exhaustion of the HPA system in these illnesses, and how they should be considered as separate disorders from ordinary depression.

When there is hypoperfusion of the limbic, prefrontal and basal ganglia areas, SSRI's can be either ineffective or worsen symptoms. Agents which increase dopamine and nor-epinephrine are most likely to be helpful, with Wellbutrin leading the list. You've probably tried it, but I thought I'd mention it, in case you haven't. As to the Nemeroff article about using dexamethasone, I've never heard of it actually being used in clinical practice, but it could certainly be used safely for a short period. The problem would be that it is supplying steroids which your body can't provide, and presumably would only be helpful while you take it. Still, short-term use (? a week) might give you a lift which could then be better sustained with something like Wellbutrin.

In addition, you've probably read some of the many posts here about fish oil! It prompted me to take at least 1gm. of EPA- I think it has helped enough that I wouldn't want to run out of it- or forget to take it with me when I travel! I also would not want to be without high doses of B12 and folic acid.

You have had more thorough neuro-imaging and neuro-endocrine testing than anyone who has posted here- that I know of. I would be extremely interested to learn what treatment program your doctor is developing for you on the basis of all of this information. I will keep looking for your posts, and, in the meantime, wish you the very, very best in your search.

Pfinstegg


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URL: http://www.dr-bob.org/babble/social/20021206/msgs/33397.html