Posted by Anna Laura on December 17, 2002, at 6:31:43
In reply to next steps - Anna Laura, posted by pfinstegg on December 16, 2002, at 1:03:59
> 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
>Hi Pfinstegg
The levels which you're reffering to are different from those in my country. Anyway, my THS is above low-normal line, as well as my T4, the lattest being just above the low-normal line. T3 is normal. (?!).
I'm going to repeat those tests anyway.
I've done testosterone test as well which showed up to be within the normal range but i never took that test before so that it might not be significative. I was worried about testosterone 'cause it's believed to play a role in females' libido as well, and i have got a low libido, almost not-existing. The strange thing is that when i lost my libido (around the sixth year of my depression) my muscles mass decreased dramatically as well (especially around my neck and shoulders; i never excercised or did sports whatsoever it was a natural, "genetic" muscle building and it was all gone in a matter of few months).
I developed social phobia as well; i felt like i turned in to a feeble, weak person, and i never really felt like that even when i was seriously depressed. I developed sensory clouding and anhedonia got worse.
The symptoms above seem to be related to a dopaminergic link. CFS might have a dopaminergic link as well.
I took high-dose Effexor for a year then i added Wellbutrin, i took that combo for a while, then i dropped Effexor and staied on Wellbutrin; i somehow felt less apathetic and my sensory clouding slightly improved, i experienced a small, short-lived relief of anhedonia and apathy, and the sensory system basic feelings such as smells and touch had returned as well: there's a pine-tree down the road where i live and i could smell the pine scent again. But that was short-lived unfortunately. My libido had improved as well even though it was too low still. My muscle mass increased as well (!!).
Anyway i quit researches after having being diagnosed bipolar II by a University Clinic psychopharmacologists' team 'cause i thought they'd know better. I somehow sensed i wasn't getting anywhere with my researches and sometimes i ended up being even more depressed; i strongly believed that Mirapex, being a dopamine agonist, was going to help me but it made me even more depressed and numb (like atypical AP'S). My Tegretol trial failed as well (no significant response). See what's next. I'm trying to keep my hope even if it's hard sometimes.Be well
Anna Laura
poster:Anna Laura
thread:33204
URL: http://www.dr-bob.org/babble/social/20021206/msgs/33451.html