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Dr. Bob is Robert Hsiung, MD,
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Posted by Elroy on May 5, 2005, at 6:49:05
In reply to Re: Urine Test to Measure Neurotransmitter Levels??? » Elroy, posted by Larry Hoover on May 4, 2005, at 22:24:32
I had the fancy blood test done. That was the one which showed the moderately low dopamine, very low normal range epinephrine, and the extremely low norepinephrine (way off the chart, BELOW the bottom of the normal range).
The endocrinologist said that was a great result as it meant that my adrenal gland tumor was not only benign, but that it was NOT a "Pheo" tumor.
The fact that I had circulating levels of very low adrenaline meant nothing to him.
Now my psych doc was puzzled as I have had severe anxiety (kept at bay only by daily Xanax XR, and then just barely as it is always lurking in the background) for almost a year now and she would have (in her words) bet serious money that those levels would have been not only high, but very high.
Well, what about the BEAM Scans (I think that's what they are called) as used by Dr. Eric Braverman and highlighted in his books and practice? Anyone have any experience with that testing protocol as relates to determining actual neurotransmitter levels?
QUOTE: Eric Braverman, M.D. - An Innovator of Brain and Body Medicine by Maria Rabat
BEAM differs from CT scans and MRIs because neither of the latter procedures can assess the brain’s signal activities. Due to the fact that these signals regulate the body, abnormalities that originate within the brain may contribute to or worsen physical illness. Dr. Braverman has worked with this tool for over 20 years, and mainstream medical professionals are just now recognizing it as an essential part of any health assessment. “Once we crack the brain code, we can start repairing what needs to be fixed,” says Dr. Braverman. “BEAM picks all this up in 10 minutes, it’s like a cardiogram of the brain... In addition to his private practice in New York City (with satellite locations in Princeton, NJ, and Penndel, PA), Dr. Braverman is also director of the PATH Foundation, a nonprofit research organization devoted to preventing and treating all aspects of brain chemical disorders as they relate to general health. Dr. Braverman often is called on to lecture at major medical conferences, and has trained hundreds of physicians and health practitioners in his brain-based approach to health care. He is a diplomat of the American Board of Anti-Aging, with training at Harvard, Yale, and NYU medical schools. END QUOTEOr possibly SPECT/PET (single photon/positron emission computed tomography) scans? Anyone have any experience with that testing protocol? Just seems that determining what NTs are actually deficient makes more sense than just throwing serotonin enhancement at every mental problem....
Anyway, I personally would still think that 24-hour urine tests of neurotransmitters would be beneficial just from the viewpoint of knowing what overall body levels were even aside from what was coursing through the brain. Low levels of dopamine, NE and epinephrine along with low levels of cortisol and DHEA would probably be a pretty strong signal that one might be approaching adrenal fatigue, for example (which is NOT a good medical condition to be in).
BTW, I did talk my psych doc into starting me on a dose of 5mg Selegiline twice a day to hopefully start getting those levels up. I have apparently adapted at those low levels (and they've been ery low for a while) as our inclusion of DLPA and / or Tyrosine was immediately felt to be "too much" with an increase in agitation and increase in some of my phsycial symptoms that have been ongoing. In fact, had to start out at 2.5mg once a day (half tablet) and then work up to 5mg once a day and then gradually up to 5mg twice a day and then maybe look at adding in Tyrosine or DLPA....
Just to track the overall body's NT levels have recently asked by endo to include 24-hr urine test (General Assessment Neurotransmitter Test Panel - tracks levels of Serotonin, Dopamine, Epinephrine, Norepinephrine, GABA, PEA, Histamine and Glutamate) along with my monthly 24-hr UFC for cortisol.
Elroy
P.S. Thanks for your info and insight!X
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X> > Ran across this quote on a web site:
> >
> > QUOTE: The most effective way to correct a neurotransmitter deficiency is to perform a simple urine test to measure the neurotransmitter levels. END QUOTE
>
> This has recently been discussed at great length on the alternative board. Here's a post with a link to one of the labs that does the urine testing:
>
> http://www.dr-bob.org/babble/alter/20050414/msgs/484920.html
>
> A prominent warning on the lab site reads:
>
> "We have become aware of claims that neurotransmitter testing could be used to diagnose illness. There is no in clinic patient treatment data or work in the world to support claims such as this. Furthermore, the hyperexcretion of neurotransmitters means that the testing is meaningless for diagnostic purposes at this time....Neurotransmitter testing is of no value or benefit at this time when preformed prior to starting treatment of the patient."
>
> The truth of the matter is, they're absolutely correct. 90% of serotonin metabolism is outside the brain, but all the waste goes to urine. Just how are you going to fractionate undifferentiated waste, and imply anything about brain function? They can't even do that from a spinal tap of cerebrospinal fluid.
>
> > (Actually I would personally believe this to be not quite that accurate... Dopamine, Acetylcholine, GABA and Serotonin are probably the most important brain neurotransmitters with dopamine, being the "precursor" for norepinephrine and epinephrine - elroy)
>
> See, there are more reasons to be sceptical.
>
> > I asked my psych doc and she was like clueless. She "seemed" to indicate that she wasn't aware that there was such a test that could be run to determine NT levels (other than running an expensive BEAM scan)?
>
> If such a urine test was useful, it would be routinely used. It's that simple. No guesswork at the doctor's office. Pee in a cup, and get a drug recommendation.
>
> The fact of the matter is, these lab tests are hocus-pocus, used to sell you on the treatment.....which is, ta-da! nutrients. Now, would those nutrients fail to work in the absence of a urine test. No, of course they would work. Do the nutrients depend on a urine confirmatory test to work? Of course not. The urine test is part of the profit-making process for the clinic. Nothing more, and should be given no other credit of any kind.
>
> > It seems to make sense to me that one would check something like this. Why would a psych doc prescribe an SSRI for serotinin deficiency if the patient high normal or even high levels of serotonin but was deficient in dopamine or some other NT??? Is it because this particular SSRI or that particular SSNRI happens to be the flavor of the month?
>
> Based on symptoms. And, if you actually read in the in-depth process of assessment at these clinics that offer urinalysis, they do a physical consult and interview. Seems to me they're planning on treating your symptoms, after all, not your urine.
>
> > Anyone familiar with this test and what it is "technically" called? I believe that it is a 24-hour urine test like that run for cortisol to show your daily total.
>
> Snake oil.
>
> > I'd like to have one run and ascertain my levels. I have anxiety problems almost exclusively (along with a number of other cortisol and possibly candida related {HYSICAL problems) and have been fighting off taking a SSRI or SSNRI....
>
> The salivary cortisol is actually a useful test, and I believe the salivary DHEA is coming up as valid. The only other "fringe" nutrient test I know of that seems to have some science behind is one for zinc, copper, and the metallothionien carrier proteins. That's about it, off the top of my head.
>
> Urine testing for neurotranmsitter waste has never been validated to any internal measure of psychiatric or biochemical function.
>
> > A recent blood test that I took (to check for a pheo tumor) showed that - at that moment - I had minor low dopamine levels, low normal epinephrine and below normal norepinephrine. Unfortunately that was all the NTs that particular test showed, and a blood test only reveals what's circulating at that given moment, so isn't as accurate as a 24-hr urine test for showing totals....
> >
> > Thanks.
>
> If you're low, then I'd be taking dopamine precursors, and B-vitamins. And I would be you dollars to donuts that if you had that fancy bloodtest, they'd start you on dopamine precursors and B-vitamins. Maybe some zinc.
>
> I would be thrilled to trumpet the utility of a test that would match patient to treatment by more than some black magic process, but I don't yet get to do that.
>
> Sorry. But do lest us know if you go ahead. Make sure you note the history and symptoms they ask about, and if the eventual treatment would have made sense without needing the urine-testing.
>
> Best,
> Lar
Posted by djmmm on May 5, 2005, at 10:19:38
In reply to Urine Test to Measure Neurotransmitter Levels???, posted by Elroy on May 4, 2005, at 18:58:16
> Ran across this quote on a web site:
>
> QUOTE: The most effective way to correct a neurotransmitter deficiency is to perform a simple urine test to measure the neurotransmitter levels. END QUOTE
>
> http://www.theelementsofhealth.com/pages.html?section=resources&page=nttherapy
>
> The article has some other interesting things to say:
>
> QUOTE: Neurotransmitters (NTs) are essential chemical messengers that regulate brain, muscle, nerve and organ function. The most common neurotransmitters are serotonin, dopamine, norepinephrine, and epinephrine. Low levels of these important chemicals is extremely common in the general public and is due to innumerable lifestyle, environmental, and dietary factors. This article is intended to help the reader determine whether they may be deficient in neurotransmitters and how evaluation and treatment of this disorder can help.
>
> (Actually I would personally believe this to be not quite that accurate... Dopamine, Acetylcholine, GABA and Serotonin are probably the most important brain neurotransmitters with dopamine, being the "precursor" for norepinephrine and epinephrine - elroy)
>
> People with neurotransmitter deficiency disorder can suffer from one or more of the following conditions: obesity, depression, anxiety, fibromyalgia, chronic fatigue, insomnia, attention deficit, learning disorders, panic attacks, migraines, pms, menopausal symptoms, digestive complaints and many more.
>
> Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac, Zoloft, Effexor, Celexa, Wellbutrin, etc. are currently some of the most commonly prescribed drugs. They work by artificially increasing the amount of serotonin in the synapse of the nerve which allows a temporary improvement in the chemical messaging system.
>
> The problem with this approach is that these drugs DO NOT increase serotonin levels and in fact deplete reserves of the NT. This occurs because the SSRI class drugs cause an increase in an enzyme called MAO It is common for people to experience only temporary improvement due to this effect.
>
> The most effective way to correct a neurotransmitter deficiency is to perform a simple urine test to measure the neurotransmitter levels. The treatment for optimizing the neurotransmitter levels is to provide the basic amino acid precursors or building blocks so the body can replenish the inadequate neurotransmitter levels. END QUOTE
>
> I asked my psych doc and she was like clueless. She "seemed" to indicate that she wasn't aware that there was such a test that could be run to determine NT levels (other than running an expensive BEAM scan)?
>
> It seems to make sense to me that one would check something like this. Why would a psych doc prescribe an SSRI for serotinin deficiency if the patient high normal or even high levels of serotonin but was deficient in dopamine or some other NT??? Is it because this particular SSRI or that particular SSNRI happens to be the flavor of the month?
>
> Anyone familiar with this test and what it is "technically" called? I believe that it is a 24-hour urine test like that run for cortisol to show your daily total.
>
> I'd like to have one run and ascertain my levels. I have anxiety problems almost exclusively (along with a number of other cortisol and possibly candida related {HYSICAL problems) and have been fighting off taking a SSRI or SSNRI....
>
> A recent blood test that I took (to check for a pheo tumor) showed that - at that moment - I had minor low dopamine levels, low normal epinephrine and below normal norepinephrine. Unfortunately that was all the NTs that particular test showed, and a blood test only reveals what's circulating at that given moment, so isn't as accurate as a 24-hr urine test for showing totals....
>
> Thanks.I had a urinary catecholamine test years ago. It was the first thing my doc did before putting me on medication.
I had fairly severe anxiety/social phobia, such a test can help determine any medical problems that may be contributing to (in my case) anxiety.
Some rare cases of treatment resistant anxiety are caused by Pheochromocytoma (tumors that increase catecholamines).
The catecholamine test was one of a few tests (including a CBC) that I received.
Posted by Chairman_MAO on May 5, 2005, at 20:24:40
In reply to Urine Test to Measure Neurotransmitter Levels???, posted by Elroy on May 4, 2005, at 18:58:16
This is all B.S. It is so much more complicated than "neurotransmitter levels"; neurotransmitters aren't like gasoline stored in a tank. You don't "top it off" when it gets low, etc. What matters is which neurons fire, and where, receptor densities, second messenger systems (G protein coupled receptors) etc, etc. The urine tests can measure metabolites of neurotransmitters to get some sort of vague idea, but these tests are not routinely run precisely because their results have very limited diagnostic import. What it really comes down to is we have no idea how neural firing relates to consciousness, and it is in the conscious mind--not the brain--where all of these disorders ultimately reside. Despite what anyone tells you, psychiatry today still dispenses drugs based upon their BEHAVIORAL effects, not their neurological ones.
Posted by Elroy on May 6, 2005, at 22:29:58
In reply to Re: Urine Test to Measure Neurotransmitter Levels???, posted by djmmm on May 5, 2005, at 10:19:38
My most recent round of testing specifically was looking at checking fr a Pheo tumor. A tumor had been located in left adrenal gland back last October. First series of test ruled out that it was responsile for ultra high levels of cortisol (i.e., Cushing's Syndrome). This last round of testing ruled that it was NOT a Pheo tumor....
So apparently it's just a benign "non biologically active" tumor that's just sitting there.
BTW, the second CT Scan, done last month showed that the Housefield Units went from - 5 to -7 (the higher the number in the + range, the more likely to be malignant), AND that it had shruck about 25%....
X
X
X
X
X
> I had a urinary catecholamine test years ago. It was the first thing my doc did before putting me on medication.
>
> I had fairly severe anxiety/social phobia, such a test can help determine any medical problems that may be contributing to (in my case) anxiety.
>
> Some rare cases of treatment resistant anxiety are caused by Pheochromocytoma (tumors that increase catecholamines).
>
> The catecholamine test was one of a few tests (including a CBC) that I received.
Posted by Elroy on May 6, 2005, at 22:49:10
In reply to Re: Urine Test to Measure Neurotransmitter Levels??? » Elroy, posted by Chairman_MAO on May 5, 2005, at 20:24:40
I can agree with a lot of that, but if a particular class of NTs stand out as being well under a normal reference range or way above a stndard reference range, shouldn't that still wave warning flag as to whether or not more - or less- might be needed?
The reference range for NE is something like 80 to 520, so knowing that you had a 26 should be SOME sort of signal? In addition, take GABA. We have GABA receptors all over our body. A seriously noted lack of GABA in the body could be a raise of concern even outside psyhcological concerns, no?
Just a thought by a humble pilgrim seeking The Way,,,,
I'm still trying to figure out how in mid May of 2004 I could be in excellent condition, have severe anxiety hit in mid June and by early July have (almost overnight) gove from great shape to severe anxiety with hypogonadism, peripherial neuropathy, some kind of burning urethra . proststitis type pain, occasional cold hands and constant super icy cold feet (even when the surface of the has that stinging / burning pain from the neuropathy), and tinnitus... as the main, constant severe symptoms - not even counting the minor ones....
And the tests show abnormally low testosterone, abnormally high, ultra high cortisol, low dopamine, pretty low epinephrine, and super low norepinehrine!!!
X
X
X
X> This is all B.S. It is so much more complicated than "neurotransmitter levels"; neurotransmitters aren't like gasoline stored in a tank. You don't "top it off" when it gets low, etc. What matters is which neurons fire, and where, receptor densities, second messenger systems (G protein coupled receptors) etc, etc. The urine tests can measure metabolites of neurotransmitters to get some sort of vague idea, but these tests are not routinely run precisely because their results have very limited diagnostic import. What it really comes down to is we have no idea how neural firing relates to consciousness, and it is in the conscious mind--not the brain--where all of these disorders ultimately reside. Despite what anyone tells you, psychiatry today still dispenses drugs based upon their BEHAVIORAL effects, not their neurological ones.
Posted by Larry Hoover on May 9, 2005, at 11:27:34
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 5, 2005, at 6:49:05
> I had the fancy blood test done. That was the one which showed the moderately low dopamine, very low normal range epinephrine, and the extremely low norepinephrine (way off the chart, BELOW the bottom of the normal range).
Have you tried high dose vitamin C, for example? The conversion of dopamine to NE requires vitamin C and B6. You may have a defect in activating B6, too. You may need P5P instead of B6.
I'm sorry if we've been over this before. I have trouble remembering who I talked to about what. I remember the what part, not the who.
> The endocrinologist said that was a great result as it meant that my adrenal gland tumor was not only benign, but that it was NOT a "Pheo" tumor.
>
> The fact that I had circulating levels of very low adrenaline meant nothing to him.Did you dose with adrenal supports? Pantothenate, vitamin C (again), vitamin E, zinc, magnesium.
What are you pituitary hormones like? Are your CRH and ACTH within normal range?
> Now my psych doc was puzzled as I have had severe anxiety (kept at bay only by daily Xanax XR, and then just barely as it is always lurking in the background) for almost a year now and she would have (in her words) bet serious money that those levels would have been not only high, but very high.
>
> Well, what about the BEAM Scans (I think that's what they are called) as used by Dr. Eric Braverman and highlighted in his books and practice? Anyone have any experience with that testing protocol as relates to determining actual neurotransmitter levels?The only issue I have with BEAM is that nothing has been published. They claim to be developing a comparative database that provides treatment guidance, but I have not seen anything that validates the methodology. They claim it works, without evidence that it does.
> Or possibly SPECT/PET (single photon/positron emission computed tomography) scans? Anyone have any experience with that testing protocol? Just seems that determining what NTs are actually deficient makes more sense than just throwing serotonin enhancement at every mental problem....
Same problems with SPECT. The existence of abnormalities does not guide treatment modalities.
> Anyway, I personally would still think that 24-hour urine tests of neurotransmitters would be beneficial just from the viewpoint of knowing what overall body levels were even aside from what was coursing through the brain. Low levels of dopamine, NE and epinephrine along with low levels of cortisol and DHEA would probably be a pretty strong signal that one might be approaching adrenal fatigue, for example (which is NOT a good medical condition to be in).Absolutely true, but did you ask your doctors if they even believe in the entity called adrenal fatigue/adrenal exhaustion? I would bet they do not.
> BTW, I did talk my psych doc into starting me on a dose of 5mg Selegiline twice a day to hopefully start getting those levels up. I have apparently adapted at those low levels (and they've been ery low for a while) as our inclusion of DLPA and / or Tyrosine was immediately felt to be "too much" with an increase in agitation and increase in some of my phsycial symptoms that have been ongoing. In fact, had to start out at 2.5mg once a day (half tablet) and then work up to 5mg once a day and then gradually up to 5mg twice a day and then maybe look at adding in Tyrosine or DLPA....Low-dose selegiline most likely works via a mechanism that is tangential to catecholamine neurotransmission, in my opinion. Just what that is, I'm not clear on. Once you begin to saturate the MAO-B sites, the crossover to MAO-A does directly affect catecholamines.
> Just to track the overall body's NT levels have recently asked by endo to include 24-hr urine test (General Assessment Neurotransmitter Test Panel - tracks levels of Serotonin, Dopamine, Epinephrine, Norepinephrine, GABA, PEA, Histamine and Glutamate) along with my monthly 24-hr UFC for cortisol.
>
> ElroyI hope you don't forget that all the testing in the world is for your cognitive experience.....the trying to understand part. It's the experiments you do, the interventions, that are actually of any use at all. They provide the only real data for further consideration. You do experiments, and see what happens. Hypothesis testing, with (hopefully) some drift towards the theoretically optimal intervention.
Best, Lar
Posted by Larry Hoover on May 9, 2005, at 11:29:18
In reply to Re: Urine Test to Measure Neurotransmitter Levels???, posted by djmmm on May 5, 2005, at 10:19:38
> I had a urinary catecholamine test years ago. It was the first thing my doc did before putting me on medication.
>
> I had fairly severe anxiety/social phobia, such a test can help determine any medical problems that may be contributing to (in my case) anxiety.
>
> Some rare cases of treatment resistant anxiety are caused by Pheochromocytoma (tumors that increase catecholamines).
>
> The catecholamine test was one of a few tests (including a CBC) that I received.Exactly the point. Your doctor was ruling out exotic, but medical, causes of your anxiety. It's part of the differential diagnosis. If you had a pheo, your urine would have had bizarrely elevated catecholamines and metabolites.
Lar
Posted by Larry Hoover on May 9, 2005, at 11:33:02
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Chairman_MAO, posted by Elroy on May 6, 2005, at 22:49:10
> I'm still trying to figure out how in mid May of 2004 I could be in excellent condition, have severe anxiety hit in mid June and by early July have (almost overnight) gove from great shape to severe anxiety with hypogonadism, peripherial neuropathy, some kind of burning urethra . proststitis type pain, occasional cold hands and constant super icy cold feet (even when the surface of the has that stinging / burning pain from the neuropathy), and tinnitus... as the main, constant severe symptoms - not even counting the minor ones....
>
> And the tests show abnormally low testosterone, abnormally high, ultra high cortisol, low dopamine, pretty low epinephrine, and super low norepinehrine!!!Have you had a brain CT scan? Whole body scan?
I can't see an endocrinologist classifying these disturbances as normal.....that is what you suggested in your prior post, is it not?
Lar
Posted by Elroy on May 9, 2005, at 20:34:00
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 9, 2005, at 11:27:34
Lar,
Thanks for the info.
I am getting more and more stumped.
Anything that increases my NE levels (or that should be increasing them) causes an extremely noticeable increase in my anxiety and also my various physical symptoms (but especially the "prostatitis type sensations" - actually it is primarily a "burning urethra" type of pain).
It first occurred when my psyc doc put me on Effexor. Even at the starting low dose, the effect was almost immediate (the same evening). That was last July. Then a couple of months ago we had the same thing happen with Cymbalta. It just took a couple of days instead of right away.
Putting together that it was the NE angle (as I had been on SSRIs before and while they didn't help my anxiety problem any, they didn't worsen it nor cause the physical symptoms to increase), I decided on an "experiment".
I obtained some Tyrosine and tried ONE 500mg tablet. Yow! Anxiety increased as did the physical symptoms (especially the prostatitis type pains - I refer to it in that sense as it has been tested numerous times with no bacterial evidence found... but then the urologists go ahead and prescribe another cycle of antibiotics). Anyway, I cut the tablets in half (250mg) and still the same reaction. I cut the tablets in half again (125mg) and again the same reaction (just slightly muted a touch).
Well, I have been taking the Selegiline for about three weeks now and it too gives that same reaction, even at quite small doses (like 2.5 mg twice a day).
My primary mental/emotional problem is high anxiety, with only mild to moderate depression (and almost all of that centered around my anxiety and various physical symptoms).
As these total symptoms all came on within about 2 - 3 weeks of the severe anxiety onset, it just seems to me that there HAS to be some inter-relations there. I had chronic, high-level stress from 1996 to around 2002 and then moderate anxiety (so mild that ir was treated only with "talk therapy" and Ambien for a sleep aid) from July 2002 on. Anyway, it appears that all during that time my cortisol levels were steadily rising and that I hit some type of threshhold in June of 2004 when the severe anxiety and the various physical symptoms hit. The primary physical (main) symptoms include hypogonadism, burning / stinging pains of the hands and feet (to include at times lower arms and lower legs), yet icy cold sensations of insides of feet, the prosatitis type pain, tinnitus, and severe insomnia.
What is difficult for the MDs to fully understand is that these symptoms literally came on that quickly (almost overnight). What each want to do is look at each symptom as existing by itself. So the prostatitis is strictly a urology problem (with the urologist now being completely stumped) and the tinnitus being strictly an ENT problem (with the ENT doc being completely stumped), and the abnormally low testosterone being strictly an endo problem (and the endo doc being completely stumped), and the highly elevated cortisol being strictly an endo problem (and THAT endo doc being completely stumped)!
In fact, I am now in the proverbial "Catch-22" situation. The main endo says that the severe anxiety is "likely" causing elevated cortisol levels while the psych doc says that the elevated cortisol is "likely" causing the severe anxiety - with each saying that there's not much more that they can do!
As my Xanax XR is getting less and less effective, am I stuck in a Twilight Zone where I just keep increasing the doses of Xanax to (barely) keep a lid of the ongoing anxiety?
Anyway, I have also stopped the Selegiline. It's obvious that either my levels of NE are much higher than what the one blood test revealed or I have some super sensitivity to NE or something.
SSRIs (specifically Lexapro) caused their own terrible reactions, a deadening of emotions without really affecting the anxiety, sexual dysfunctions and severe nausea which wouldn't get better.
I wonder if possibly utilization of Tryptophan might be an option to try and raise serotonin levels if that might be a necessary addition? SAMe? Taurine?
I hate to stay on the Xanax XR, but we first tried Ativan and it did nothing for the anxiety after about an hour or so.
Personally, I believe that the cortisol is THE key element with what is going on here and am currently starting an aggressive protocol of taking various anti-cortisol supplements (seeing as how my main endo said that since it isn't Cushings that there's not much he can do for it).
Elroy
X
X
X
X
> > I had the fancy blood test done. That was the one which showed the moderately low dopamine, very low normal range epinephrine, and the extremely low norepinephrine (way off the chart, BELOW the bottom of the normal range).
>
> Have you tried high dose vitamin C, for example? The conversion of dopamine to NE requires vitamin C and B6. You may have a defect in activating B6, too. You may need P5P instead of B6.
>
> I'm sorry if we've been over this before. I have trouble remembering who I talked to about what. I remember the what part, not the who.
>
> > The endocrinologist said that was a great result as it meant that my adrenal gland tumor was not only benign, but that it was NOT a "Pheo" tumor.
> >
> > The fact that I had circulating levels of very low adrenaline meant nothing to him.
>
> Did you dose with adrenal supports? Pantothenate, vitamin C (again), vitamin E, zinc, magnesium.
>
> What are you pituitary hormones like? Are your CRH and ACTH within normal range?
>
> > Now my psych doc was puzzled as I have had severe anxiety (kept at bay only by daily Xanax XR, and then just barely as it is always lurking in the background) for almost a year now and she would have (in her words) bet serious money that those levels would have been not only high, but very high.
> >
> > Well, what about the BEAM Scans (I think that's what they are called) as used by Dr. Eric Braverman and highlighted in his books and practice? Anyone have any experience with that testing protocol as relates to determining actual neurotransmitter levels?
>
> The only issue I have with BEAM is that nothing has been published. They claim to be developing a comparative database that provides treatment guidance, but I have not seen anything that validates the methodology. They claim it works, without evidence that it does.
>
> > Or possibly SPECT/PET (single photon/positron emission computed tomography) scans? Anyone have any experience with that testing protocol? Just seems that determining what NTs are actually deficient makes more sense than just throwing serotonin enhancement at every mental problem....
>
> Same problems with SPECT. The existence of abnormalities does not guide treatment modalities.
>
> > Anyway, I personally would still think that 24-hour urine tests of neurotransmitters would be beneficial just from the viewpoint of knowing what overall body levels were even aside from what was coursing through the brain. Low levels of dopamine, NE and epinephrine along with low levels of cortisol and DHEA would probably be a pretty strong signal that one might be approaching adrenal fatigue, for example (which is NOT a good medical condition to be in).
>
> Absolutely true, but did you ask your doctors if they even believe in the entity called adrenal fatigue/adrenal exhaustion? I would bet they do not.
>
> > BTW, I did talk my psych doc into starting me on a dose of 5mg Selegiline twice a day to hopefully start getting those levels up. I have apparently adapted at those low levels (and they've been ery low for a while) as our inclusion of DLPA and / or Tyrosine was immediately felt to be "too much" with an increase in agitation and increase in some of my phsycial symptoms that have been ongoing. In fact, had to start out at 2.5mg once a day (half tablet) and then work up to 5mg once a day and then gradually up to 5mg twice a day and then maybe look at adding in Tyrosine or DLPA....
>
> Low-dose selegiline most likely works via a mechanism that is tangential to catecholamine neurotransmission, in my opinion. Just what that is, I'm not clear on. Once you begin to saturate the MAO-B sites, the crossover to MAO-A does directly affect catecholamines.
>
> > Just to track the overall body's NT levels have recently asked by endo to include 24-hr urine test (General Assessment Neurotransmitter Test Panel - tracks levels of Serotonin, Dopamine, Epinephrine, Norepinephrine, GABA, PEA, Histamine and Glutamate) along with my monthly 24-hr UFC for cortisol.
> >
> > Elroy
>
> I hope you don't forget that all the testing in the world is for your cognitive experience.....the trying to understand part. It's the experiments you do, the interventions, that are actually of any use at all. They provide the only real data for further consideration. You do experiments, and see what happens. Hypothesis testing, with (hopefully) some drift towards the theoretically optimal intervention.
>
> Best, Lar
Posted by Elroy on May 9, 2005, at 20:51:30
In reply to Re: Urine Test to Measure Neurotransmitter Levels???, posted by Larry Hoover on May 9, 2005, at 11:29:18
Lar,
If only your statement would have been true.
My endo was only concerned about my high cortisol levels and his hopes that it would end up being a legitimate Cushings case and he could "Dr House" a diagnosis that located the offending tumor and refer it for surgical intervention. From Day One he has never concerned himself with my high anxiety levels (he in fact mostly refuses to concede the relationship between the two - in spite of the facts: see my previous post).
In fact, having tested and found initially that even if it was Cushings, it definitely wasn't coming from an adrenal source, he had written off the KNOWN adrenal tumor as being nothing to be concerned about. It was only when my PCP doc began making noises about it being possibly a "Pheo" tumor that he (the main endo) decided abruptly to do tests to check that out (and yes, you're right, if it had been a "Pheo", the catecholamines of epoinephrine, NE, etc., would have been wildly elevated... mine were noticeably LOW, especially the NE).
And now that the latest tests have completely ruled out Cushings at all, he has declared that the elevated cortisol is "Pseudo Cushings" and that there's nothing that he can do for it, that my psych doc should be treating my anxiety "more aggressively" and that will bring the cortisol levels down...
Meanwhile my psych doc believes that the HPA Axis is malfunctioning and that the cortisol - which probably was caused to be elevated by tears of ongoing stress and milder anxiety - is now controlling the ballgame and is actually causing the severe anxiety and many of the physical symptoms (just as it would with real Cushings, symptom wise there's no difference between "real" Cushings and "Pseudo" Cushings)...
So there's NO "differential diagnosis" going on. Simply a disappointment that it wasn't a tumor caused Cushings and an "ol' well, sorry about that"....
Elroy
X
X
X
X
> > I had a urinary catecholamine test years ago. It was the first thing my doc did before putting me on medication.
> >
> > I had fairly severe anxiety/social phobia, such a test can help determine any medical problems that may be contributing to (in my case) anxiety.
> >
> > Some rare cases of treatment resistant anxiety are caused by Pheochromocytoma (tumors that increase catecholamines).
> >
> > The catecholamine test was one of a few tests (including a CBC) that I received.
>
> Exactly the point. Your doctor was ruling out exotic, but medical, causes of your anxiety. It's part of the differential diagnosis. If you had a pheo, your urine would have had bizarrely elevated catecholamines and metabolites.
>
> Lar
>
Posted by Elroy on May 9, 2005, at 20:57:55
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 9, 2005, at 11:33:02
No, I have not... well, just the two abdominal CT scans. The one that found the adrenal gland tumor and the second recent one that was a follow-up for it.
These physical symptoms seem to mean nothing to the endo as relates to the elevated cortisol. I have been sent off to various other specialists for the various symptoms without any correlation between their possible inter-relation.
In fact, tomorrow I now see a neurologist to test the "peripheral neuropathy type pains" - and possibly also the tinnitus now that the ENT has struck out and is likewise stumped now.
P.S. He did want to do an MRI - back when he felt that it still might be "real" Cushings (as that can usually be caused by a pituitary tumor), but once the advanced chemical / blood tests reevaled it wasn't Cushing's then that quickly came off of the shelf!X
X
X
> > I'm still trying to figure out how in mid May of 2004 I could be in excellent condition, have severe anxiety hit in mid June and by early July have (almost overnight) gove from great shape to severe anxiety with hypogonadism, peripherial neuropathy, some kind of burning urethra . proststitis type pain, occasional cold hands and constant super icy cold feet (even when the surface of the has that stinging / burning pain from the neuropathy), and tinnitus... as the main, constant severe symptoms - not even counting the minor ones....
> >
> > And the tests show abnormally low testosterone, abnormally high, ultra high cortisol, low dopamine, pretty low epinephrine, and super low norepinehrine!!!
>
> Have you had a brain CT scan? Whole body scan?
>
> I can't see an endocrinologist classifying these disturbances as normal.....that is what you suggested in your prior post, is it not?
>
> Lar
Posted by Larry Hoover on May 9, 2005, at 22:17:56
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 9, 2005, at 20:34:00
> What is difficult for the MDs to fully understand is that these symptoms literally came on that quickly (almost overnight). What each want to do is look at each symptom as existing by itself. So the prostatitis is strictly a urology problem (with the urologist now being completely stumped) and the tinnitus being strictly an ENT problem (with the ENT doc being completely stumped), and the abnormally low testosterone being strictly an endo problem (and the endo doc being completely stumped), and the highly elevated cortisol being strictly an endo problem (and THAT endo doc being completely stumped)!
It would be totally remarkable if each turned out to have a distinct but separate cause, wouldn't it? No, there must be a common thread.
> I wonder if possibly utilization of Tryptophan might be an option to try and raise serotonin levels if that might be a necessary addition? SAMe? Taurine?
Tryptophan or taurine would be absolutely risk free, IMHO. The SAMe might be even more stimulating. It's hard to say.
> I hate to stay on the Xanax XR, but we first tried Ativan and it did nothing for the anxiety after about an hour or so.
>
> Personally, I believe that the cortisol is THE key element with what is going on here and am currently starting an aggressive protocol of taking various anti-cortisol supplements (seeing as how my main endo said that since it isn't Cushings that there's not much he can do for it).
>
> ElroyLicorice root will do that.
I asked about your CRH and ACTH hormone levels. Do you have any idea what they scored at?
Licorice tricks your hypothalamus and pituitary into thinking the adrenals are pumping out excess cortisol, and they shut down their adrenal stimulatory activity. The whole system should go into a temporary rest phase.
Now, I don't know if your body will act like that, because it's hard to figure out what's out of whack. Did you have a head CT? Pituitary tumor ruled out?
Lar
Posted by Larry Hoover on May 9, 2005, at 22:36:48
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 9, 2005, at 20:34:00
Been ponderating a bit more.
What's your thyroid hormone status? Have you had a panel recently?
Thyroid hormone can be used to bring down cortisol. It improves hypothalamic sensitivity to cortisol.
About supplements. You can do these experiments without involving the doctors.
Tryptophan checks out as a valid trial. Serotonin also improves hypothalamic sensitivity to cortisol.
Taurine might well be good just because it is generally calming. If the subjective experience is beneficial, who needs any better rationale than that for taking it.
Phosphatidylserine. That's another one that could bring about a shift in the hypothalamic sensitivity.
There are three different glandular function/feedback loops, each having two components in common. There's the HPA (hypothalamus/pituitary/adrenal), the HPG (same, but gonadal), and the HPT (same, but thyroid).
The tingling and the tinnitus could be thyroid related. The hypogonadism is obvious (and could promote prostatitis). The adrenal link is also clear.
Maybe the nodule on your adrenal is an innocent bystander. There could be an HP link, and that usually is pituitary.
You could safely go ahead with trying some tryptophan, taurine, and phosphatidylserine. They're all good for you.
Lar
Posted by Elroy on May 15, 2005, at 21:33:36
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 9, 2005, at 22:17:56
Yes, indeed, It would be totally remarkable if each turned out to have a distinct but separate cause, wouldn't it? No, there must be a common thread!
Think of that.
On Memorial Day last year I had NONE of those symptoms nor any anxiety. By mid June I had developed severe anxiety and by July 4th had ALL of those various symptoms (peripheral neuropathy type pains that are not - according to a major metro neurologist - peripehral neuropathy, prostatitis type pains that are not prostatitis, constant extremely icy cold feeling to feet, occasional cold feeling to hands, hypogonadism, tinnitus - and a host of more minor symptoms). And the anxiety.
Let's see. CRH levels, I am not sure about. ACTH levels have always been pretty much mid range, occasional upper normal range. My lab's reference range is 5 - 50 and I've run the range from a 16 to a 36. Mostly in the 16-25 range.
Also, your info about samE maybe being too "stimulating" appears to be right on the mark. Am even still trying to take 1/4 tablet of Tyrosine without too much stimulation (especially in the result of having the prostatitis type pain - burning urethra - flare up and the anxiety feelings enhance somewhat). 1/4 tablet is 125 mgs in my case (maybe I need to find 100 mg tablets and cut them down??? or maybe just let go that angle for right now and assume that I've actually got more than sufficient dopamine / adrenaline levels???).
Anyway, I recall some info about licorice. As I recall, there's two types. Actually only one type but processed differently?? One type boosts the adrenal glands and could actually increase production of cortisol while other type is an effective "anti-cortisol" product. Can't remember offhand which is which. Let's see, something like non-deglycyrrhinized licorice and deglycyrrhinized licorice, but can't recall which does which (darn brain fog!).
I found your comment (as follows) very interesting:
QUOTE: Licorice tricks your hypothalamus and pituitary into thinking the adrenals are pumping out excess cortisol, and they shut down their adrenal stimulatory activity. The whole system should go into a temporary rest phase. END QUOTE
Do you have any links to further information on that process?
You see, I have developed the following theory:
1. Long-term stress (1996 - 2002) and mild-to-moderate anxiety (2002 - 2004, clinical to the point of being treated via talk therapy and ambien for sleep but no other meds) resulted in
continual over-secretion of cortisol.2. Somewhere along the way the HPA Axis "broke down" and cortisol production went whacko.
3. While elevated cortisol was initially caused by the ongoing anxiety, now the elevated cortisol is "running the show" and causing the continuation of the anxiety (even making it worse) and most of the other symptoms (for example, high cortisol is a direct a cause of ssecondary hyporgonadism).
I have been so convinced of this that I have spoke very strongly with my endo about looking into an attempt at RU486 therapy to "re-set" the HPA Axis. For further info on that, review these links:
http://www.healthyplace.com/communities/depression/psychotic.asp
http://www.healthyplace.com/communities/depression/psychotic_ru486.asp
http://www.psychiatrictimes.com/p040592.html
http://news-service.stanford.edu/news/2000/november8/ru486-1108.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11593077&dopt=Abstract
http://www.psychosomaticmedicine.org/cgi/content/full/61/5/698Anyway, that RU486 protocol seems quite interesting.... but if I can accomplish the same thing with the use of licorice, well, a "trial run" would be worthwhile, eh?
Like I said, any more info on specific protocol recommendations (type, doses, daily amounts, length of time on protocol, etc.). would be appreciated.
Elroy
P.S. Have also been given information that shows that constant elevated cortisol levels can establish an excellent breeding ground for establishment of systemic candida and that it might be what I developed in June of last year that accounted for a lot of these symptoms.... I don't have much info or experience in that area - other than to note that my wife is currently being treated for thrush and also knowing than my mother had a severe "breathing problem" that lasted for years and years which ended up actually being candida and cleared up within a few weeks after being treated as such. She was diagnosed with asthma, cheronic bronchitis, pinched nerve in her back ribs, etc., etc. and it ended up being candida that had spread to her lungs.> > What is difficult for the MDs to fully understand is that these symptoms literally came on that quickly (almost overnight). What each want to do is look at each symptom as existing by itself. So the prostatitis is strictly a urology problem (with the urologist now being completely stumped) and the tinnitus being strictly an ENT problem (with the ENT doc being completely stumped), and the abnormally low testosterone being strictly an endo problem (and the endo doc being completely stumped), and the highly elevated cortisol being strictly an endo problem (and THAT endo doc being completely stumped)!
>
> It would be totally remarkable if each turned out to have a distinct but separate cause, wouldn't it? No, there must be a common thread.
>
> > I wonder if possibly utilization of Tryptophan might be an option to try and raise serotonin levels if that might be a necessary addition? SAMe? Taurine?
>
> Tryptophan or taurine would be absolutely risk free, IMHO. The SAMe might be even more stimulating. It's hard to say.
>
> > I hate to stay on the Xanax XR, but we first tried Ativan and it did nothing for the anxiety after about an hour or so.
> >
> > Personally, I believe that the cortisol is THE key element with what is going on here and am currently starting an aggressive protocol of taking various anti-cortisol supplements (seeing as how my main endo said that since it isn't Cushings that there's not much he can do for it).
> >
> > Elroy
>
> Licorice root will do that.
>
> I asked about your CRH and ACTH hormone levels. Do you have any idea what they scored at?
>
> Licorice tricks your hypothalamus and pituitary into thinking the adrenals are pumping out excess cortisol, and they shut down their adrenal stimulatory activity. The whole system should go into a temporary rest phase.
>
> Now, I don't know if your body will act like that, because it's hard to figure out what's out of whack. Did you have a head CT? Pituitary tumor ruled out?
>
> Lar
Posted by Elroy on May 15, 2005, at 21:53:01
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 9, 2005, at 22:36:48
Let's see.
Have had one thyroid hormone panel. Last year, around September / October (when my cortisol was at highest levels that it's been).
T4 Total was 8.2 (reference range 3.8 to 12.0)
T4 Free was 3.13 (reference range 1.20 to 3.22)
T3 Uptake was 38.2 (reference range 22 to 37)The endo (separate one from one I have now) said these were good figures and that the slightly high T3 Uptake was no concern, probably's body's reaction against ultra high cortisol (at that time my cortisol levels were almost six times the maximum of the normal reference range).
What's your take on 5HTP in place of the Tryptophan? I have started using the 5HTP (50mg twice a day during day and 100mg at bedtime). Is Tryptophan a better option? Good source for bulk purchases??? (I'm familiar with BAC and SMI2LE).
Also have been using Taurine for a while now. Seems to work really well (at calming) at times but then barely work other times.
Also Phosphatidylserine (along with magnolia bark extract products) have become the mainstay of my current anti-cortisol problem... though I would really, really like some further info on that approah with licorice.
Again, thanks for your info.
As always, very interesting.
Elroy
X
X
X
X> Been ponderating a bit more.
>
> What's your thyroid hormone status? Have you had a panel recently?
>
> Thyroid hormone can be used to bring down cortisol. It improves hypothalamic sensitivity to cortisol.
>
> About supplements. You can do these experiments without involving the doctors.
>
> Tryptophan checks out as a valid trial. Serotonin also improves hypothalamic sensitivity to cortisol.
>
> Taurine might well be good just because it is generally calming. If the subjective experience is beneficial, who needs any better rationale than that for taking it.
>
> Phosphatidylserine. That's another one that could bring about a shift in the hypothalamic sensitivity.
>
> There are three different glandular function/feedback loops, each having two components in common. There's the HPA (hypothalamus/pituitary/adrenal), the HPG (same, but gonadal), and the HPT (same, but thyroid).
>
> The tingling and the tinnitus could be thyroid related. The hypogonadism is obvious (and could promote prostatitis). The adrenal link is also clear.
>
> Maybe the nodule on your adrenal is an innocent bystander. There could be an HP link, and that usually is pituitary.
>
> You could safely go ahead with trying some tryptophan, taurine, and phosphatidylserine. They're all good for you.
>
> Lar
Posted by Larry Hoover on May 16, 2005, at 10:42:36
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 15, 2005, at 21:33:36
I've re-organized your post a bit.
> Anyway, I recall some info about licorice. As I recall, there's two types. Actually only one type but processed differently?? One type boosts the adrenal glands and could actually increase production of cortisol while other type is an effective "anti-cortisol" product. Can't remember offhand which is which. Let's see, something like non-deglycyrrhinized licorice and deglycyrrhinized licorice, but can't recall which does which (darn brain fog!).
> Do you have any links to further information on that process?
DGL is the one that does not affect cortisol. Regular (unprocessed) licorice root affects cortisol. But, rather than increasing cortisol production, literally, it inhibits the conversion of cortisol to cortisone, via the enzyme 11beta-hydroxysteroid dehydrogenase type 2. This actually enhances the systemic cortisol signal, and shuts down the adrenal gland production, via cortisol receptors in the hypothalamus. This sounds contrary to what you seek, but:
Food Chem Toxicol. 2002 Oct;40(10):1525-7.
Liquorice (Glycyrrhiza glabra) and the adrenal-kidney-pituitary axis in rats.Al-Qarawi AA, Abdel-Rahman HA, Ali BH, El Mougy SA.
The effect of oral administration of a water freeze-dried extract of Glycyrrhiza glabra (liquorice) has been studied at doses of 100, 250 and 500 mg/kg in rats on the plasma concentration of cortisol, adrenocorticotrophic hormone (ACTH), aldosterone, renin, sodium (Na) and potassium (K). The results indicated that treatment induced dose-dependent and mostly significant decreases in the concentration of cortisol, ACTH, aldosterone and K. There were concomitant dose-dependent increases in the concentrations of renin and Na. The results suggest a strong and dose-dependent suppression of the adrenal-pituitary axis, accompanied by stimulation of renin production from the kidney.
When I was looking at this more closely, in response to your questions, I began to see an apparent contradiction between human and animal studies. It seems my suggestion was informed by study of rats. They are different than us.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8733012
They have different receptors than we do, and thus their response to cortisolic regulators is different than ours. *OR*, the time-dependency of the measures accounts for the differences.
I've been "thinking this through" as I wrote this post. Despite the apparent contradictions, it seems that mifepristone and licorice have a similar mechanism.
> I found your comment (as follows) very interesting:
>
> QUOTE: Licorice tricks your hypothalamus and pituitary into thinking the adrenals are pumping out excess cortisol, and they shut down their adrenal stimulatory activity. The whole system should go into a temporary rest phase. END QUOTEThat would be mediated by hypothalamic response to cortisolic receptor binding (GR and MR).....but it depends on your initial ACTH (and CRH, but they are usually very closely linked). And....
> Let's see. CRH levels, I am not sure about. ACTH levels have always been pretty much mid range, occasional upper normal range. My lab's reference range is 5 - 50 and I've run the range from a 16 to a 36. Mostly in the 16-25 range.
Your ACTH is in the normal range despite excessive cortisol. You seem like you're not responding to excess cortisol already (i.e. I presume normal CRH).
And that leads directly to the following:
> I have been so convinced of this that I have spoke very strongly with my endo about looking into an attempt at RU486 therapy to "re-set" the HPA Axis.
That sounds like an excellent option. I was unaware of the selective GR antagonism of this drug. On its face, it sound like it has a very similar mechanism of action as does licorice, except I don't know if licorice antagonizes the GR receptor. You'll note in your last reference that mifepristone has the short term effect of increasing cortisol. So would licorice. The idea, I suppose, is to shock the sytem back into a more normal "rhythm", like shocking a heart that is beating too fast. I suspect the short-term increase in cortisol ought to be seen as a side-effect of the therapy. The true intent is to get the hypothalamus back into balance.
The advantages of mifepristone would be direct medical supervision and very controlled dosage. Also, you know it has GR antagonism.
For both licorice and mifepristone, the treatment period should be no more than 3-4 weeks.
No matter what course you take (if you do), you're pretty much in uncharted territory. Have you ever done a dexamethasone suppression test? It would confirm the GR non-responsivity issue.
> Also, your info about samE maybe being too "stimulating" appears to be right on the mark. Am even still trying to take 1/4 tablet of Tyrosine without too much stimulation (especially in the result of having the prostatitis type pain - burning urethra - flare up and the anxiety feelings enhance somewhat). 1/4 tablet is 125 mgs in my case (maybe I need to find 100 mg tablets and cut them down??? or maybe just let go that angle for right now and assume that I've actually got more than sufficient dopamine / adrenaline levels???).
I would stay away from something that seems to clearly aggravate some of your symptoms.
I am really wondering if anything I talk about is of any use to you at all.
Regards,
Lar
Posted by Larry Hoover on May 16, 2005, at 10:51:35
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 15, 2005, at 21:53:01
> Let's see.
>
> Have had one thyroid hormone panel. Last year, around September / October (when my cortisol was at highest levels that it's been).
>
> T4 Total was 8.2 (reference range 3.8 to 12.0)
> T4 Free was 3.13 (reference range 1.20 to 3.22)
> T3 Uptake was 38.2 (reference range 22 to 37)
>
> The endo (separate one from one I have now) said these were good figures and that the slightly high T3 Uptake was no concern, probably's body's reaction against ultra high cortisol (at that time my cortisol levels were almost six times the maximum of the normal reference range).Seems quite reasonable.
> What's your take on 5HTP in place of the Tryptophan? I have started using the 5HTP (50mg twice a day during day and 100mg at bedtime). Is Tryptophan a better option? Good source for bulk purchases??? (I'm familiar with BAC and SMI2LE).
I tend to prefer tryptophan, as 5-HTP is not normally circulating in the blood, as it would be after an oral supplement is absorbed.
I use veterinary tryptophan.
http://www.buygpdirect.com/gpefeed.htm
The ultra-pure product is mixed with a little dextrose, for some reason. Probably equine palatability? <shrug>
> Also have been using Taurine for a while now. Seems to work really well (at calming) at times but then barely work other times.
Glad to get the feedback. I suspect that you might get clues from your "psych environment", e.g. the differential impact of fatigue vs. acute stimulation. Frustrated vs. wound up. That sort of comparison.
What's your dose of taurine?
> Also Phosphatidylserine (along with magnolia bark extract products) have become the mainstay of my current anti-cortisol problem... though I would really, really like some further info on that approah with licorice.
Licorice is speculative, as I say in the other post. It may be a worthy experiment, but I don't know that it will help.
> Again, thanks for your info.
>
> As always, very interesting.
>
> Elroy
You're welcome. You're in a tough space, and I'm happy to share my thoughts with you.Lar
Posted by Elroy on May 16, 2005, at 12:49:50
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 16, 2005, at 10:42:36
Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
> I've re-organized your post a bit.
>
> > Anyway, I recall some info about licorice. As I recall, there's two types. Actually only one type but processed differently?? One type boosts the adrenal glands and could actually increase production of cortisol while other type is an effective "anti-cortisol" product. Can't remember offhand which is which. Let's see, something like non-deglycyrrhinized licorice and deglycyrrhinized licorice, but can't recall which does which (darn brain fog!).
>
> > Do you have any links to further information on that process?
>
> DGL is the one that does not affect cortisol. Regular (unprocessed) licorice root affects cortisol. But, rather than increasing cortisol production, literally, it inhibits the conversion of cortisol to cortisone, via the enzyme 11beta-hydroxysteroid dehydrogenase type 2. This actually enhances the systemic cortisol signal, and shuts down the adrenal gland production, via cortisol receptors in the hypothalamus. This sounds contrary to what you seek, but:
>
> Food Chem Toxicol. 2002 Oct;40(10):1525-7.
>
> Liquorice (Glycyrrhiza glabra) and the adrenal-kidney-pituitary axis in rats.
>
> Al-Qarawi AA, Abdel-Rahman HA, Ali BH, El Mougy SA.
>
> The effect of oral administration of a water freeze-dried extract of Glycyrrhiza glabra (liquorice) has been studied at doses of 100, 250 and 500 mg/kg in rats on the plasma concentration of cortisol, adrenocorticotrophic hormone (ACTH), aldosterone, renin, sodium (Na) and potassium (K). The results indicated that treatment induced dose-dependent and mostly significant decreases in the concentration of cortisol, ACTH, aldosterone and K. There were concomitant dose-dependent increases in the concentrations of renin and Na. The results suggest a strong and dose-dependent suppression of the adrenal-pituitary axis, accompanied by stimulation of renin production from the kidney.
>
> When I was looking at this more closely, in response to your questions, I began to see an apparent contradiction between human and animal studies. It seems my suggestion was informed by study of rats. They are different than us.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8733012
>
> They have different receptors than we do, and thus their response to cortisolic regulators is different than ours. *OR*, the time-dependency of the measures accounts for the differences.
>
> I've been "thinking this through" as I wrote this post. Despite the apparent contradictions, it seems that mifepristone and licorice have a similar mechanism.
>
> > I found your comment (as follows) very interesting:
> >
> > QUOTE: Licorice tricks your hypothalamus and pituitary into thinking the adrenals are pumping out excess cortisol, and they shut down their adrenal stimulatory activity. The whole system should go into a temporary rest phase. END QUOTE
>
> That would be mediated by hypothalamic response to cortisolic receptor binding (GR and MR).....but it depends on your initial ACTH (and CRH, but they are usually very closely linked). And....
>
> > Let's see. CRH levels, I am not sure about. ACTH levels have always been pretty much mid range, occasional upper normal range. My lab's reference range is 5 - 50 and I've run the range from a 16 to a 36. Mostly in the 16-25 range.
>
> Your ACTH is in the normal range despite excessive cortisol. You seem like you're not responding to excess cortisol already (i.e. I presume normal CRH).
>
> And that leads directly to the following:
>
> > I have been so convinced of this that I have spoke very strongly with my endo about looking into an attempt at RU486 therapy to "re-set" the HPA Axis.
>
> That sounds like an excellent option. I was unaware of the selective GR antagonism of this drug. On its face, it sound like it has a very similar mechanism of action as does licorice, except I don't know if licorice antagonizes the GR receptor. You'll note in your last reference that mifepristone has the short term effect of increasing cortisol. So would licorice. The idea, I suppose, is to shock the sytem back into a more normal "rhythm", like shocking a heart that is beating too fast. I suspect the short-term increase in cortisol ought to be seen as a side-effect of the therapy. The true intent is to get the hypothalamus back into balance.
>
> The advantages of mifepristone would be direct medical supervision and very controlled dosage. Also, you know it has GR antagonism.
>
> For both licorice and mifepristone, the treatment period should be no more than 3-4 weeks.
>
> No matter what course you take (if you do), you're pretty much in uncharted territory. Have you ever done a dexamethasone suppression test? It would confirm the GR non-responsivity issue.
>
> > Also, your info about samE maybe being too "stimulating" appears to be right on the mark. Am even still trying to take 1/4 tablet of Tyrosine without too much stimulation (especially in the result of having the prostatitis type pain - burning urethra - flare up and the anxiety feelings enhance somewhat). 1/4 tablet is 125 mgs in my case (maybe I need to find 100 mg tablets and cut them down??? or maybe just let go that angle for right now and assume that I've actually got more than sufficient dopamine / adrenaline levels???).
>
> I would stay away from something that seems to clearly aggravate some of your symptoms.
>
> I am really wondering if anything I talk about is of any use to you at all.
>
> Regards,
> Lar
Posted by Elroy on May 16, 2005, at 21:54:22
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 16, 2005, at 10:51:35
In regard to particulars you sent, noted specific product "Super Calm"???
Interesting....
> > Let's see.
> >
> > Have had one thyroid hormone panel. Last year, around September / October (when my cortisol was at highest levels that it's been).
> >
> > T4 Total was 8.2 (reference range 3.8 to 12.0)
> > T4 Free was 3.13 (reference range 1.20 to 3.22)
> > T3 Uptake was 38.2 (reference range 22 to 37)
> >
> > The endo (separate one from one I have now) said these were good figures and that the slightly high T3 Uptake was no concern, probably's body's reaction against ultra high cortisol (at that time my cortisol levels were almost six times the maximum of the normal reference range).
>
> Seems quite reasonable.
>
> > What's your take on 5HTP in place of the Tryptophan? I have started using the 5HTP (50mg twice a day during day and 100mg at bedtime). Is Tryptophan a better option? Good source for bulk purchases??? (I'm familiar with BAC and SMI2LE).
>
> I tend to prefer tryptophan, as 5-HTP is not normally circulating in the blood, as it would be after an oral supplement is absorbed.
>
> I use veterinary tryptophan.
>
> http://www.buygpdirect.com/gpefeed.htm
>
> The ultra-pure product is mixed with a little dextrose, for some reason. Probably equine palatability? <shrug>
>
> > Also have been using Taurine for a while now. Seems to work really well (at calming) at times but then barely work other times.
>
> Glad to get the feedback. I suspect that you might get clues from your "psych environment", e.g. the differential impact of fatigue vs. acute stimulation. Frustrated vs. wound up. That sort of comparison.
>
> What's your dose of taurine?
>
> > Also Phosphatidylserine (along with magnolia bark extract products) have become the mainstay of my current anti-cortisol problem... though I would really, really like some further info on that approah with licorice.
>
> Licorice is speculative, as I say in the other post. It may be a worthy experiment, but I don't know that it will help.
>
> > Again, thanks for your info.
> >
> > As always, very interesting.
> >
> > Elroy
>
>
> You're welcome. You're in a tough space, and I'm happy to share my thoughts with you.
>
> Lar
Posted by Larry Hoover on May 17, 2005, at 6:39:57
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 16, 2005, at 12:49:50
> Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
Eh? What?
How on earth is it that synthetic glucocorticoid suppresses your cortisol, whereas your native cortisol itself does not? Post dexamethasone, was your cortisol still above range?
Lar
P.S. I found an interesting study that shows that mifepristone can act as either a full agonist or a full antagonist, due to differences in GR-receptor density (and coupling proteins). Explains how some people get that "paradoxical response" thing going.
Lar
Posted by Dr. Bob on May 17, 2005, at 23:17:59
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 16, 2005, at 21:54:22
> In regard to particulars you sent, noted specific product "Super Calm"???
Sorry to interrupt, but I'd like to redirect follow-ups regarding alternative treatments to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20050510/msgs/499244.html
Thanks,
Bob
Posted by Elroy on May 18, 2005, at 20:36:38
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by Larry Hoover on May 17, 2005, at 6:39:57
Yes, weird, isn't it?
Now with Cushing's, it is understood that the elevated levels will return as a tumor on the pituitary gland or in the adrenal gland is "forcing" the cortisol production. And with Cushing's (whatever variant), the daily cycle or rythym of secretion is greatly disturbed (so that excess secretion occurs late at night also). But with Pseudo Cushings (which includes everything else that result in high cortisol), that daily cycle is maintained.
In fact, that is the main test to differentiate between Cushings and Pseudo Cushings. It's the Late Night Salivary Cortisol Test. You spit into a test tube between 11 PM and Midnite and they analyze it to see if your levels are high or not (like around 100 or higher - usually much higher). I have had about seven of those done and my ranges have been anywhere from 13 to 40.
And yes, with multiple Dex Suppression tests done, I have always suppressed - and then reverted to elevated cortisol following said test!
But then that's not unusual in many "psychotic depression cases" (see the various studies done with the RU486 therapy and addressing "psychotic depression").
In those cases, the patient had highly elevated (but non Cushings) cortisol levels and were either cured following RU486 therapy OR previously unsuccessful anti-depression therapies rapidly were successful... (btw, the definition of psychotic depression seems pretty clearly to fit what I refer to as my "severe anxiety problem").
So it seems obvious that in these cases, the HPA Axis has malfunctioned or somehow become dysfunctional and needs to be "re-set", no???
And note that these are all therapies involving very short-term application of the RU486. Usually in the range of 4 to 7 days. RU486 - which was originally developed (France, I believe) as an anti-cortisol med for Cushing's patients (ones who couldn't have surgical intervention for some reason, etc.) - can have some nasty side effects if taken over a period of time, but I don't recall any of these studies or trials where subjects developed adverse side effects of any nature simply because the therapy protocol is conducted over such a short time period.
Also, in one "informal" experiment that I did (i.e., w/out endo knowing about it), I found that aggressive supplementation with OTC anti-cortisol supps clearly brought the cortisol levels down. I'm not sure of the exact figures, but prior to starting those supps, my cortisol levels were in the range of 250 - 300 (with the reference range being 20 - 100). The next two tests were then around 150 *after about three weeks of supps) and the one after that around 110 (after about another months of supps). I then stopped the OTC supps - for about 3 weeks - and my next test (the last one done) was something like 243.
So taking anti cortisol supps (aggressive doses) seems to be a good thing, except one notes that my levels went right back up when the supps were stopped. So it doesn't appear that this strategy of OTC anti-cortisol supps is "re-setting" the HPA Axis.... That's kind of one of the reasons why I thought that a short-term (say two weeks) of aggressive supplementation with licorice might be in order to see if it would duplicate the effects of the RU486 protocol (but then it seems to me that in the studies that I've seen, the RU486 drove the cortisol levels WAY down and that was what "re-set" the HPA Axis... it seems that the licorice injestion would have the opposite effect of raising cortisol levels quite a bit (and back last September my levels were almost 600 and that didn't "re-set anything so simply raising my own cortisol levels doesn't seem to be a logical answer)...
Or is it that the aggressive OTC anti-cortisol supp protocol needs to be continued - possibly for several months - before the HPA Axis would normalize?
Or is it that the severe anxiety (or psychotic depression?) is causing the elevated cortisol as a simple "side effect" and the cortisol problem will naturally correct once the anxiety (or whatever) problem clears?
Elroy
P.S. Thanks for the link. Will forward to my endo. Not sure it will do any good, tho... He's primarily a Cushings specialist, so once he determined that this isn't Cushings and is "Pseudo Cushings", his level of interest clearly waned. I finally did talk him into letting me send him some stuff on the RU486 therapy so with any luck at all.....
X
X
X
X
X
> > Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
>
> Eh? What?
>
> How on earth is it that synthetic glucocorticoid suppresses your cortisol, whereas your native cortisol itself does not? Post dexamethasone, was your cortisol still above range?
>
> Lar
>
> P.S. I found an interesting study that shows that mifepristone can act as either a full agonist or a full antagonist, due to differences in GR-receptor density (and coupling proteins). Explains how some people get that "paradoxical response" thing going.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14636830
>
> Lar
Posted by 4WD on May 19, 2005, at 15:33:06
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 18, 2005, at 20:36:38
> Yes, weird, isn't it?
>
> Now with Cushing's, it is understood that the elevated levels will return as a tumor on the pituitary gland or in the adrenal gland is "forcing" the cortisol production. And with Cushing's (whatever variant), the daily cycle or rythym of secretion is greatly disturbed (so that excess secretion occurs late at night also). But with Pseudo Cushings (which includes everything else that result in high cortisol), that daily cycle is maintained.
>
> In fact, that is the main test to differentiate between Cushings and Pseudo Cushings. It's the Late Night Salivary Cortisol Test. You spit into a test tube between 11 PM and Midnite and they analyze it to see if your levels are high or not (like around 100 or higher - usually much higher). I have had about seven of those done and my ranges have been anywhere from 13 to 40.
>
> And yes, with multiple Dex Suppression tests done, I have always suppressed - and then reverted to elevated cortisol following said test!
>
> But then that's not unusual in many "psychotic depression cases" (see the various studies done with the RU486 therapy and addressing "psychotic depression").
>
> In those cases, the patient had highly elevated (but non Cushings) cortisol levels and were either cured following RU486 therapy OR previously unsuccessful anti-depression therapies rapidly were successful... (btw, the definition of psychotic depression seems pretty clearly to fit what I refer to as my "severe anxiety problem").
>
> So it seems obvious that in these cases, the HPA Axis has malfunctioned or somehow become dysfunctional and needs to be "re-set", no???
>
> And note that these are all therapies involving very short-term application of the RU486. Usually in the range of 4 to 7 days. RU486 - which was originally developed (France, I believe) as an anti-cortisol med for Cushing's patients (ones who couldn't have surgical intervention for some reason, etc.) - can have some nasty side effects if taken over a period of time, but I don't recall any of these studies or trials where subjects developed adverse side effects of any nature simply because the therapy protocol is conducted over such a short time period.
>
> Also, in one "informal" experiment that I did (i.e., w/out endo knowing about it), I found that aggressive supplementation with OTC anti-cortisol supps clearly brought the cortisol levels down. I'm not sure of the exact figures, but prior to starting those supps, my cortisol levels were in the range of 250 - 300 (with the reference range being 20 - 100). The next two tests were then around 150 *after about three weeks of supps) and the one after that around 110 (after about another months of supps). I then stopped the OTC supps - for about 3 weeks - and my next test (the last one done) was something like 243.
>
> So taking anti cortisol supps (aggressive doses) seems to be a good thing, except one notes that my levels went right back up when the supps were stopped. So it doesn't appear that this strategy of OTC anti-cortisol supps is "re-setting" the HPA Axis.... That's kind of one of the reasons why I thought that a short-term (say two weeks) of aggressive supplementation with licorice might be in order to see if it would duplicate the effects of the RU486 protocol (but then it seems to me that in the studies that I've seen, the RU486 drove the cortisol levels WAY down and that was what "re-set" the HPA Axis... it seems that the licorice injestion would have the opposite effect of raising cortisol levels quite a bit (and back last September my levels were almost 600 and that didn't "re-set anything so simply raising my own cortisol levels doesn't seem to be a logical answer)...
>
> Or is it that the aggressive OTC anti-cortisol supp protocol needs to be continued - possibly for several months - before the HPA Axis would normalize?
>
> Or is it that the severe anxiety (or psychotic depression?) is causing the elevated cortisol as a simple "side effect" and the cortisol problem will naturally correct once the anxiety (or whatever) problem clears?
>
> Elroy
>
> P.S. Thanks for the link. Will forward to my endo. Not sure it will do any good, tho... He's primarily a Cushings specialist, so once he determined that this isn't Cushings and is "Pseudo Cushings", his level of interest clearly waned. I finally did talk him into letting me send him some stuff on the RU486 therapy so with any luck at all.....
>
>
> X
> X
> X
> X
> X
>
>
> > > Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
> >
> > Eh? What?
> >
> > How on earth is it that synthetic glucocorticoid suppresses your cortisol, whereas your native cortisol itself does not? Post dexamethasone, was your cortisol still above range?
> >
> > Lar
> >
> > P.S. I found an interesting study that shows that mifepristone can act as either a full agonist or a full antagonist, due to differences in GR-receptor density (and coupling proteins). Explains how some people get that "paradoxical response" thing going.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14636830
> >
> > Lar
This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
Any advice would be much appreciated.
Marsha
Posted by 4WD on May 19, 2005, at 15:48:19
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 18, 2005, at 20:36:38
I forgot to ask. When you were taking the cortisol lowering supplements, did you notice a difference in the way you felt? Less anxiety? less depression? Did you take RelaCore or Cortislim?
Marsha
Posted by Elroy on May 19, 2005, at 21:45:06
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by 4WD on May 19, 2005, at 15:33:06
OK, will try to provide sufficient detail but keep it simple enough to insure that the main points are covered.
By the way, do you have any of your actual numbers AND the reference range that your lab uses (for example, cortisol is at 276 with a reference range of 20 - 100 for normal range)???
The dex suppression test being borderline is enough evidence to raise suspicions (obviously in combination with the known high cortisol). But the dex suppression test itself does not have a high degree of absolute reliability.
The CRH test is an older test that was done to (hopefully) determine Cushings or not - and to give some degree of an indication whether or not it is pituitary related or adrenal related.
QUOTE: The differentiation between mild Cushing’s syndrome and pseudo-Cushing’s syndrome can prove extremely difficult and poses a considerable challenge to the physician. A pseudo-Cushing’s state may be defined as some or all of the clinical features that resemble true Cushing’s syndrome together with some evidence of hypercortisolism, but resolution of the underlying primary condition results in the disappearance of the Cushing’s-like state. Such findings may appear particularly in patients with depression and alcohol-induced pseudo-Cushing’s syndrome... In both Cushing’s syndrome and pseudo-Cushing’s states there is prevailing hypercortisolemia, and hence there may be almost complete overlap between groups on basal 24-h UFC collections (58). When the results seen during investigation of individuals with Cushing’s syndrome and pseudo-Cushing’s states are compared directly, a value of UFC above 100 nmol/liter on the second day of a 48-h 2 mg/day LDDST gave a specificity of 100% and a sensitivity of 56% for the diagnosis of Cushing’s syndrome, while a 48-h plasma cortisol of 38 nmol/liter or more gave a specificity of 100% and a sensitivity of 90%. In contrast, although patients with depression usually demonstrate a blunted response to the administration of CRH, there is a large overlap with the responses seen in patients with Cushing’s disease, and thus testing with this peptide does not provide good discrimination END QUOTE
A much better test is the combined Dex/CRH Test. During that test you take the dexamethasone every six hours for two days (with it scheduled so that your last dose is at midnite on day 2). Then early on the next morning you go in and have the CRH test performed. Has something like a 95% reliability rating and is better at providing indicators of pituitary versus adrenal. My doctor also had me do a 24-hour UFC (Urinary Free Cortisol) test on day 2 of the dexamethasone phase.
QUOTE: In an effort to further improve diagnostic accuracy, it has recently been suggested that improved discrimination between Cushing’s syndrome and pseudo-Cushing’s states may be achieved by using a combined test with the administration of CRH after the 48-h, 2 mg/day LDDST, with a response to CRH being seen in individuals with Cushing’s syndrome but not in those with pseudo-Cushing’s states and a mild degree of hypercortisolism (58). In this retrospective study there was complete discrimination between patients with Cushing’s syndrome and pseudo-Cushing’s states, and it has thus been recommended for this purpose (274). Although the basal UFCs showed almost total overlap between Cushing’s syndrome and pseudo-Cushing’s groups (see above), emphasizing the similar biochemical pictures seen in these groups, with postinjection of CRH 100 µg iv, a plasma cortisol value at 15 min of greater than 38 nmol/liter (1.4 µg/dl) was seen in all patients with Cushing’s syndrome, but in none with a pseudo-Cushing’s state, giving it a sensitivity and specificity of 100%. END QUOTE
The BEST test however for determining if it is actual Cushings or "Pseudo Cushings" however is actually a very simple saliva test. It is called the Late Night Salivary Cortisol Test and consists of spitting a certain amount of saliva into provided test tube between 11 PM and Midnite. Cortisol is not secreted at the same rate throughout the day. It begins declining at night (that's what makes you sleepy) and is at a lowest point around 11 PM to Midnite (and somewhat later) and then begins rising again in the morning (that's what wakes you up). That cycle is called the circadian rhythm. People with "regular" Cushings no longer have that circadian rhythm as the offending tumor is "forcing" the excess production of the cortisol at all times. If your levels are definitely within the normal range (not "borderline" or especially not elevated) then there is an excellent chance that you are NOT a regular Cushings.
Here's a link with some better explanation (would print it out and take it to your doctor... btw, Dr. Friedman is considered THE guru of Cushings specialists).
http://www.goodhormonehealth.com/symptoms/pseudocush.pdf
I would NOT take any anti cortisol supps (OTC or otherwise) at any time during the time period of any of this type of testing. If you have real Cushings, the positive effect of OTC anti cortisol products would be very minimal (as they cannot overcome the power of the offending tumor)... BUT, if you are borderline, well, one would not want to do anything that would cause a positive result to end up "borderline".
Cushings is a very serious disorder and one needs to find out absolutely for sure whether or not one in fact has it or not (many doctors unfortunately will try to diagnose it simply by "visual symptoms"... so if you have highly elevated cortisol and a borderline dex suppression test, but don't have the major "usual" visual symptoms, then they declare that you're not Cushings and let it go at that... where in fact Cushings has numerous symptoms and many people do not have the "usual" visual symptoms but in fact ARE Cushings!).
That said, both depression (especially the type more often refered to as "psychotic depression") and anxiety very definitely cause elevated cortisol levels... and elevated cortisol causes increased anxiety and / or depression. Vicious cycle. Also, is very obvious in people who have become treatment resistant.
BTW, there is some clinical information out there that Prozac (and other SSRI meds) actually INCREASES cortisol levels (thereby worsening the situation*). I know that most people go nuts at the idea of benzos, but my psychiatrist put me on Ativan last October (my current problem actually only started last June!), and when that wasn't sufficient she replaced it with Xanax XR (the extended release version), at a low level (1mg twice a day) probably around early December. In addition, she put me on first Ambien and then Restoril as a sleep aid. Usually I would use the Ambien put if I had an especially tough evening, then I would opt to take the Restoril (Actually, now I often can even go without either one and just use Melatonin and Valerain). My main sleep problem currently is that I get up (without fail) between 3:30 and 4:30 AM and frequently have a problem getting back to sleep then... guess what, that's when the cortisol levels are starting to climb up again). In my case, I definitely have the correct circadian rhythm, but when my levels start climbing, they obviously quickly start shooting up above normal which results in that inability to get back to sleep. Anyway, my point is that you might want to talk to your doc - either a psych doc on endo -about getting you on something specifically for the anxiety. I truly believe that the Xanax XR "saved my life" in that the anxiety levels had climbed that tremendously!
See: http://www.remedyfind.com/HC-Anxiety.asp
http://www.remedyfind.com/all_remedies.asp?id=85BTW, have you had any similar - or otherwise related - physical symptoms?
* QUOTE: Studies at the University of Colorado and Greenslopes Private Hospital in Brisbane, Australia, showed that Prozac (fluoxetine) increases both cortisol and ACTH levels... Research at the Vanderbilt University School of Medicine in Nashville, Tennessee, also documented the cortisol-boosting effects of Prozac. .. Laudenslager ML, Clarke AS. Antidepressant treatment during social challenge prior to 1 year of age affects immune and endocrine responses in adult macaques. Psychiatry Res. 2000 Jul 24;95(1):25-34... Torpy DJ et al. Diurnal effects of fluoxetine and naloxone on the human hypothalamic-pituitary-adrenal axis. Clin Exp Pharmacol Physiol. 1997 June; 24 (6):421-3
http://members.aol.com/atracyphd/
http://health-essentials.info/science/health-issues/ssri01.htmlI have even read some information that indicates 5HTP (and tryptophan?) might cause increases in cortisol... and hope that someone like Larry Hoover might have some further information on that.... (that would be very unfortunate as tryptophan/5HTP are highly touted natural anti-anxiety supps).
http://www.earthtym.net/ref-serotonin.htm
http://www.rdc.ab.ca/scottpsych/website/student/herbal.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15202683I know that elevated cortisol has a strong effect on the utilization of tryptophan and believe that 5htp - if it in fact does NOT increase cortisol - might be a better choice than tryptophan....
QUOTE: Why should I consider 5-HTP supplementation?
All serotonin used by brain cells must be made within the neurons, since serotonin cannot cross the blood-brain barrier. Therefore, the synthesis of serotonin is heavily dependent upon the availability of L-tryptophan within the CNS. The production and transport of L-Tryptophan from the bloodstream into the CNS can be compromised by several factors including ostress, elevated cortisol levels, vitamin B6 deficiency, and even high dosages (above 2,000 mg) of L-Tryptophan, which all stimulate the conversion of L-Tryptophan to kynurenine, lowering serum tryptophan levels.1-3o END QUOTEhttp://www.millnut.com/L5HTP.shtml
http://www.smart-drugs.net/ias-tryptophan-article.htmWell, getting way off topic here.
I'm going to go out on a limb here - while insisting that proper follow-up testing be conducted - and offer my opinion. I believe that you will test out as non Cushings - or more technically correct as "Pseudo Cushings".
I suggest that as you make the following statement: "... have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night." That shouldn't be the case with "real" Cushings (though maybe it's an early onset - which is why one should have the testing!).
That SUGGESTS to me that your cortisol levels are following the normal rhythm pattern of declining at night and then rising significantly in the morning (and staying high through the day before once again declining at night).
Sounds very, very familiar to me!
Please keep updated as to testing done and results of same.... in addition to testing for Cushings, it might be of interest to have tests done for a Pheo tumor. While quite rare (a tumor inside an adrenal gland), Pheo tumors are notorious for producing anxiety. Generally those are accompanied (tho not always) by very high blood pressure. You mentioned "Metanephrines were normal although normetanephrine was high normal"... that sounds like it may have come from a test for checking the possibility of a Pheo tumor. Do you know if that was the case? I "believe" that in the case of a Pheo tumor that your Metanephrine would be highly elevated....
ElroyX
X
X
X
X
> This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.
>
> My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
>
> The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
>
> My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
>
> Any advice would be much appreciated.
>
> Marsha
>
>
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