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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Pfinstegg on September 8, 2002, at 18:17:47
I have been lurking on the sites here for about a month and have learned a tremendous amount about the neurophysiology of depression, as well as often being moved by how much strength everyone is exhibiting, and how much caring and support you are providing for one another.
I have a suspicion that I am not in the usual age-groups of posters, as I am 73. To summarize my life as briefly as possible, I grew up in a neglectful (mother) and abusive(alcoholic father) family. In my early twenties, I was diagnosed with anxiety, depression and borderline personality disorder. I struggled through about seven psychotherapists and psychoanalysts, with some help from almost each one, but no basic change in my illness. With the final one, however, some really wonderful changes occurred. I think that I was able to internalize him as both a better father and a better mother, and thus complete some much-needed psychosexual maturing. I was able to finish my doctoral studies, secure a university post researching, teaching, and caring for patients, marry and give birth to a son. I felt that I was living a full life and never felt the need to consult a psychiatrist again until quite recently, when I again became quite severely depressed, probably at least in part because of the inevitable losses associated with getting older. I began seeing a psychiatrist again, twice weekly, and had trials of Prozac. Paxil, Zyprexa and Wellbutrin in various combinations. All of these worked well but tended to become ineffective after several months or, in the case of the SSRIs, a few years of use.
Something that I kept noticing in passing was information about how half of depressed patients have abnormally high levels of cortisol, as do,to a lesser extent, people in general as they get older. So I asked an endocrinologist to check this for me- the levels were very high, and did not suppress at all with the dexamethasone suppression test.
While keeping up with my psychotherapy, which is extremely helpful, my endocrinologist and I are investigating ways to lower the circulating cortisol. Since there is not yet a CRH antagonist on the market, we are doing a number of other things in the hope of making some modest improvements in the levels. These include using tianeptine for its apparent effect(in tree shrews and rats) of protecting the limbic system from the damaging effects of high cortisol levels, taking phosphadatylserine, alpha-lipoic acid, Omega-3 fish oil, and 7-keto-dehydroepiandrosterone- all in low doses at least to begin with. Other general measures include vitamin and anti-oxidant supplements, daily walking, meditation and a massage once in a while. On a slightly different topic, we are also combining synthroid and cytomel (in a 4-1 ratio), and aiming for a TSH of below 0.5.
It's too early to say whether this is going to be helpful, but it seems to be working at least as well as the previous medications. In the future, we might consider using RU-486- I expect I'll be the oldest person ever to have done so!
I'm writing this because many of these ideas came from your posts, as well as from other Web-sites. I'll let you know in a while whether any of it actually worked!
thanks, everyone
Pfinstegg
Posted by Jackd on September 8, 2002, at 21:49:03
In reply to cortisol considerations (long), posted by Pfinstegg on September 8, 2002, at 18:17:47
Wow, thanks for the consideration. I've been wondering lately about different depressant and antidepressant mechanisms myself. Hope things work out old timer (teasing)!
Posted by pfinstegg on September 9, 2002, at 17:51:01
In reply to Re: cortisol considerations (long), posted by Jackd on September 8, 2002, at 21:49:03
Thanks for the response and encouragement, JackB- it really means a lot. I'll post again in a few months to let you know whether I've actually been able to bring the cortisol levels down with any of these manouevers. The best to you, too!
"Old-timer"(not a bit offended- my husband and I both started laughing, and now that's his new nickname for me!)
Posted by EarlyWakening on September 9, 2002, at 22:48:21
In reply to cortisol considerations (long), posted by Pfinstegg on September 8, 2002, at 18:17:47
> I have been lurking on the sites here for about a month and have learned a tremendous amount about the neurophysiology of depression, as well as often being moved by how much strength everyone is exhibiting, and how much caring and support you are providing for one another.
>
> I have a suspicion that I am not in the usual age-groups of posters, as I am 73. To summarize my life as briefly as possible, I grew up in a neglectful (mother) and abusive(alcoholic father) family. In my early twenties, I was diagnosed with anxiety, depression and borderline personality disorder. I struggled through about seven psychotherapists and psychoanalysts, with some help from almost each one, but no basic change in my illness. With the final one, however, some really wonderful changes occurred. I think that I was able to internalize him as both a better father and a better mother, and thus complete some much-needed psychosexual maturing. I was able to finish my doctoral studies, secure a university post researching, teaching, and caring for patients, marry and give birth to a son. I felt that I was living a full life and never felt the need to consult a psychiatrist again until quite recently, when I again became quite severely depressed, probably at least in part because of the inevitable losses associated with getting older. I began seeing a psychiatrist again, twice weekly, and had trials of Prozac. Paxil, Zyprexa and Wellbutrin in various combinations. All of these worked well but tended to become ineffective after several months or, in the case of the SSRIs, a few years of use.
>
> Something that I kept noticing in passing was information about how half of depressed patients have abnormally high levels of cortisol, as do,to a lesser extent, people in general as they get older. So I asked an endocrinologist to check this for me- the levels were very high, and did not suppress at all with the dexamethasone suppression test.
>
> While keeping up with my psychotherapy, which is extremely helpful, my endocrinologist and I are investigating ways to lower the circulating cortisol. Since there is not yet a CRH antagonist on the market, we are doing a number of other things in the hope of making some modest improvements in the levels. These include using tianeptine for its apparent effect(in tree shrews and rats) of protecting the limbic system from the damaging effects of high cortisol levels, taking phosphadatylserine, alpha-lipoic acid, Omega-3 fish oil, and 7-keto-dehydroepiandrosterone- all in low doses at least to begin with. Other general measures include vitamin and anti-oxidant supplements, daily walking, meditation and a massage once in a while. On a slightly different topic, we are also combining synthroid and cytomel (in a 4-1 ratio), and aiming for a TSH of below 0.5.
>
> It's too early to say whether this is going to be helpful, but it seems to be working at least as well as the previous medications. In the future, we might consider using RU-486- I expect I'll be the oldest person ever to have done so!
>
> I'm writing this because many of these ideas came from your posts, as well as from other Web-sites. I'll let you know in a while whether any of it actually worked!
>
> thanks, everyone
>
> PfinsteggPlease do keep us apprised. I have posted on this topic, and am very interested in the neuroendocrine approach. In particular, I would be curious whether you are able to pursue mifepristone (RU-486). I am under the impression it is pretty tightly controlled.
Posted by Ritch on September 9, 2002, at 23:28:19
In reply to Re: cortisol considerations (long), posted by EarlyWakening on September 9, 2002, at 22:48:21
............
On a slightly different topic, we are also combining synthroid and cytomel (in a 4-1 ratio), and aiming for a TSH of below 0.5.
.....................Hi,
I am also especially interested in the "neuroendocrine" approach to treat bipolar disorder. Have you "reached" this TSH level yet? If so, how does it appear to be working for you?
thanks in advance,
Mitch
Posted by pfinstegg on September 10, 2002, at 18:57:01
In reply to Re: cortisol considerations (long), posted by EarlyWakening on September 9, 2002, at 22:48:21
Ritch and EarlyWakening,
As to the TSH, I have to wait six weeks to have it retested after each medication adjustment. It shouldn't be hard to get it down to 0.5- just takes time and tweaking.
The mifepristone, although approved in 2000 as the "morning-after" pill, is still embroiled in political controversy, and can be hard to obtain, depending on which state you live in. However, using it for depression at this point would be "off-label" and premature. I was just thinking ahead towards something which might be more effective than the treatments I've had so far. The studies at Stanford and NIH were on the 15% of people who have major depression with psychotic features- and the numbers of patients were very small. Things like dosages and length of treatment have not yet been worked out at all. Also, the cortisol metabolism in those patients was extremely abnormal. What helped them might not
help those of us with non-psychotic major depression or bipolar disorder. Still, the studies were encouraging enough for the FDA to "fast-track" them, so it is encouraging!
Posted by McPac on September 13, 2002, at 17:20:11
In reply to cortisol considerations (long), posted by Pfinstegg on September 8, 2002, at 18:17:47
Pfin
Remeron, in lower doses, lowers cortisol levels.
Various nutrients can also.
Posted by pfinstegg on September 13, 2002, at 19:21:17
In reply to Re: cortisol considerations (long), posted by McPac on September 13, 2002, at 17:20:11
Thanks for the information on how low doses of Remeron lower cortisol. I'm making a note of that. However, in another post today, you said Remeron wasn't working for you at all, although I think you said it had been only 10 days since you started taking it.
At this point I must be taking every nutritional supplement known to man! I also am taking tianeptine, which is a serotonin uptake enhancer. so I don't think I can take an SSRI at the same time. I've been on this regimen for about 2 1/2 weeks, and in the past week I've noticed that nearly all of the major depressive symptoms have disappeared. My pdoc, endocrinologist and I have adopted this unorthodox approach, and are flying in unknown territory here, aiming primarily to treat the cortisol elevations rather than the depressive symptoms, which we just didn't seem to be able to do with 8 years of trying. It may all be a placebo effect, but I'll take it!
I hope to hear soon that the your combination is starting to work for you, and always appreciate input and information- all the very best to you.
pfinstegg
Posted by EarlyWakening on September 14, 2002, at 18:41:56
In reply to Re: cortisol considerations (long) » McPac, posted by pfinstegg on September 13, 2002, at 19:21:17
> Thanks for the information on how low doses of Remeron lower cortisol. I'm making a note of that. However, in another post today, you said Remeron wasn't working for you at all, although I think you said it had been only 10 days since you started taking it.
>
> At this point I must be taking every nutritional supplement known to man! I also am taking tianeptine, which is a serotonin uptake enhancer. so I don't think I can take an SSRI at the same time. I've been on this regimen for about 2 1/2 weeks, and in the past week I've noticed that nearly all of the major depressive symptoms have disappeared. My pdoc, endocrinologist and I have adopted this unorthodox approach, and are flying in unknown territory here, aiming primarily to treat the cortisol elevations rather than the depressive symptoms, which we just didn't seem to be able to do with 8 years of trying. It may all be a placebo effect, but I'll take it!
>
> I hope to hear soon that the your combination is starting to work for you, and always appreciate input and information- all the very best to you.
>
> pfinsteggpfinstegg,
Please keep us posted on this progress, also.
I had read that tianeptine showed effects of normalizing the HPA axis. It sounds like your doctor is supervising this tactic. Is he/she procuring it for you? I understand that M.D.s can legally requisition drugs from other countries even if not FDA-approved here.Also, how are the side-effects?
Posted by pfinstegg on September 14, 2002, at 21:28:40
In reply to Re: cortisol considerations (long) » pfinstegg, posted by EarlyWakening on September 14, 2002, at 18:41:56
It's not hard to get tianeptine, as it's legal all through Europe, where it has been used for about five years; if your pdoc is willing, he/she can easily obtain it. I would like to tell you a bit more about that, but if I do, Dr. Bob will probably reprimand me!
All the posts that I have read on Psychobabble have described tianeptine as being ineffective, and that's the reason given for why no drug company has been interested in marketing it here. Granted that everyone reacts differently, but this is by far the most effective anti-depressant I have used, and I haven't noticed any side effects at all; compared to the SSRIs, I feel much more alive and interested in things and people, much more interested in sex- just much more the old me.A month ago, I was really struggling with just trying to get going in the morning, and had recurrent suicidal ideation all day long, so I am so relieved and grateful for this change.
I feel that I'm fortunate with my doctors, as I have an open-minded pdoc, and an endocrinologist who is genuinely interested in the pseudo-Cushing's Syndrome which can accompany depression. He wants to follow the cortisol levels a few times a year and think about additional treatment if they don't come down with what we are doing now.
It's my understanding that tianeptine blocks cortisol from harming the hippocampus, but doesn't actually lower the circulating levels. If it can eventually reset the HPA axis, the levels should come down over time, but I'm not sure whether it can do this or not. I'll let you know.
take care,
Pfinstegg
Posted by McPac on September 15, 2002, at 17:47:20
In reply to Re: cortisol considerations (long) » McPac, posted by pfinstegg on September 13, 2002, at 19:21:17
Here's the quick 'scoop':
Lower doses of Remeron do lower cortisol levels.
While I was taking the Remeron at 7.5 mg/nightly (15 mg. should be fine also), at that dose it DOES lower cortisol doses (giving a calming, sedating effect). However, since my doc INcreased the dose to 45 mg/nightly, this causes INcreased noradrenaline levels, which, in turn, kicks the sympathetic system into overdrive (this causes anxiety/agitation/nervousness...it makes my heart beat faster at times...causes 'edginess')! Lower doses = very nice calming effect; higher doses can easily cause agitation/irrit/anxiety) Take Care! p.s.---I tried to increase the dose to use it for my OCD...but I'm most likely going to lower the dose very soon.
Posted by pfinstegg on September 15, 2002, at 20:03:09
In reply to pfinstegg!, posted by McPac on September 15, 2002, at 17:47:20
I took careful note of what you said about Remeron, and from what I was able to find out, you are absolutely right about the cortisol- lowering effects of lower dosages. Isn't it strange how one dosage level of these drugs enhances or inhibits a whole set of receptors, and higher dosages have different or opposite effects on either the same receptors- or maybe different ones?
I'm very glad to have this information; if the tianeptine doesn't work out, Remeron is the one I would try next- thanks so much.
I know very little about OCD, except that pdocs tend to use the highest doses of meds for it. But no-one should have to have all the symptoms you're describing. I hope you'll be able to find an effective combination- effective but comfortable! Be sure to let me (us) know how things go for you. Take care- and thanks!
Pfin
Posted by McPac on September 15, 2002, at 21:56:48
In reply to McPac! » McPac, posted by pfinstegg on September 15, 2002, at 20:03:09
It makes me very happy to know that my info. for you was valuable!
Take care my friend!
Posted by pfinstegg on September 16, 2002, at 2:58:51
In reply to Pfinstegg---Re: McPac!, posted by McPac on September 15, 2002, at 21:56:48
This is the end of the thread.
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