![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by catmint on November 26, 2002, at 0:54:02
I have been depressed off and on since I was 10. I am currently BP2 but in my early 20s, I was severely manic and was hospitalized once due to a psychotic episode induced from a poisonous mushroom-amanita muscaria (I know that is wierd, but some guy just popped in my mouth and I was drunk). Well, to make a long story short, I couldn't sleep for 5 days, was hallucinating, delusional, finally complete panic and tried to commit siucide, and ended up in the emergency room. The ER doc made that funny circular motion next to his head, you know the one that signifies "crazy" and basically said that my liver recieved a sort of blow and I would be fine,just don't take any sleeping pills and I was sent home. Noone, including myself knew I was bipolar. I fled the next day and recovered at a friends house, when the manic side of me kicked in and I was so called "fine."
For the next ten years, I cycled in and out of moods, and it was only after the birth of my son that a heavy depression made me seek treatment. Up until then, I was mostly manic, with short depressions, and nagging, irritable, hostile mixed states.
Now my son is ten, precisely the same age when I first became depressed following a sexual abuse incident by my father .I know, this is quite personal to divulge this to all of you but I have been posting for a couple of months now, and I feel safe enough. It is linked to my depression.
I am now the most depressed I have been, with frequent thoughts of death, anxiety, irritability, crying spells and lately,fits of rage and that, "I'm about to lose it, "nervous breakdown" feeling.
Yes, I am a mess. I am on Depakote (125mg.) Some of you might tell me to raise the dose, but I think it makes me more depressed and I am considering ditching it. I tried Prozac *again* and became "unglued" (as our friend Colin says). A lot of you might respond with what works for you and that is fine, I like hearing peoples stories.
My main question is , Does long term hard to treat depression become worse and worse and one day I will end up withered and sad in a hospital unable to speak? ( Now my anxiety is kicking in). Can long term depression cause other nuerological problems like alzheimers or amnesia.? Please help anyone, I am worried about myself. I am a sweet, loving person and I must be doing something wrong to still be depressed after all this time.
BTW here is what I have tried: Lamictal(got a rash), All SSRIs, and fish oil.
Thanks to all,
Amy
Posted by Anna Laura on November 26, 2002, at 2:50:17
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
> I have been depressed off and on since I was 10. I am currently BP2 but in my early 20s, I was severely manic and was hospitalized once due to a psychotic episode induced from a poisonous mushroom-amanita muscaria (I know that is wierd, but some guy just popped in my mouth and I was drunk). Well, to make a long story short, I couldn't sleep for 5 days, was hallucinating, delusional, finally complete panic and tried to commit siucide, and ended up in the emergency room. The ER doc made that funny circular motion next to his head, you know the one that signifies "crazy" and basically said that my liver recieved a sort of blow and I would be fine,just don't take any sleeping pills and I was sent home. Noone, including myself knew I was bipolar. I fled the next day and recovered at a friends house, when the manic side of me kicked in and I was so called "fine."
>
> For the next ten years, I cycled in and out of moods, and it was only after the birth of my son that a heavy depression made me seek treatment. Up until then, I was mostly manic, with short depressions, and nagging, irritable, hostile mixed states.
>
> Now my son is ten, precisely the same age when I first became depressed following a sexual abuse incident by my father .I know, this is quite personal to divulge this to all of you but I have been posting for a couple of months now, and I feel safe enough. It is linked to my depression.
>
> I am now the most depressed I have been, with frequent thoughts of death, anxiety, irritability, crying spells and lately,fits of rage and that, "I'm about to lose it, "nervous breakdown" feeling.
>
> Yes, I am a mess. I am on Depakote (125mg.) Some of you might tell me to raise the dose, but I think it makes me more depressed and I am considering ditching it. I tried Prozac *again* and became "unglued" (as our friend Colin says). A lot of you might respond with what works for you and that is fine, I like hearing peoples stories.
>
> My main question is , Does long term hard to treat depression become worse and worse and one day I will end up withered and sad in a hospital unable to speak? ( Now my anxiety is kicking in). Can long term depression cause other nuerological problems like alzheimers or amnesia.? Please help anyone, I am worried about myself. I am a sweet, loving person and I must be doing something wrong to still be depressed after all this time.
>
> BTW here is what I have tried: Lamictal(got a rash), All SSRIs, and fish oil.
>
> Thanks to all,
>
> AmyDear Amy,
I asked the same question to an experienced researcher and pharmacologist months ago and the answer was no; to put it in a few words, she believed that depression might get worse with time if untreated (or medicated with the "wrong" compounds) but she also believed that this situation was reversible;
yes, there could be brain shrinkage related to depression and related worsening (hyppocampus is damaged usually) but good news! it's reversible; (see studies on the french med Tianeptine).Take care
Posted by colin wallace on November 26, 2002, at 5:32:54
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
Amy,
I really feel for you, believe me.It's taken me a full three months to hall myself up from the point you're at now(my last big crash) , and I know that it's an awful place to be.
Are you only taking Depakote? I was too, because I think my doc. underestimated my depressive side, and believed that this would eventually even out and prevent my mood troughs.Wrong.I spiralled quickly. without an AD.
I know it's a tough call for people like us to risk taking AD's, but if you're sinking fast, it has to be be something to seriously consider (needless to say, not the dreaded SSRI's).
I've tried virtually every med. out there, as you know, and I have to say that (aside from Lamictal) the only one that pulled me out of a hellish depression was Remeron- the only med I could tolerate at therapeutic doses. It wasn't perfect, by any means, but it didn't cause me mania(even at 45mg)and I even managed to pass a few exams whilst taking it (I'd previously been stuck in a chair for months).
It did cause me some erratic swings, but no hypomania for sure.I would take it again if I had to,in a small dose and with a low dose mood stabilizer in place of course.
I wish I could be more help here,as we're all 'shooting in the dark', but personal experience is all I've got to go on.Take care, and keep talking to your doc.
Col.
Posted by Krysti on November 26, 2002, at 7:59:31
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
Hi Amy,
As a fellow bipolar person, I totally understand how frustrating it is. Especially when in the depressed state, it seems there is no way out and is hard to understand why we can't just pull ourselves out of it.
For me, I truly look at this as a chemical imbalance that I have to find the right meds to treat. As we all know, different meds affect different people differently. You need to find what works for you. If you are depressed on the Depakote and have already tried adding anti-depressants with no success, maybe it's time to try another stabilizer. There are a lot more out there than just Lamictal. The one I found that seems to be working for me so far is Trileptal. I haven't had any anxiety or depression, I have my personality back and am able to concentrate and focus again.
It sounds like you are beating yourself up for being depressed - it's not your fault. Talk to anyone with depression, it's not something you can control or just snap out of. I know it feels that way when you are going through it, like it's a weakness or something, but it is not. Just like you couldn't control being manic, you cannot control being depressed.
Keep working with your pdoc and try to find the medication or combo of medication that works for you. It is so worth it. Once you are feeling better, you will be able to look back and see how you are feeling right now - was not your fault.
Krysti
Posted by Larry Hoover on November 26, 2002, at 13:33:37
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
I hope you'll take a look at the thread "Anxiety causes brain damage????"
Your brain is constantly changing, to adapt to all influences on it. There's a lot you can do to prevent and repair the effect of depression on your brain.
Lar
Posted by catmint on November 26, 2002, at 14:11:31
In reply to Re: Is depression damaging my brain? - catmint, posted by Krysti on November 26, 2002, at 7:59:31
Kristi,
Thank you for replying. My doctor did in fact suggest Trileptal but I guess I was planning on going on Depakote anyway.Have you ever been on Depakote?If so, did it make your depression worse? Also, please tell me more about your experience with Trileptal, dosage, side effects, how long you've taken it, etc.
I'm glad you found something that works for you. Maybe I will try it?
Amy
Posted by catmint on November 26, 2002, at 14:26:43
In reply to Re: Is depression damaging my brain? » catmint, posted by colin wallace on November 26, 2002, at 5:32:54
Hi Colin,
I'm so glad to have your support. There is no other way for me to communicate these issues than this board and I am really happy that you're here.Can you tell me more about Remeron, since I react to SSRIs like you, how was it different? I have read here that at 45 mg. there is less sedation, was that true for you? What other side effects did you have? Weight gain? How long did you take it?
I have taken Serzone in the past and it was definately different. I didn't really notice much of an effect on depression but it did not cause mania at all. I was tired all the time and I kind-of lost my drive to run and do other forms of exersize. I also drank a lot of coffee to counteract the drowsiness.
Anyway, I'm looking forward to hearing from you. I'm also considering trying Lamictal again, this time much more slowly. Tell me how you're doing on it now.
Amy
Posted by oracle on November 26, 2002, at 15:49:49
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
Damage is a very loaded word. Will untreated depression get worse ? Yes. Will there be changes to the brain, because of this ? Yes. Are the changes forever ? Probably not, if you get treatment.
Seems what you should worry about is not the damage but the treatment.
Posted by Pfinstegg on November 26, 2002, at 22:44:18
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
Under "normal" circumstances- i.e. optimal challenge and stress to your brain, but not continued or excessive stress, the hippocampus is thought to add several thousand new neurons each day- this is the substrate of learning. However, during periods of continued, excessive stress, the hippocampus stops creating new neurons. The neurons which remain become somewhat smaller in volume due to unfavorable changes in their metabolism, and to the shortening of their dendrites- the structures with which they communicate neurochemically with other neurons. These changes are what underlie the common findings seen on MRI's and SPECT scans during depression- a loss of volume (up to 20%) in the hippocampus- in particular the left side of it, and a decrease in the volume of bloodflow to it. The left pre-frontal region is also affected in the same manner, but to a lesser degree. It is generally thought that cell death is NOT INCREASED during depression, although of course it does occur in various types of ischemic brain injury, which is different. The changes in brain volume and blood flow seen in depression can be shown to be reversed, by natural remissions, by a number of drugs (the tricyclics seem to do it best, but SSRI's may also do it- as to the newer atypicals, I haven't been able to find out yet), and also by ECT and TMS.
So, there is much to be hopeful about-depression is a potentially reversible disorder, physically. As treatments become more focussed on regulating the abnormalities in stress hormones, it is going to be much easier for people to attain really good remissions. Specifically, these would be cortisol-lowering drugs such as mifepristone, and a bit more in the future, CRH (corticotrophin-releasing hormone) antagonists. There are others, too, but they all have in common the goal of restoring HPA (hypo-pituitary-adrenal) axis regulation, and, by doing so, preventing various hormone excesses (in chronic fatigue syndrome and atypical depression, there may be brief bursts of excess hormones, followed by too little, but in bipolar and unipolar depression, there is chronic overproduction). Regulating these various hormones will, in turn, allow the hippocampal and pre-frontal neurons to regain normal volumes and dendrites, which should allow the various neurotransmitters- serotonin, dopamine and nor-epinephrine, plus others-to be released and taken up in a normal fashion.
That being said, we are all faced with the realities of our present situation. I think it is true that the longer a depression goes on, and the more severe it is, the more difficult it is to recover by the means we presently have. The medications we have now just attempt to treat one of the end-stage manifestations of the disease- the neurotransmitter levels, and I think it is quite uncommon for someone to feel that they have been cured of their symptoms completely by any of the drugs we have now.
I think that someone with either bipolar or unipolar depression, which is severe, long-lasting, and resistant to a range of drug trials, should consider either ECT, TMS or one of the mifepristone trials. Mifepristone is the first drug ever to have been "fast-tracked" for depression by the FDA (it did that in August, '02). Because it has been used so often as an abortifacient, a lot is already known about its safety, which is very good for short-term use. The trials going on at present are of 7 to 10 days in length, with investigation of "booster" doses- a lot like ECT, and apparently at least as effective.
It's really encouraging to know that the hippocampus can renew itself if the stress hormones can be regulated- the only thing is- it's so hard to wait for the new treatments!
Pfinstegg
Posted by wendy b. on November 26, 2002, at 22:45:21
In reply to Re: Is depression damaging my brain? - » Krysti, posted by catmint on November 26, 2002, at 14:11:31
Amy,
Just to chime in here -- Depakote is NOT a panacea drug, does not work for everyone with bipolar. In fact, I've heard more stories of difficulty on it (and weight gain, and increased depression, and hypersomnia, and apathy) than I've heard good. Although it must work for some people. Just know that if it doesn't work for you, you wouldn't be alone...
Check the archives here - search on 'depakote' on psychobabble, and you can read a ton about what others have experienced. Just use the SEARCH button you find at the bottom of any psychobabble page.
Good luck to you. I have a 10-yr old who I often wonder about, i.e., will she get what I've got (bipolar, mostly depressive) or worse, the obsessive-compulsive personality disorder her father has...! What a legacy. How is your child's father? Is he depressed too?
Wendy
> Kristi,
> Thank you for replying. My doctor did in fact suggest Trileptal but I guess I was planning on going on Depakote anyway.
>
> Have you ever been on Depakote?If so, did it make your depression worse? Also, please tell me more about your experience with Trileptal, dosage, side effects, how long you've taken it, etc.
>
> I'm glad you found something that works for you. Maybe I will try it?
>
> Amy
Posted by colin wallace on November 27, 2002, at 5:08:24
In reply to Re: Is depression damaging my brain? » colin wallace, posted by catmint on November 26, 2002, at 14:26:43
Can you tell me more about Remeron, since I react to SSRIs like you, how was it different? I have read here that at 45 mg. there is less sedation, was that true for you? What other side effects did you have? Weight gain? How long did you take it?
Hi Amy,
My Remeron experience was pretty much a positive one; I'd reacted terribly to prozac and the UK tricyclic Lofepramine,was pretty clueless at the time as regerds AD's, and hit upon the idea of Remeron after scouring this board actually.My anxiety was very severe at the time(I was taking around 4mg xanax)and the depression was slipping out of control too.I started on 15mg of Remeron for a month, and it was a really tough month- couldn't speak properly,incoordination ,crazy outlandish dreams, long periods of stupor and vacuity- well spaced out and zombefied about sums it up.Almost straightaway though, it seemed to 'numb' the anxiety, and I felt much more level (even if suicidally level!)than I had on other AD's.
Things improved fairly quickly as I climbed the dose range as I remember, and after around two months or so,I definitely wasn't suicidal and was tolerating it quite well- slept like a log, and my old self was beginning to filter through.
I began to be able to think reasonably clearly again, and moved up to 45 mg.This was my mistake, because at the time I hadn't grasped my med. sensitivity, and thought climbing high was the way to go.I eventually reached 60mg, and was taking it in divided doses throughout the day-no sedation( though I'd lost the daytime sedation at 30mg too).
This dose was WAY too high for me, and I basically became kind of 'submerged', like being anaesthetised.Also, I started studying an intensive IT course WAY too soon, and began to unravel all the gains I'd made through stress. Dimwit.
Personal verdict: excellent med. for anxiety and depression- should have stayed at 30mg though.Sedation does wear off(regardless of high/low doses), great for sleep, no mania, appetite like a horse (yup,some weight gain, unfortunately) but never could shake the 'wooly-headed' or medicated feeling.Some erratic moods, but never full blown swings or anger.Much better than being seriously depressed, but should have had a mood stabilizer (lithium?) in place, with hindsight.
Switched to Effexor after 8 months or so, and went completely ballistic!!
>>>I'm also considering trying Lamictal again, this time much more slowly. Tell me how you're doing on it now.Better, Amy, than I'd ever have dared believe!I don't feel like I'm on medication at all- i'm fast approaching something like a 'normal' state of mind- neutral at least.The serious illness of a close relative- and no job after three years illness-and the stinking weather here are all huge stresses for me, but my resilience is back and I'm coping.
This is worth preaching about, so although I shouldn't, I gonna suggest a re-run of the Lamictal at TINY doses over a much longer period than normal.I mean like 2mg weekly to start, rather than 25mg,until you get to grips with it.What's to lose? If you get a rash at these initial tiny doses(unlikely I think), then you'll know for sure it's not for you.
I'm now at 75mg BTW, and if I can tolerate it, anyone can!!
Make your own decisions here though by all means-if your not comfortable with it, don't go for it, obviously.
But take care anyhow.
Col.
> > Amy
>
>
>
Posted by Ritch on November 27, 2002, at 8:15:13
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
> I have been depressed off and on since I was 10. I am currently BP2 but in my early 20s, I was severely manic and was hospitalized once due to a psychotic episode induced from a poisonous mushroom-amanita muscaria (I know that is wierd, but some guy just popped in my mouth and I was drunk). Well, to make a long story short, I couldn't sleep for 5 days, was hallucinating, delusional, finally complete panic and tried to commit siucide, and ended up in the emergency room. The ER doc made that funny circular motion next to his head, you know the one that signifies "crazy" and basically said that my liver recieved a sort of blow and I would be fine,just don't take any sleeping pills and I was sent home. Noone, including myself knew I was bipolar. I fled the next day and recovered at a friends house, when the manic side of me kicked in and I was so called "fine."
>
> For the next ten years, I cycled in and out of moods, and it was only after the birth of my son that a heavy depression made me seek treatment. Up until then, I was mostly manic, with short depressions, and nagging, irritable, hostile mixed states.
>
> Now my son is ten, precisely the same age when I first became depressed following a sexual abuse incident by my father .I know, this is quite personal to divulge this to all of you but I have been posting for a couple of months now, and I feel safe enough. It is linked to my depression.
>
> I am now the most depressed I have been, with frequent thoughts of death, anxiety, irritability, crying spells and lately,fits of rage and that, "I'm about to lose it, "nervous breakdown" feeling.
>
> Yes, I am a mess. I am on Depakote (125mg.) Some of you might tell me to raise the dose, but I think it makes me more depressed and I am considering ditching it. I tried Prozac *again* and became "unglued" (as our friend Colin says). A lot of you might respond with what works for you and that is fine, I like hearing peoples stories.
>
> My main question is , Does long term hard to treat depression become worse and worse and one day I will end up withered and sad in a hospital unable to speak? ( Now my anxiety is kicking in). Can long term depression cause other nuerological problems like alzheimers or amnesia.? Please help anyone, I am worried about myself. I am a sweet, loving person and I must be doing something wrong to still be depressed after all this time.
>
> BTW here is what I have tried: Lamictal(got a rash), All SSRIs, and fish oil.
>
> Thanks to all,
>
> AmyHi Amy, wow that sounds like the course of my illness with exception to your unfortunate mushroom incident. I've noticed a tendency for depression to dominate as well with progression of time. I've got a couple of suggestions though. You mentioned below about becoming "unglued" on SSRI's. Have you ever tried taking microdoses (2.5mg of Prozac, i.e.) of them as a maintenance along with your Depakote to help settle your anxiety? If I take a standard dose I flip out big time, but if I come off of them completely I get this residual panicky anxiety that tends to build over weeks into a doom/gloom/agitative depression with what I call "menacing" free-floating anxiety. Depakote increase to 250mg might be helpful, too. I came *down* from 250mg to 125mg of Depakote recently and added 150mg of Trileptal, and that fixed my "sleep inertia" in the mornings, but I feel a little more "zingy" than I really like and I feel a return of some "simmering" anger (not explosive, though-whew). I may have to bring the Dep back up to 250mg and leave the Trileptal in and see if I can still get up in the morning again! Hang in there, I know this is a hassle. Well, I'm fixing to hit the road.
Happy Thanksgiving,
Mitch
Posted by Krysti on November 27, 2002, at 12:55:47
In reply to Re: Is depression damaging my brain? - » Krysti, posted by catmint on November 26, 2002, at 14:11:31
Hi Amy,
When I was diagnosed 6 months ago, I was manic and I was put on Depakote. It was wonderful for bringing me down and completely took away my anxiety (which I had suffered from daily for 6 years). Unfortunately, I ended up becoming really blah on it, like I had no personality anymore and nothing really to say. I also gained weight rapidly after about a month or so of being on it - I was hungry ALL the time. I was switched to Gabitril, had no weight gain, but became depressed on it and had crying spells after about a month or two.
I have been on Trileptal for 2 weeks. Not a very long time to say it's going to work in the long run, but I have felt the best on this one so far. Not only do I have my personality back, but I am able to focus and concentrate better. I started taking 300mg in the morning and at night. I now take 300mg in the morning and 600mg at night. The therapeutic dose is supposed to be 600mg in the morning and 600mg at night, but I haven't gone up to that because at night, after I take the pill, it makes me pretty tired within about an hour (which is great for night-time). I will keep you updated if anything starts to change, but I definitely like this one the best so far. I haven't had any bad side effects either so far. I've read some pretty good things about it from other people too. I think I'll start another thread to see what other people say about it.
You will have to keep us updated on what you decide to try. Whatever you do, don't give up. There is something out there that will help you. As long as you stay focused on trying to find it, you will : )
Krysti
Posted by catmint on November 27, 2002, at 17:03:11
In reply to Re: Is depression damaging my brain? - » catmint, posted by wendy b. on November 26, 2002, at 22:45:21
Wendy,
Hello~ Thanks for writing. My son's father has ADD (not diagnosed), anxiety and he is a binge drinker. My son sees him about once a month.Wierd how I chose someone like that to have a kid with, then again I was out of my mind.
All in all my son appears to be more on the ADD side of things. He used to have terrible fits and then be fine right after. I've heard the difference between ADD and bipolar in a child is that after a fit, a bipolar child's mood is down for a while, while the ADD child perks right back up.
Haven't even considered Ritalin. Mostly I feed him good and tried some supplements.
I know exactly how you feel. I worry about my son a lot.
Amy
Posted by catmint on November 27, 2002, at 17:10:09
In reply to Re: Is depression damaging my brain? - catmint, posted by Krysti on November 27, 2002, at 12:55:47
Posted by ItsHowdyDudyTime on November 27, 2002, at 21:11:02
In reply to Is depression damaging my brain?, posted by catmint on November 26, 2002, at 0:54:02
OK I found out I was posting those in Spanish and coming out weird. This should come out normally.
To answer your question, yes depression does damage the brain. Particularly when the depression is severe, left untreated or partially treated for long time periods. What is a long time period? Several years is what I was told by a famous TRD researcher at a elite teaching hospital. Severe depression causes literal atrophy of brain tissue, the frontal lobes shrink in size, the hippocampus atropies. There are many physical brain changes that occur in severe depression.
This is all the reason to catch it early, get a correct diagnosis early on and get on the correct class of psychiatric medication early on. Stringing things along only prolongs recovery. Those who have had severe, untreated or partially treated depression for years on end oftentimes find it nearly impossible to fully recover no matter what they do. This is the hard, sad reality of severe mental illness.
ECT is probably your best bet if you are one of these folks who has ignored your mood disorder for years. MAOIs are also good for longstanding, severe and unsuccessfully treated depression. MAOIs can be combined with mood stabilizers like lithium or depakote in bipolar individuals.
Severe mood disorders are nothing to play around with. They tend to sneak up on you, snowball, get worse and worse and one day you realize you are chronically disabled...or worse almost dead. All because you didnt handle it properly in the beginning. Do not underestimate the severity and lethality of a severe mood disorder and Im not even talking about suicide here. Im talking about things like you will never have another good night of sleep for the rest of your life, severe cognition problems, lack of sex drive for the rest of your life which results in inability to maintain meaningful relationships with the opposite sex. Its just bad news and its too bad more people dont understand the true nature of severe depression or manic depression left untreated or undertreated.
Howdy Doody
Posted by catmint on November 28, 2002, at 0:07:43
In reply to Re: Is depression damaging my brain? » catmint, posted by Pfinstegg on November 26, 2002, at 22:44:18
>>As treatments become more focussed on regulating the abnormalities in stress hormones, it is going to be much easier for people to attain really good remissions. Specifically, these would be cortisol-lowering drugs such as mifepristone.
Pfinstegg,
This is interesting. I read somewhere that survivors of sexual abuse have very high cortisol levels. That might explain why I was hospitalized at age 10 for a week due to severe pain in the kidney region (adrenals).They never found out what was wrong with me, I was tested for almost everything, appendicitis, kidney disease, nothing turned up.
In retrospect, I think I was having a major reaction to being abused and I couldn't physically handle the stress. Call it "psychosomatic" but I don't think so. Now, I am 36, bipolar, mostly depressed, and at my wits end as to what treatment to try next.
I've often thought I have high cortisol levels and wonder why this is largely ignored by doctors, especially if there is a history of child abuse.I took mifepristone precisely for it's regulated use. I had no idea it lowered cortisol levels. How can I get more info on mifepristone for depression. Also, do you know if there is an accurate test to show high cortisol levels? If so, is it expensive (I'm in the US)?
Thank you,
Amy
Posted by Larry Hoover on November 28, 2002, at 9:11:30
In reply to Re: Is depression damaging my brain? » catmint, posted by Pfinstegg on November 26, 2002, at 22:44:18
> So, there is much to be hopeful about-depression is a potentially reversible disorder, physically. As treatments become more focussed on regulating the abnormalities in stress hormones, it is going to be much easier for people to attain really good remissions. Specifically, these would be cortisol-lowering drugs such as mifepristone, and a bit more in the future, CRH (corticotrophin-releasing hormone) antagonists. There are others, too, but they all have in common the goal of restoring HPA (hypo-pituitary-adrenal) axis regulation, and, by doing so, preventing various hormone excesses (in chronic fatigue syndrome and atypical depression, there may be brief bursts of excess hormones, followed by too little, but in bipolar and unipolar depression, there is chronic overproduction). Regulating these various hormones will, in turn, allow the hippocampal and pre-frontal neurons to regain normal volumes and dendrites, which should allow the various neurotransmitters- serotonin, dopamine and nor-epinephrine, plus others-to be released and taken up in a normal fashion.Just wanted to focus on this bit, and the stages of glandular exhaustion.
In crude terms, chronic stimulation of the HPA can cause the system to get stuck in hyper mode. In time, the adrenal glands start to "sputter", giving oscillations of hormonal response to the continuous onslaught of ACTH. Finally, glandular exhaustion arrives, and hypo symptoms set in.
That's one theoretical model of adrenal fatigue.
Proc Assoc Am Physicians 1999 Jan-Feb;111(1):22-34
The endocrinology of melancholic and atypical depression: relation to neurocircuitry and somatic consequences.Gold PW, Chrousos GP.
National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-1284, USA.
The cardinal clinical manifestations of major depression with melancholic features include sustained anxiety and dread for the future as well as evidence of physiological hyperarousal (e.g., sustained hyperactivity of the two principal effectors of the stress response, the corticotropin-releasing-hormone, or CRH, system, and the locus ceruleus-norepinephrine, or LC-NE, system). Sustained stress system activation in melancholic depression is thought to confer both behavioral arousal as well as the hypercortisolism, sympathetic nervous system activation, and inhibition of programs for growth and reproduction that consistently occur in this disorder. Data also suggest that activation of the CRH and LC systems in melancholia are involved in the long-term medical consequences of depression such as premature coronary artery disease and osteoporosis, the two-three-fold preponderance of females in the incidence of major depression, and the mechanism of action of antidepressant drugs. In addition, recent data reveal important bidirectional interactions between stress-system hormonal factors in depression and neural substrates implicated in many discrete behavioral alterations in depression (e.g., the medial prefrontal cortex, important in shifting affect based on internal and external cues, the mesolimbic dopaminergic reward system, and the amygdala fear system). We have also advanced data indicating that the hypersomnia, hyperphagia, lethargy, fatigue, and relative apathy of the syndrome of atypical depression are associated with concomitant hypofunctioning of the CRH and LC-NE systems. These data indicate the need for an entirely different therapeutic strategy than that used in melancholia for the treatment of atypical depression, and they suggest that this subtype of major depression will be associated with its own unique repertoire of long-term medical consequences.
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