Psycho-Babble Medication Thread 337707

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HPA axis dysregulation vs. hypercortisolism in MDD

Posted by jrbecker on April 19, 2004, at 10:08:27

Potential key HPA axis dysregulation feature in MDD identified

Psych Res 2004; 126: 1-13

Contrary to expectations, investigators have found that the characteristic feature of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in patients with major depressive disorder (MDD) may be erratic cortisol secretion, rather than hypercortisolism.

"Dysregulation of the HPA axis is an important feature of MDD, but relatively little attention has been given to within-person variability of hormone secretion over time," observe Frenk Peeters (Maastricht University, The Netherlands) and colleagues.

To address this issue, the team took multiple salivary cortisol samples from 47 outpatients with MDD and 39 mentally healthy controls over a 6-day period.

Overall, there was no evidence for daytime hypercortisolism in the depressed outpatient group relative to controls, although self-reported symptom severity was associated with higher cortisol levels.

The researchers report that "a more striking finding" was the erratic pattern of cortisol secretion among MDD patients, as evidenced by lower cortisol autocorrelations, in comparison with controls.

They note in the journal Psychiatry Research that these secretions were particularly erratic among patients with more severe or recurrent episodes. This finding is consistent with the hypothesis that "repeated episodes result in more severe, perhaps structural, changes in HPA axis function," the team says.

Although the underlying cause of this increased intraindividual variability remains unclear, Peeters et al suggest that vulnerability factors may combine with clinical characteristics to produce a spectrum of HPA axis disturbances in MDD. The subtle changes in cortisol secretion seen in their study may represent one of the initial manifestations of this spectrum of disturbances.

"Longitudinal studies in MDD might therefore be useful for evaluating the prognostic value of cortisol secretory variability, as well as the effects of pharmacotherapy, other treatments, and clinical recovery on this aspect of HPA axis dysfunction," the researchers conclude.


 

Re: HPA axis dysregulation vs. hypercortisolism in MDD jrbecker

Posted by Pfinstegg on April 19, 2004, at 10:44:58

In reply to HPA axis dysregulation vs. hypercortisolism in MDD, posted by jrbecker on April 19, 2004, at 10:08:27

Thanks! As always, a very thoughtful and helpful contribution from you. I'm really looking forward to the day when HPA axis dysregulation can be modulated safely. At the moment, the one treatment which (temporarily) normalizes my cortisol is TMS. That's the main reason I'm willing to travel to receive it.

 

Re: HPA axis dysregulation vs. hypercortisolism in MDD

Posted by jrbecker on April 19, 2004, at 15:27:10

In reply to Re: HPA axis dysregulation vs. hypercortisolism in MDD jrbecker, posted by Pfinstegg on April 19, 2004, at 10:44:58

thanks for your kind reply.

How's the TMS going by the way? I've always been curious to try it since it seems that adverse events are low and most studies allow you to stay on current med regimens. Unfortunately, all the sites near me are only testing TMS vs ECT -- the latter of which I'm not psycked about.

few questions if you don't mind...

How long and how many treatments have you have had?

How would you rate your response in comparison to all other treatments you have tried?

Is this treatment in combo with any meds currently?

thanks in advance for your response.

JRB

> Thanks! As always, a very thoughtful and helpful contribution from you. I'm really looking forward to the day when HPA axis dysregulation can be modulated safely. At the moment, the one treatment which (temporarily) normalizes my cortisol is TMS. That's the main reason I'm willing to travel to receive it.

 

Re: HPA axis dysregulation vs. hypercortisolism in MDD jrbecker

Posted by Pfinstegg on April 19, 2004, at 20:32:55

In reply to Re: HPA axis dysregulation vs. hypercortisolism in MDD, posted by jrbecker on April 19, 2004, at 15:27:10

I had an initial course of 15 TMS treatments in January 2003, with three additional booster sessions (two treatments per day for 3 days) every few months. I would rate it as the most helpful thing i have done, although, at least for me, the effect lasts only about two months- so you have to keep on doing it! There is no problem with taking any AD's. For about half of the past year, I have taken just tianeptine, fish oil, lots of vitamins. The other part of the year i have been taking Lexapro 10 mg. instead of tianeptine. I think it's a very good treatment, as it apparently lowers one's cortisol output for a while, increases levels of all three neurotransmitters, increases BNDF and left cortical blood flow. I feel relaxed, undepressed and like my old self after having them. It's also very safe and easy to take- no memory problems. The doctor who gives them to me is trying to wean his most severely depressed patients off monthly ECT and onto TMS. Although he considers TMS somewhat less powerful than ECT, the quality of life for his patients is so much better if they can make the switch.

 

Re: HPA axis dysregulation vs. hypercortisolism in MDD Pfinstegg

Posted by jrbecker on April 20, 2004, at 10:35:56

In reply to Re: HPA axis dysregulation vs. hypercortisolism in MDD jrbecker, posted by Pfinstegg on April 19, 2004, at 20:32:55

interesting. sounds like it's really working for you.

so are you in a clinical trial or are you paying out of pocket for the treatment?

> I had an initial course of 15 TMS treatments in January 2003, with three additional booster sessions (two treatments per day for 3 days) every few months. I would rate it as the most helpful thing i have done, although, at least for me, the effect lasts only about two months- so you have to keep on doing it! There is no problem with taking any AD's. For about half of the past year, I have taken just tianeptine, fish oil, lots of vitamins. The other part of the year i have been taking Lexapro 10 mg. instead of tianeptine. I think it's a very good treatment, as it apparently lowers one's cortisol output for a while, increases levels of all three neurotransmitters, increases BNDF and left cortical blood flow. I feel relaxed, undepressed and like my old self after having them. It's also very safe and easy to take- no memory problems. The doctor who gives them to me is trying to wean his most severely depressed patients off monthly ECT and onto TMS. Although he considers TMS somewhat less powerful than ECT, the quality of life for his patients is so much better if they can make the switch.

 

Re: HPA axis dysregulation vs. hypercortisolism in MDD jrbecker

Posted by Pfinstegg on April 21, 2004, at 1:07:19

In reply to Re: HPA axis dysregulation vs. hypercortisolism in MDD Pfinstegg, posted by jrbecker on April 20, 2004, at 10:35:56

Unfortunately, I'm paying. I did get a full tax refund for the expenses, though- with no audit or anything.


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