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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 Elroy on May 25, 2005, at 17:57:01
Okay.... looking for any potential answers.
Have had severe anxiety for almost a year now. Started in June of 2004. Prior to that had milder anxiety (treated with talk therapy and Ambien sleep aid only) from July 2002 until Feb 2004. Then things seemed very much better ("cured") until relapse of June 2004.
Immediately following onset of severe anxiety (within 2-3 weeks) came down with a number of concurrent physical symptoms (constant tinnitus, hypogonadism, tingling/stinging pains in feet and lower legs and hands / lower arms, periodic cold hands but constantly cold / icy cold feet, really bad insomnia, itchy / stinging / flushing patches across torso - especially upper chest and upper back, mild burning / stinging sensation in mouth, and a burning urethra type pain).
Due to physical symptoms, a number of tests have been conducted. Was discovered in Sept 2004 that I had ultra high levels of cortisol (several advanced tests have ruled out Cushings Disease), also discovered a tumor in left adrenal gland (more super advanced tests ruled out both Cushings Syndrome and a "Pheo" tumor... tumor appears to be both benign AND "biologically inactive").
My "educated guess" is that stress occurring to LPHA Axis with combination of elevated stress from 1996 through 2002 and then the mild-to-moderate clinical anxiety from Jul 2002 to Feb 2004 caused a continual excessive secretion of cortisol and that the complete dysfunction of the LPHA Axis then occurred in June of 2004, causing a severe secretion of cortisol (levels in Sept were almost six times the normal max range).
Around late Sept 2004 my pdoc put me on Ativan (1mg x 3 daily). That seemed to be doing nothing so around early Dec 2004 that was changed to Xanax XR (1mg x 2 daily). In addition, I am on meds of AndroGel and Neurontin (300mg x 3 daily).
Also am doing EMDR therapy through psychiatrist office (actually that is an amazing therapy, but it seems like I keep taking 10 stesp forward and then 9 steps backwards... feel extremely well following sessions but seems to quickly fade, another reason why I think biological aspects are in play).
Another interesting aspect is that my adernaline hormone/neurotransmitter levels (the one time that they were tested) came back as low. Dopamine slightly low, epinephrine noticeably low, and norepinephrine extremely low. That seems to be somewhat "strange" for a primarily anxiety situation (I believe that what depression that I have is simply what has developed over the last several months due to my ongoing condition). Even more strangely, anything that tends to elevate those adrenaline levels (dopamine, epinephrine or NE) causes very noticeable flare-ups in both anxiety levels and in my various physical symptoms!
That includes Effexor (was only on it for a few days as it caused an immediate and extreme increase in those "burning urethra" type pains, similar to, but not quite like, prostatitis), Cymbalta (same increase in burning urethra type pain and severe anxiety, just not as immediate nor quite as severe), and even things like low doses Selegiline (I can tolerate 2.5 mg daily but that's it), DLPA and even medium doses of tyrosine! One would think that being able to gradually raise those adrenaline base line levels would be a positive factor.
Also had no luck with SSRIs, well, Lexapro anyway. Aside from extreme nausea which simply wouldn't get better, just simply felt "dead" emotionally with the Lexapro and could feel appetite increasing quite a bit... plus then have since read where Prozac (and other SSRIs???) actually increase cortisol. Many depressives (and people with PTSD) are low in cortisol, so this is probably a very good feature for them as it would "normalize" their cortisol levels... but is the last thing that I need right now. (BTW, tried Lexapro two different occasions)
My question is if anyone out there has any ideas?
I believe that the cortisol levels are directly tied in to whatever is going on. As to the "chicken or the egg" question, I personally believe that the chronic stress and (milder) anxiety led to the breakdown of the LHPA Axis initially, but that the elevated cortisol which exists because of that LHPA Axis breakdown is now keeping the anxiety levels elevated (and likely responsible for many of the physical symptoms - as most are listed for Cushings patients who likewise have elevated cortisol).
Just not sure where to go to from here. Don't believe that SSRIs are the answer and SSNRIs (like Effexor) seem to make the situation worse.
I am currently thinking about discussing with my pdoc about having my Xanax XR switched over to Klonopin. No real reason other than that I've been on the Xanax XR for about six months now and felt that switching around to different benzos might be of benefit???
Also have read some information about Remeron both reducing cortisol AND "re-setting" the HPA Axis. Anyone have any direct experience or more detailed info regarding that data (BTW, I could see where - if that is true - that Remeron might NOT be a VG choice for depressed persons - or PTSD - who were depressed due to LOW cortisol levels, I wonder if it could actually make situation worse?). Anyway, would be looking at Remeron - if applicable - for the specific purpose of lowering the cortisol and "re-setting" the LHPA Axis, so feel that a low dose and moderate-term usage might be effective (???).
Also has been some tantalizing trial data out there concerning the SHORT-TERM use of RU486 to both lower cortisol and to "re-set" the HPA Axis, specifically in cases of non Cushings persons with depression or "psychotic depression" (anxiety) and elevated levels of cortisol. Trial data that I read dealt with therapy regimens of anywhere from 4 to 7 days!
Any and all reasonable suggestions and comments or ideas would be appreciated....
Elroy
Posted by SLS on May 26, 2005, at 0:16:43
In reply to Severe Anxiety, Moderate Depression High Cortisol, posted by Elroy on May 25, 2005, at 17:57:01
> Any and all reasonable suggestions and comments or ideas would be appreciated....
I can't guarantee that any idea I come up with will be reasonable, but it might be an interesting experiment for you to try taking ketoconazole to see if it helps at all - even slightly. It acts as a cortisol synthesis inhibitor, and is sometimes used for Cushings. Did you know that metyrapone is used in Europe to treat Cushings? If you can get a hold of that drug from Novartis and combine it with ketoconazole, it makes for a good antiglucocorticoid treatment.
- Scott
Posted by Pfinstegg on May 26, 2005, at 0:40:28
In reply to Severe Anxiety, Moderate Depression High Cortisol, posted by Elroy on May 25, 2005, at 17:57:01
My first choice, in your situation, would be to try to get into a Mefipristone (RU486) trial. That's the best one to lower your HPA axis overactivity. They are doing it at Stanford, and undoubtedly other places, and the FDA has "fast-tracked" it. I read a year or two ago that they were then focussing mainly on psychotic depression, which is quite extreme and unusual. I'm not sure whether that is still the focus. It's such a short treatment (a week, maximum) that I wonder what they are thinking of for follow-up treatment. I mean, I wonder if they repeat it if it's needed.
From what I've read, if you can get your HPA axis down to normal, you will be able to prevent the "downstream" events in your left frontal and hippocampal areas which lead to major depression. This would be such an improvement over trying to fix things up "downstream' when damage has already occurred- what we do now with the SSRIs, SNRIs, mood-stabilizers, etc.
If this really interests you, i think you could receive it "off-label" if you can find a doctor to do it. After all, it does have another quite common use...
Posted by SLS on May 26, 2005, at 8:15:28
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by Pfinstegg on May 26, 2005, at 0:40:28
Hi Guys.
The NIMH recently began a study of mifepristone (RU-486) to treat bipolar depression.
Rather than reducing the synthesis of cortisol, mifepristone blocks directly the cortisol receptors.
- Scott
Posted by glenn on May 26, 2005, at 8:53:40
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by Pfinstegg on May 26, 2005, at 0:40:28
Hi there, long time since we talked, how are you ?
and your hubby?
Seems like the "cortisol controversy" has hit psychobabble again, I seem to remember us doing this years ago!!
I don't go here very often any more, feeling better seems to lessen the "need" for me.heres hoping you are well.
Glenn
Posted by Pfinstegg on May 26, 2005, at 11:50:05
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by glenn on May 26, 2005, at 8:53:40
Hi Glenn! So nice to see you again, after nearly three years, I think. And we're obviously still talking about the same old stuff! It's so good to hear that you are feeling better- that's the best news anyone could jump in with! I've made improvements, with analytic therapy, and convincing my local pdoc to give maintenance rTMS off-label, but I have a ways to go still. I have improved my cortisols and become a DST-suppressor again- I think it's the TMS which has done that- so that has been a big change for the better. I know that the origins of my depression lies in trauma, but I think the subsequent physical stresses and
changes in my brain have really been helped by the TMS. (I am an AD drop-out, after taking them for about 10 years- I do stick with the fish oil, vitamins, meditation, etc)
Posted by jasmineneroli on May 27, 2005, at 0:33:46
In reply to Severe Anxiety, Moderate Depression High Cortisol, posted by Elroy on May 25, 2005, at 17:57:01
Hi: I'm a big believer in the 'HPA axis "failure" due to consistent elevated cortisol levels',concept. Although have never had my cortisol levels tested, I suspect this was involved in my anxiety disorder.
I recommend giving Klonopin a try - I use it with success, and there is some evidence to suggest that BZD's can put "the brakes" on your brain, for long enough for the brain to re-balance or re-adjust.
Also, the french drug, Tianeptine (Stablon) is purported to lower cortisol levels, if you can get hold of it where you live. It's an anti-anxiety AD.
Best of luck,
Jas
Posted by sabre on May 27, 2005, at 2:23:50
In reply to Severe Anxiety, Moderate Depression High Cortisol, posted by Elroy on May 25, 2005, at 17:57:01
Hi Elroy
Beta blockers promote the reuptake of noradrenaline.NARIs like reboxetine, inhibit the reuptake of NA which raise the levels of plasma and salivary cortisol.
Have you tried beta blockers?
Read these:
Reboxetine acutely stimulates cortisol, ACTH, growth hormone and prolactin secretion in healthy male subjects.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14604600&query_hl=5
Sex differences in cortisol response to reboxetine.I hope it helps
Sabre
Posted by Elroy on May 27, 2005, at 17:22:53
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by SLS on May 26, 2005, at 0:16:43
Thanks for info but endo will NOT go along with ketoconazole under any circumstance (too concerned about side effects). He is something of a Cushings specialist and is really stumped now that it has become officially "Pseudo Cushings".
He believes that the high cortisol levels are being caused by the severe depression (I keep telling him that the only depression that I have is about not getting better, that what I have is severe ANXIETY)... and that the cortisol levels will go down once the depression (anxiety) is relieved.
My pdoc thinks that the anxiety problem may have caused the HPA Axis to go dysfunctional, but that the elevated cortisol levels caused the huge jump in anxiety and is keeping the anxiety levels pumping (I have to admit that she has indicated that what I have is close to being a "psychotic depression" as that is defined by high anxiety and aditation levels). She has become a believer in getting the HPA Axis under control - but isn't up to speed with the pharmaceutical approach in doing that.
I did have some luck in talking my endo in letting me send him some documents pertaining to the RU486 therapy as relates to elevated cortisol, depression and "re-setting" the HPA Axis. Of course I haven't heard anything back from him.
One of the things that impresses me with the RU486 therapy is that it is a very SHORT-TERM program and thereby avoids normal RU486 side effects. In addition, RU486 is not only an FDA approved drug, but also was originally developed as an anti-cortisol treatement for Cushings patients (so it makes one wonder why my endo would be so negative about giving that therapy a try)....
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Anyway, I finally
> > Any and all reasonable suggestions and comments or ideas would be appreciated....
>
> I can't guarantee that any idea I come up with will be reasonable, but it might be an interesting experiment for you to try taking ketoconazole to see if it helps at all - even slightly. It acts as a cortisol synthesis inhibitor, and is sometimes used for Cushings. Did you know that metyrapone is used in Europe to treat Cushings? If you can get a hold of that drug from Novartis and combine it with ketoconazole, it makes for a good antiglucocorticoid treatment.
>
>
> - Scott
>
Posted by Elroy on May 27, 2005, at 22:26:04
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by Pfinstegg on May 26, 2005, at 0:40:28
So far have not been able to locate such a study (at least one that I could get into). I have researched a lot (I mean a LOT) of info on the RU486 therapy and have found it to be very interesting.
In my case, there is very definitely extreme HPA Axis hyperactivity and that obviously fuels the interest.
I believe the initial trials covered "psychotic depression" simply because that is one of the most severe types (in its full form version anyway) and also more treatment-resistant types of depression (one could note that many of the characteristics of "psychotic depression" also fit the definitions for "severe anxiety"). Anyway, I have read where some current testing is now being done in bipolar depression conditions (again, somewhat more severe version of depresion and again often more treatment-resistant ). Kind of like they are looking for the "worse case scenarios" to address initially in their trials?
Obviously this type of therapy is not a "Cure-All" as some forms of depression are caused by too LOW of cortisol levels (or at least are characterized by too low cortisol being present).
I know that many have questioned which ciame first, the chicken or the egg (i.e., does elevated cortisol cause the anxiety / depression or is the anxiety / depression causing the elevated cortisol)?
In Cushing's patients, it's obvious that the elevated cortisol is causing the anxiety / depression as said anxiety / depression disappears almost overnight with surgical correction of the problem (removal of tumor causing cortisol levels to be elevated). In severely depressed (to include anxiety) persons - WITH HIGH CORTISOL - they, however, do not have such an offending tumor.... but they still do have elevated cortisol levels (often at levels as high as many Cushing's patients).
I believe that the theory of these studies is that the HPA Axis has become dysfunctional and that is what is causing the elevated cortisol. Very likely chronic stress, chronic lower level anxiety, an acute life trauma, etc., originally caused the HPA Axis to "break down", but (IMHO) once the HPA Axis became dysfunctional that the elevated cortisol is now "running the show" and causing the continuation (and escalation) of the anxiety and / or depression.
I believe that is why many depressions (to include anxiety situations) are treatment resistant... and why some studies have shown that HPA Axis dysfunction problems are strongpredictors of relapes from successful treatment.
Now, my pdoc has been reading all of the material (that I have provided) in regard this RU486 therapy and finds it very encouraging and is supportive of giving it a try... but is reluctant to provide it herself as this med is still in clinical trials phases for "psychiatric treatments".
Now my endo has every right to prescribe this medication as it is an FDA approved anti-cortisol medication (RU486 was first developed many years ago as an anti-cortisol treatment for Cushings patients), but is extremely wary about the "severe side effects" of RU486 and any other anti-cortisol medication... as he confuses the normal Cushing's therapy of long-term medication with the very short-term therapy for purposes of "re-setting" the HPA Axis in depression / anxiety situations.
As to follow-up treatment, I don't believe that there is any (other than isolated cases of relapse). It seemed to my interpretation that the "re-setting" of the HPA Axis in fact "cured" the depression / anxiety (as that WAS the cause... just like in Cushing's patients: once the offending tumor is removed and the cortisol faucet turned down, the anxiety / depression simply went away... in most cases almost overnight to within a couple of weeks). So obviously there are known cases of where it was the elevated cortisol causing the the depression / anxiety.
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XElroy
> My first choice, in your situation, would be to try to get into a Mefipristone (RU486) trial. That's the best one to lower your HPA axis overactivity. They are doing it at Stanford, and undoubtedly other places, and the FDA has "fast-tracked" it. I read a year or two ago that they were then focussing mainly on psychotic depression, which is quite extreme and unusual. I'm not sure whether that is still the focus. It's such a short treatment (a week, maximum) that I wonder what they are thinking of for follow-up treatment. I mean, I wonder if they repeat it if it's needed.
>
> From what I've read, if you can get your HPA axis down to normal, you will be able to prevent the "downstream" events in your left frontal and hippocampal areas which lead to major depression. This would be such an improvement over trying to fix things up "downstream' when damage has already occurred- what we do now with the SSRIs, SNRIs, mood-stabilizers, etc.
>
> If this really interests you, i think you could receive it "off-label" if you can find a doctor to do it. After all, it does have another quite common use...
>
>
Posted by Elroy on May 27, 2005, at 23:15:30
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol » Elroy, posted by jasmineneroli on May 27, 2005, at 0:33:46
Thanks for info.
Currently using low dose (1mg) of Xanax XR (extended release) twice a day to keep a handle of some sort on my anxiety. Cannot say that it is fully effective however. What advantage would Klonopin have over Xanax XR, if any? Also am on Neurontin for some of the physical pains that came on concurrent with this severe anxiety (peripheral neuropathy type pains, prostatitis type pains, and tinnitus). Again, works "somewhat". Am currently looking forward to the release of Lyrica which is supposed to be both very good for the pain relief and also has VG antianxiety effects (check out ratings at RemedyFind.com).
Would definitely look into having cortisol levels checked. Best test to have done initially is the 24-hour UFC (Urinary Free Cortisol), and to initially have two or three done over a 2 week time period.
If any one of the three are elevated, then have a couple Late Night Salivary Tests done just to make sure that you're not Cushing's (well, actually, if you have elevated cortisol, highly elevated cortisol, and its from a tumor or cancer then it's Cushings, whereas if it's from whatever else then it's Pseudo Cushing's... which is still Cushing's... I guess).
> Hi: I'm a big believer in the 'HPA axis "failure" due to consistent elevated cortisol levels',concept. Although have never had my cortisol levels tested, I suspect this was involved in my anxiety disorder.
> I recommend giving Klonopin a try - I use it with success, and there is some evidence to suggest that BZD's can put "the brakes" on your brain, for long enough for the brain to re-balance or re-adjust.
> Also, the french drug, Tianeptine (Stablon) is purported to lower cortisol levels, if you can get hold of it where you live. It's an anti-anxiety AD.
> Best of luck,
> Jas
Posted by Elroy on May 27, 2005, at 23:34:24
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by SLS on May 26, 2005, at 8:15:28
Yes, I picked up on that info also. Looks like they're spreading out the various forms of depression / anxiety to check to see if RU486 may be an effective therapy. The common denominator with the tests seem to be the existence of highly elevated cortisol in some type of depression setting where HPA Axis dysfunction could be likely.
It seems to me that some of the reports of tests already conducted indicated that the therapy had apparently "re-set" the HPA Axis resulting in lowered cortisol secretion.
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X> Hi Guys.
>
> The NIMH recently began a study of mifepristone (RU-486) to treat bipolar depression.
>
> Rather than reducing the synthesis of cortisol, mifepristone blocks directly the cortisol receptors.
>
>
> - Scott
Posted by Elroy on May 27, 2005, at 23:45:45
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by sabre on May 27, 2005, at 2:23:50
No, have not tried beta blockers.
Not sure how accurate they are (as levels of most hormones can cycle from highs to lows throughout the day), but I had one blood test that showed levels of dopamine, epinephrine, and norepinephrine.
The dopamine was somewhat low, the epinephrine was noticeably low and the norepinephrine was extremely low (well below bottom of normal range). My pdoc was stunned as she ahd felt with my high anxiety that those adrenaline hormone levels would be off the chart.... on the HIGH side! (My pdoc had not ordered that specific test, my endo had to see if I had a Pheo tumor - which can cause severe anxiety... but I had naturally shared the results with my pdoc).
So not sure if beta blockers would be a good idea if those levels are alerady that low. Also have normally lower blood pressure and not sure what effect beta blockers would have on that.
Interestingly NE boosters such as Effexor or Cymbalta make both my anxiety and physical symptoms MUCH worse).
And obviously would want to stay away from NARIs like reboxetine which raise cortisol levels.
Likewise with SSRIs... they have either been too stimulating and worsened the problem or simply provided nothing but side effects.
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X> Hi Elroy
> Beta blockers promote the reuptake of noradrenaline.
>
> NARIs like reboxetine, inhibit the reuptake of NA which raise the levels of plasma and salivary cortisol.
>
> Have you tried beta blockers?
>
> Read these:
>
> Reboxetine acutely stimulates cortisol, ACTH, growth hormone and prolactin secretion in healthy male subjects.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14604600&query_hl=5
> Sex differences in cortisol response to reboxetine.
>
> I hope it helps
> Sabre
Posted by SLS on May 28, 2005, at 7:54:52
In reply to Re: Severe Anxiety, Moderate Depression High Corti » Pfinstegg, posted by Elroy on May 27, 2005, at 22:26:04
> Now my endo has every right to prescribe this medication as it is an FDA approved anti-cortisol medication (RU486 was first developed many years ago as an anti-cortisol treatment for Cushings patients)
When did this happen? It was my impression that the FDA still allows only one indication for mifepristone (RU-486) - that of an abortifacient.
On to CRH antagonists!
- Scott
Posted by Elroy on May 28, 2005, at 20:14:57
In reply to Re: Severe Anxiety, Moderate Depression High Corti » Elroy, posted by SLS on May 28, 2005, at 7:54:52
Must have been some time ago from some of the material that was passed on to me. (???)
I know that my Endo had indicated that he was aware of RU486 being a standardc therapy in "certain Cushings cases, such as those where surgery was impractical or had to be put off for a while". He also told me that he thought that it had been originally developed in Europe specifically as a treatment for Cushing's patients.
I did find one encyclopedia entry that indicated:
QUOTE: The compound was discovered by researchers at Roussel Uclaf of France in 1980 while studying glucocorticoid receptor antagonists. Clinical testing began in 1982. It was first licensed in France in 1988... END QUOTE
Possibly he was referring to earleir uses in Europe for anti-cortiso treatments in Cushing's cases.
I know that there have been a number ofclinical trials in the US concerning RU486 effects in psychotic depression cases and believe that there is either an ongoing study (or recently concluded) one involving RU486 and Bipolar Depression.
My belief is that RU486 will have the same success rate with any type of depression or anxiety that involves highly elevated cortisol due to HPA dysfunction....
Interesting comment here:
http://www.nap.edu/books/0309049490/html/229.html
"In patients with long-standing hypercortisolism not caused by Cushing's disease, however, RU 486-induced antagonism of peripheral glucocorticoid effects presumably would not be overcome. This concept was tested in a few patients with ectopic ACTH secretion and proved correct. At daily doses of 5–22 mg/kg, RU 486 reversed psychosis, hypokalemia, hypertension, weight gain, inhibition of luteinizing hormone, follicle-stimulating hormone, testosterone, thyroid-binding globulin (TBG), corticosteroid-binding protein (CBG), and T4, and restored euglycemia..."
We sparred over using it for lowering cortisol levels (and thereby possibly anxiety levels) because he kept confusing what I was talking about with the standard long-term regimen that is sued in Cushing's treatment (versus what I was talking about as a strictly short-term therapy for purposes of hopefully causing the HPA Axis to re-set and normalize cortisol secretion).
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X> > Now my endo has every right to prescribe this medication as it is an FDA approved anti-cortisol medication (RU486 was first developed many years ago as an anti-cortisol treatment for Cushings patients)
>
> When did this happen? It was my impression that the FDA still allows only one indication for mifepristone (RU-486) - that of an abortifacient.
>
> On to CRH antagonists!
>
>
> - Scott
Posted by zola on May 29, 2005, at 12:31:20
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol, posted by Pfinstegg on May 26, 2005, at 0:40:28
Hi Pfinsteg, I'm sorry to interrupt this thread, but would like to ask if your rTMS is still working as I am considering going to Vancouver to receive it. I can't figure out any other way to reach you. I posted on this board on 5/28 under the title rTMS, if it would be more appropriate to talk there. Again, sorry to all for interrupting this thread.
Thank you, Zola
Posted by Pfinstegg on May 29, 2005, at 23:05:20
In reply to Re: Severe Anxiety, Moderate Depression High Cortisol » glenn, posted by Pfinstegg on May 26, 2005, at 11:50:05
Hi, Zola. As far as I can tell, I'm the only person on the boards to have reported real improvement with rTMS. I think it works for about 50% of the people who try it; I'm in the lucky half- it works very well, bringing my depression down to essentially zero. It does not last too long: I have maintenance of one or two treatments about every 6-8 weeks. The word is that it will be FDA-approved in July,2006. I have posted about it here probably dozens of times, so you can look up either rTMS and or Pfinstegg in the archives to learn more. All the best to you if you try it!
Posted by Elroy on June 9, 2005, at 18:10:01
In reply to Re: Severe Anxiety, Moderate Depression High Corti » SLS, posted by Elroy on May 28, 2005, at 20:14:57
Well, started on Remeron on Monday night (15mg a day for two weeks and then going to 30 mg day). Remeron has some studies showing significant effects at lowering cortisol levels (can post some links if anyone would like).
Remeron is one of those drugs where its side effects are strongest at the lowest levels. Its primary side effects include sedation, hunger pangs and weight gain. I have noted very minimal hunger pangs so don't think that the weight gain will be too much of a problem... except that I have noted an extreme sedating effect!
Now having had insomnia for over a year now (and off-and-on for a couple years before that), it's really, really hard right now to complain about sleeping too much. It just feels so great... but I am sleeping from like midnight to 8 AM (with maybe one wake-up during the night to go potty) and then dozing on-and-off until noon! And then not feeling like I've "woke up" until around 3 or 4 PM!!!
Hopefully this is a "side effect" that will ease off when I go up to 30 mg. And hopefully just the day time sleepiness will go away (the night time sleepiness is great). I believe that this is definitely a result of the Remeron significantly reducing the cortisol levels. If so, the bottom line will be this: does the Remeron allow the HPA Axis to "re-set" itself and if so, how long does that process take?
Elroy
This is the end of the thread.
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