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Dr. Bob is Robert Hsiung, MD,
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Posted by Elroy on June 21, 2005, at 18:46:08
In reply to Re: HPA Axis Anti-Cortisol Therapy - MORE INFO 4 » Elroy, posted by Elroy on June 21, 2005, at 18:28:03
A really great explanation page, with more specific data about cortisol amd hypercortisolism as relates to psychiatric disorders...
http://www.psychiatrictimes.com/p040592.html
Despite considerable advances in the treatment of mood disorders during previous decades, there remains an urgent need to identify compounds that will successfully treat mood episodes (including the associated neurocognitive impairments) and prevent their recurrence. This article reviews some of these recent developments, with an emphasis on the role of cortisol in relation to depression...
Glucocorticoids are the end product of the hypothalamic-pituitary-adrenal (HPA) axis and are central to the stress response. There is overwhelming evidence that during periods of acute stress, glucocorticoids promote survival by mobilizing energy reserves. In addition to these short-term adaptive changes, glucocorticoids are also involved in other longer-term, stress-related adaptive changes such as shaping and regulating a number of physiological processes, including immune responsiveness and activation of the sympathetic nervous system. Although glucocorticoid production is essential for survival, overproduction is associated with a significant disruption of cellular functioning, which, in turn, leads to widespread physiological dysfunction...
Cortisol, a glucocorticoid released from the adrenal cortex, is the end product of the HPA axis. The HPA axis comprises the tissues of the hypothalamus, pituitary and adrenal cortices; regulatory neuronal inputs; and a variety of releasing factors and hormones... A variety of stressors, both physical and psychological, cause the neurosecretory cells within the paraventricular nucleus of the hypothalamus to secrete corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) into the microportal circulatory system of the pituitary stalk. These secretions cause the release of adrenocorticotropic hormone (ACTH) from the anterior lobe of the pituitary. Cortisol is released from the adrenal cortex in response to ACTH. Cortisol has a panoply of central and peripheral effects that are mediated via at least two intracellular specialized glucocorticoid receptor subtypes: the high-affinity type I receptor (or MR) and the low-affinity type II receptor (or GR). ... activity of the HPA axis is highly regulated. Secretory cells within the paraventricular nucleus receive neuronal inputs from a number of brain regions including the amygdala, hippocampus and nuclei within the midbrain (Figure 2). The HPA axis also has an autoregulatory mechanism mediated by cortisol. Endogenous cortisol binds to glucocorticoid receptors in the HPA axis tissues and hippocampus and acts as a potent negative regulator of HPA activity. The relative contribution of the two receptor subtypes (GR and MR) in the regulation of HPA activity is as yet unclear. The MRs have a high affinity for endogenous glucocorticoids such as cortisol, as well as for the salt-regulating hormone aldosterone. However, the GRs have a relatively low affinity for cortisol, but bind avidly to synthetic steroids such as dexamethasone. These differences in affinity suggest that MRs play a primary role in regulating basal cortisol levels when hormone levels are low. When cortisol levels rise, as from stress or circadian fluctuations, the MRs become saturated, and GRs become the main transducers of glucocorticoid activity and therefore the primary mediators of HPA feedback. These regulatory mechanisms are important in determining basal levels and circadian fluctuations in cortisol levels. Changes in GR number or function may be important in altering the homeostatic function of the HPA axis observed in healthy individuals....
first observations of abnormalities of cortisol levels in patients with depression were made in the late 1950s by Board and colleagues (Michael and Gibbons, 1963), and these observations have been consistently replicated. Subsequent studies have shown that HPA hyperactivity--as manifested by hypersecretion of CRH; increased cortisol levels in plasma, urine and cerebrospinal fluid; exaggerated cortisol responses to ACTH; and enlarged pituitary and adrenal glands--occurs in individuals suffering from severe mood disorders... It is interesting, however, that neither citalopram (Celexa) (Seckl and Fink, 1992) nor fluoxetine (Prozac) (Rossby et al., 1995) alters GR mRNA or GR binding capacity, which suggests that the selective serotonin reuptake inhibitor class of antidepressants may lack the ability to modulate GR expression and/or function. This evidence suggests that if indeed GR regulation is involved in the therapeutic mechanism(s) of action of antidepressant drugs and mood stabilizers, it is not a unitary mechanism. Antidepressant drugs that have the ability to regulate GR expression and binding may, however, have greater therapeutic efficacy in patients who have hypercortisolemia...
Paradoxically, glucocorticoid receptor antagonists have also been advocated as agents with potential therapeutic properties for mood disorders. This is based on the ability of the GR antagonist to block any detrimental effect of hypercortisolemia and on the ability of an antagonist to upregulate its receptor. Administration of a GR antagonist results in an acute antiglucocorticoid effect, while presumably causing a compensatory upregulation of GR numbers, leading to enhanced negative feedback of the HPA axis. Initial clinical studies using the GR antagonist mifepristone (Mifeprex, RU-486) have been encouraging, but some clinical efficacy may have been masked by the prolonged administration of the drug (Murphy et al., 1993). Animal studies suggest that GR numbers are increased rapidly (within hours) after the administration of mifepristone, which may restore normal feedback, thus "resetting" the HPA axis (Lupien and McEwen, 1997). Such data suggest that a brief period of treatment with the GR antagonist may be adequate for restoring normal HPA axis function. This might reduce problems of noncompliance and side effects associated with longer-term administration.... Twenty patients, ages 18 to 65, with a diagnosis of BD (confirmed using the Structured Clinical Interview for DSM-IV [SCID]) and residual depressive symptoms were recruited. Patients' medication had been unchanged for six weeks prior to participation and remained so throughout the study period. Seventeen patients were taking at least one mood stabilizer, with 13 taking at least one antidepressant and 11 taking an antipsychotic agent. Following an initial baseline assessment of neurocognitive function and mood and basal neuroendocrine profiling, patients were randomly assigned to receive either 600 mg/day mifepristone or placebo for seven days. Administration was in a double-blind design. Mood ratings were taken after the week's treatment and then at weekly intervals. At day 21, the groups crossed over and received the alternative treatment (placebo or mifepristone) for seven days, again with ratings taken following the week's treatment and at weekly intervals. Neurocognitive function was assessed on three occasions over the study period: at baseline and 21 days after both treatments.... At 14 days following treatment with mifepristone, depression rating scores had significantly improved from baseline levels, without any significant change being observed at any time point following placebo. The Brief Psychiatric Rating Scale (BPRS) scores were also significantly lower in the mifepristone group at day 14 compared with baseline, with a similar lack of change in the placebo-treated group. With regard to neurocognitive performance, the mifepristone-treated group showed a significant reduction in the error rate of the spatial working memory task (Figure 4) compared with baseline. No such changes were observed in the placebo-treated patients. Furthermore, baseline cortisol output correlated positively with the percentage improvement in spatial working memory error rate following mifepristone administration. Verbal fluency and spatial recognition memory also improved in those patients treated with mifepristone...
Posted by Elroy on June 21, 2005, at 18:51:40
In reply to Re: HPA Axis Anti-Cortisol Therapy - MORE INFO 5, posted by Elroy on June 21, 2005, at 18:46:08
Misc Info:
Holsboer, F. (2003). "Corticotropin-releasing hormone modulators and depression." Curr Opin Investig Drugs 4(1): 46-50.
Basic and clinical studies demonstrate that the central corticotropin-releasing hormone (CRH) circuits are overactive among depressives, a phenomenon frequently reflected by enhanced cortisol and corticotropin levels in the peripheral blood of these patients. Behavioral pharmacology provided evidence that CRH overexpression accounts for many signs and symptoms characteristic of depression. CRH-type 1 receptors (CRHR), were identified as responsible for conveying the CRH signal into cellular circuitries, thereby inducing depression-related symptoms. In order to decrease CRH signaling, many pharmaceutical companies have developed small molecules that after oral ingestion, penetrate the blood-brain barrier and selectively bind at CRHR1 with high affinity. These compounds have been tested in animal models and patients with major depression. One of these compounds, R-121919 (Neurocrine Biosciences Inc), ameliorated depressive symptomatology without unwanted endocrine side effects or other adverse effects. While clinical trials of R-121919 have been discontinued after phase IIa studies, a number of other CRHR1 antagonists are being developed, and hopefully this advance will ultimately lead to a favorable alternative to currently available antidepressant drugs.
Parker, K. J., A. F. Schatzberg, et al. (2003). "Neuroendocrine aspects of hypercortisolism in major depression." Horm Behav 43(1): 60-6.
A consistent finding in biological psychiatry is that hypothalamic-pituitary-adrenal (HPA) axis physiology is altered in humans with major depression. These findings include hypersecretion of cortisol at baseline and on the dexamethasone suppression test. In this review, we present a process-oriented model for HPA axis regulation in major depression. Specifically, we suggest that acute depressions are characterized by hypersecretion of hypothalamic corticotropin-releasing factor, pituitary adrenocorticotropic hormone (ACTH), and adrenal cortisol. In chronic depressions, however, enhanced adrenal responsiveness to ACTH and glucocorticoid negative feedback work in complementary fashion so that cortisol levels remain elevated while ACTH levels are reduced. In considering the evidence for hypercortisolism in humans, studies of nonhuman primates are presented and their utility and limitations as comparative models of human depression are discussed.
Rothschild, A. J. (2003). "Challenges in the treatment of depression with psychotic features." Biol Psychiatry 53(8): 680-90.
Major depression with psychotic features (MDpsy), a disorder with considerable morbidity and mortality, is more common than is generally realized and is a most difficult form of depression to treat. Patients with MDpsy exhibit more frequent relapses and recurrences and have increased use of services, greater disability, and a poorer clinical course when compared with nonpsychotically depressed patients. Patients with MDpsy demonstrate distinct biological abnormalities in studies of the hypothalamic-pituitary-adrenal (HPA) axis, dopaminergic activity, enzyme studies, brain imaging, electroencephalogram sleep profiles, and measures of serotonergic function when compared with nonpsychotic depression. The social and occupational impairment in MDpsy has been hypothesized to be secondary to subtle cognitive deficits caused by the higher cortisol levels frequently observed in MDpsy patients. Several studies support a relationship between bipolar disorder and MDpsy, particularly in young-onset MDpsy. The most efficacious treatments for MDpsy include the combination of an antidepressant and an antipsychotic, amoxapine, or electroconvulsive therapy. Atypical antipsychotic medications may have particular relevance for the treatment of MDpsy because of the potential for reduced risk of extrapyramidal side effects and tardive dyskinesia, as well as antipsychotic and possibly antidepressant qualities. Based on the observations that MDpsy patients exhibit marked dysregulation of the HPA axis and elevated cortisol levels, several antiglucocorticoid strategies have been employed to treat MDpsy patients. Many questions regarding the acute and long-term treatment of MDpsy remain for future studies to address.
Elroy
Posted by Chairman_MAO on June 22, 2005, at 18:13:42
In reply to Re: HPA Axis and Anti-Cortisol Therapy, posted by KaraS on June 19, 2005, at 17:58:53
The best AD available for normalizing the HPA axis and reversing hippocampal atrophy due to excess cortisol is tianeptine.
Prevention of stress-induced
morphological and cognitive consequences
by
McEwen BS; Conrad CD; Kuroda Y;
Frankfurt M; Magarinos AM; McKittrick C
Laboratory of Neuroendocrinology,
Rockefeller University,
New York, NY 10021, USA.
Eur Neuropsychopharmacol, 1997 Oct, 7 Suppl 3:, S323-8.ABSTRACT
Atrophy and dysfunction of the human hippocampus is a feature of aging in some individuals, and this dysfunction predicts later dementia. There is reason to believe that adrenal glucocorticoids may contribute to these changes, since the elevations of glucocorticoids in Cushing's syndrome and during normal aging are associated with atrophy of the entire hippocampal formation in humans and are linked to deficits in short-term verbal memory. We have developed a model of stress-induced atrophy of the hippocampus of rats at the cellular level, and we have been investigating underlying mechanisms in search of agents that will block the atrophy. Repeated restraint stress in rats for 3 weeks causes changes in the hippocampal formation that include suppression of 5-HT1A receptor binding and atrophy of dendrites of CA3 pyramidal neurons, as well as impairment of initial learning of a radial arm maze task. Because serotonin is released by stressors and may play a role in the actions of stress on nerve cells, we investigated the actions of agents that facilitate or inhibit serotonin reuptake. Tianeptine is known to enhance serotonin uptake, and we compared it with fluoxetine, an inhibitor of 5-HT reuptake, as well as with desipramine. Tianeptine treatment (10 mg/kg/day) prevented the stress-induced atrophy of dendrites of CA3 pycamidal neurons, whereas neither fluoxetine (10 mg/kg/day) nor desipramine (10 mg/kg/day) had any effect. Tianeptine treatment also prevented the stress-induced impairment of radial maze learning. Because corticosterone- and stress-induced atrophy of CA3 dendrites is also blocked by phenytoin, an inhibitor of excitatory amino acid release and actions, these results suggest that serotonin released by stress or corticosterone may interact pre- or post-synaptically with glutamate released by stress or corticosterone, and that the final common path may involve interactive effects between serotonin and glutamate receptors on the dendrites of CA3 neurons innervated by mossy fibers from the dentate gyrus. We discuss the implications of these findings for treating cognitive impairments and the risk for dementia in the elderly.
Posted by Elroy on June 22, 2005, at 20:10:28
In reply to Re: HPA Axis and Anti-Cortisol Therapy » KaraS, posted by Chairman_MAO on June 22, 2005, at 18:13:42
This is a 1997 study that was performed just a year after Remeron came out and before testing had been done on Remeron. I don't doubt that tianeptine might be effective in that regard, but am also aware of sveral studies with Remeron (initial links are general studies with later links involving cortisol / HPA Axis):
http://www.pslgroup.com/dg/994E.htm
http://www.pslgroup.com/dg/88A7E.htm
http://www.pslgroup.com/dg/BC202.htm
http://www.pslgroup.com/dg/150D62.htm
http://www.pslgroup.com/dg/1D25B6.htm
http://my.webmd.com/content/article/35/1728_59748
http://www.docguide.com/news/content.nsf/news/EC40CE41EC274B65852569BC006474FA
http://www2.eclinicalpsychiatrynews.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=aqc010291124
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256C670056CC80
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256DB7007131E7
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256DBF00474CA2
http://www.docguide.com/news/content.nsf/news/8525697700573E188525700E00608A93Here's where it gets real interesting:
http://www.pslgroup.com/dg/2030E2.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10451911&dopt=Abstract
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256CFD004B4129
http://qualitycounts.com/fp/remeron.htmAt least one study, reported in 2001 showed that tianeptine actually (starting at week 4) INCREASED cortisol levels in test rats... It also referes to yet another study where the same thing (elevated cortisol levels were found)...
QUOTE: Stress-Induced Activation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis. Psychosocial stress induced a sustained activation of the HPA axis, as indicated by the nonadapting elevation of urinary cortisol excretion in the two stress groups (Table 2). No statistical differences between the Stress and Stress + Tianeptine group were found, except on week 4 yielding significantly HIGHER cortisol excretion (P < 0.02) in stressed animals treated with tianeptine. Despite the daily treatment of subordinate animals with tianeptine (Stress + Tianeptine), cortisol did not return to basal levels (Table 2). This finding is in line with one study in rats showing that stress-elicited elevations in plasma corticosterone were not reduced by tianeptine treatment (39). Other studies, however, demonstrated that tianeptine clearly reduces HPA response to stress (40). No effects on urinary cortisol excretion were observed in animals of the two control groups (Control; Control + Tianeptine). END QUOTE
I also noted the fact that it appears to "reduce HPA response to stress activity" (which is a far cry from "re-setting" the HPA Axis... if it did that the cortisol levels should return to normal and not remain elevated), but if one is experiencing effects of elevated cortisol above and beyond one's severe anxiety / depression then clearly more is needed...
Other sites have refered to tianeptine "countering the effects" of elevated cortisol. Again, quite different from actually reducing the cortisol and fully "re-setting" the HPA Axis (which should return cortisol secretions to normal).
Additionally, I believe that tianeptine is still not available in the US market (another disadvantage compared to Remeron).
And the bottom line is that neither of these show the benefits that have - so far - been noted in studies involving RU486 in a SHORT-TERM therapy mode. That protocol thereby avoided RU486's side effects (as when taken long term) but displayed some really significant results in re-setting the HPA Axis, resulting in lowered to normal cortisol levels and tremendous benefits with anxiety / depression situation.
FDA has supposedly "fast-tracked" RU486, so will be interesting to see just exactly what that ends up meaning....
That said, if Tianeptine was available on US market I personally would give a try if the Remeron doesn't do completely what I want it to! Have seen ancedotal instances of persons who have had very good AD effects from Tianeptine who had also tried Remeron and had just "so-so" effects.... unfortunately in none of those ancedotal stories did it mention the individual having elevated cortisol levels (they were taking it for anxiety and / or depression problems and made no mention of having certified high cortisol levels).
Elroy
X
X
X
> The best AD available for normalizing the HPA axis and reversing hippocampal atrophy due to excess cortisol is tianeptine.
>
> Prevention of stress-induced
> morphological and cognitive consequences
> by
> McEwen BS; Conrad CD; Kuroda Y;
> Frankfurt M; Magarinos AM; McKittrick C
> Laboratory of Neuroendocrinology,
> Rockefeller University,
> New York, NY 10021, USA.
> Eur Neuropsychopharmacol, 1997 Oct, 7 Suppl 3:, S323-8.
>
> ABSTRACT
>
> Atrophy and dysfunction of the human hippocampus is a feature of aging in some individuals, and this dysfunction predicts later dementia. There is reason to believe that adrenal glucocorticoids may contribute to these changes, since the elevations of glucocorticoids in Cushing's syndrome and during normal aging are associated with atrophy of the entire hippocampal formation in humans and are linked to deficits in short-term verbal memory. We have developed a model of stress-induced atrophy of the hippocampus of rats at the cellular level, and we have been investigating underlying mechanisms in search of agents that will block the atrophy. Repeated restraint stress in rats for 3 weeks causes changes in the hippocampal formation that include suppression of 5-HT1A receptor binding and atrophy of dendrites of CA3 pyramidal neurons, as well as impairment of initial learning of a radial arm maze task. Because serotonin is released by stressors and may play a role in the actions of stress on nerve cells, we investigated the actions of agents that facilitate or inhibit serotonin reuptake. Tianeptine is known to enhance serotonin uptake, and we compared it with fluoxetine, an inhibitor of 5-HT reuptake, as well as with desipramine. Tianeptine treatment (10 mg/kg/day) prevented the stress-induced atrophy of dendrites of CA3 pycamidal neurons, whereas neither fluoxetine (10 mg/kg/day) nor desipramine (10 mg/kg/day) had any effect. Tianeptine treatment also prevented the stress-induced impairment of radial maze learning. Because corticosterone- and stress-induced atrophy of CA3 dendrites is also blocked by phenytoin, an inhibitor of excitatory amino acid release and actions, these results suggest that serotonin released by stress or corticosterone may interact pre- or post-synaptically with glutamate released by stress or corticosterone, and that the final common path may involve interactive effects between serotonin and glutamate receptors on the dendrites of CA3 neurons innervated by mossy fibers from the dentate gyrus. We discuss the implications of these findings for treating cognitive impairments and the risk for dementia in the elderly.
Posted by Jakeman on June 22, 2005, at 22:26:41
In reply to Re: HPA Axis and Anti-Cortisol Therapy » Chairman_MAO, posted by Elroy on June 22, 2005, at 20:10:28
Remeron has its strong points. Unfortunately it made me want everything in the house. 25 pounds later I gave it up. I did a trial of tianeptine a few years ago and felt absolutely no effect. I think phosphatidylcholine is helpful as an anti-cortisol agent.
best regards ~ Jake
Posted by Jakeman on June 22, 2005, at 22:32:16
In reply to Re: HPA Axis and Anti-Cortisol Therapy » Elroy, posted by Jakeman on June 22, 2005, at 22:26:41
> Remeron has its strong points. Unfortunately it made me want everything in the house. 25 pounds later I gave it up. I did a trial of tianeptine a few years ago and felt absolutely no effect. I think phosphatidylcholine is helpful as an anti-cortisol agent.
>
> best regards ~ JakeI meant to say phosphatidyl*serine*
Posted by Elroy on June 23, 2005, at 1:32:46
In reply to Re: HPA Axis and Anti-Cortisol Therapy » Elroy, posted by Jakeman on June 22, 2005, at 22:26:41
Ahhh.. kind of opposite with me.. well PS - along with some other OTC products that I was taking, and taking very aggresively (things like Relora and Holy Basil and amino acis Glutamate w/ NAC, etc., etc.... and I was taking 800mg of PS daily know matter what other supps I was also taking for anti-cortisol) allowed me to get my cortisol levels down to 108, with a reference range of 20 - 100.. close... but when I stopped them for just two weeks prior to my next test, my cortisol was back up to 240-something... so clearlt by HPA Axis hadn't re-set (or my cortisol levels would started normalizing rather than going back up).
I had some significant sedation effects on first few days when dose was at 15mg but since I've gone to 30 mg I've had that swdation almost completely disappear. Appetite had no increase at 14mg and maybe a very, very slight increase at 30 mg... As to cortisol levels, won't know for about a month as
next testing time is around July 20th...Elroy
X
X
X
X
X
> Remeron has its strong points. Unfortunately it made me want everything in the house. 25 pounds later I gave it up. I did a trial of tianeptine a few years ago and felt absolutely no effect. I think phosphatidylcholine is helpful as an anti-cortisol agent.
>
> best regards ~ Jake
Posted by Jakeman on June 23, 2005, at 12:29:20
In reply to Re: HPA Axis and Anti-Cortisol Therapy » Jakeman, posted by Elroy on June 23, 2005, at 1:32:46
> Ahhh.. kind of opposite with me.. well PS - along with some other OTC products that I was taking, and taking very aggresively (things like Relora and Holy Basil and amino acis Glutamate w/ NAC, etc., etc.... and I was taking 800mg of PS daily know matter what other supps I was also taking for anti-cortisol) allowed me to get my cortisol levels down to 108, with a reference range of 20 - 100.. close... but when I stopped them for just two weeks prior to my next test, my cortisol was back up to 240-something... so clearlt by HPA Axis hadn't re-set (or my cortisol levels would started normalizing rather than going back up).
>
> I had some significant sedation effects on first few days when dose was at 15mg but since I've gone to 30 mg I've had that swdation almost completely disappear. Appetite had no increase at 14mg and maybe a very, very slight increase at 30 mg... As to cortisol levels, won't know for about a month as
> next testing time is around July 20th...
>
> Elroy
>Good luck with the Remeron, it works for many people. I'm glad you're posting results from your research and personal experience, it's very informative.
~Jake
Posted by KaraS on June 24, 2005, at 3:59:43
In reply to Re: HPA Axis and Anti-Cortisol Therapy » KaraS, posted by Chairman_MAO on June 22, 2005, at 18:13:42
> The best AD available for normalizing the HPA axis and reversing hippocampal atrophy due to excess cortisol is tianeptine.
>
> Prevention of stress-induced
> morphological and cognitive consequences
> by
> McEwen BS; Conrad CD; Kuroda Y;
> Frankfurt M; Magarinos AM; McKittrick C
> Laboratory of Neuroendocrinology,
> Rockefeller University,
> New York, NY 10021, USA.
> Eur Neuropsychopharmacol, 1997 Oct, 7 Suppl 3:, S323-8.
>
> ABSTRACT
>
> Atrophy and dysfunction of the human hippocampus is a feature of aging in some individuals, and this dysfunction predicts later dementia. There is reason to believe that adrenal glucocorticoids may contribute to these changes, since the elevations of glucocorticoids in Cushing's syndrome and during normal aging are associated with atrophy of the entire hippocampal formation in humans and are linked to deficits in short-term verbal memory. We have developed a model of stress-induced atrophy of the hippocampus of rats at the cellular level, and we have been investigating underlying mechanisms in search of agents that will block the atrophy. Repeated restraint stress in rats for 3 weeks causes changes in the hippocampal formation that include suppression of 5-HT1A receptor binding and atrophy of dendrites of CA3 pyramidal neurons, as well as impairment of initial learning of a radial arm maze task. Because serotonin is released by stressors and may play a role in the actions of stress on nerve cells, we investigated the actions of agents that facilitate or inhibit serotonin reuptake. Tianeptine is known to enhance serotonin uptake, and we compared it with fluoxetine, an inhibitor of 5-HT reuptake, as well as with desipramine. Tianeptine treatment (10 mg/kg/day) prevented the stress-induced atrophy of dendrites of CA3 pycamidal neurons, whereas neither fluoxetine (10 mg/kg/day) nor desipramine (10 mg/kg/day) had any effect. Tianeptine treatment also prevented the stress-induced impairment of radial maze learning. Because corticosterone- and stress-induced atrophy of CA3 dendrites is also blocked by phenytoin, an inhibitor of excitatory amino acid release and actions, these results suggest that serotonin released by stress or corticosterone may interact pre- or post-synaptically with glutamate released by stress or corticosterone, and that the final common path may involve interactive effects between serotonin and glutamate receptors on the dendrites of CA3 neurons innervated by mossy fibers from the dentate gyrus. We discuss the implications of these findings for treating cognitive impairments and the risk for dementia in the elderly.---------------------------------------------
Thanks for the info. I had read that tianeptine could reverse hippocampal atrophy but I didn't realize that it was any better at it than any other antidepressant.
Kara
Posted by Jakeman on June 25, 2005, at 16:14:23
In reply to Re: HPA Axis and Anti-Cortisol Therapy » KaraS, posted by Chairman_MAO on June 22, 2005, at 18:13:42
> The best AD available for normalizing the HPA axis and reversing hippocampal atrophy due to excess cortisol is tianeptine.
>It's my understanding that tianeptine is not available in the US. Does anyone know what's up with this.. is there a particular reason? I've read quite a bit of positive information in the scientific literature about this drug, but there seems to be a dearth of anecdotal reports. Is it used much in the UK?
thanks ~Jake
Posted by Elroy on June 25, 2005, at 17:48:11
In reply to Re: HPA Axis and Anti-Cortisol Therapy- tianeptine » Chairman_MAO, posted by Jakeman on June 25, 2005, at 16:14:23
No idea on this one.... maybe politics at play? How long has it been in use in Europe, etc? It seems that it has a really good track record....
Kind of like the situation with Pfizer and their drug Lyrica. It has been approved by FDA for over six months now and still hasn't been released to the US market....
Elroy
X
X
X> > The best AD available for normalizing the HPA axis and reversing hippocampal atrophy due to excess cortisol is tianeptine.
> >
>
> It's my understanding that tianeptine is not available in the US. Does anyone know what's up with this.. is there a particular reason? I've read quite a bit of positive information in the scientific literature about this drug, but there seems to be a dearth of anecdotal reports. Is it used much in the UK?
>
> thanks ~Jake
Posted by ed_uk on June 25, 2005, at 21:15:37
In reply to Re: HPA Axis and Anti-Cortisol Therapy- tianeptine » Chairman_MAO, posted by Jakeman on June 25, 2005, at 16:14:23
Hi,
>Is it used much in the UK?
No, it's not available in the UK. It is available in France and a few other European countries.
~Ed
Posted by cache-monkey on June 29, 2005, at 0:34:17
In reply to Re: HPA Axis and Anti-Cortisol Therapy » Chairman_MAO, posted by Elroy on June 22, 2005, at 20:10:28
Hi Elroy,
I've been reading your posts on cortisol with great interest. Thanks for posting all the useful information.
In some of the links you posted on Remeron as effective cortisol therapy, the authors attribute this to its 5-HT2 blockade. Remeron is known for its 5-HT2a antagonism, but less well known is that it also blocks the 5-HT2c receptors almost as hard [1]. This is a lot like Zyprexa at low doses, although with Z you also get the D-2 antagonsim. So, Zyprexa might present a reasonable altertnative in reducing cortisol levels for people who can't get over the anti-histaminic effects of Remeron.
I only have personal experience with Zyprexa. So far, it seems to have mitigated a fair chunk of my free-floating anxiety that was the residual from a prolonged period of stress.
Just a thought,
cache-monkey
Posted by SLS on June 29, 2005, at 6:28:35
In reply to Anti-Cortisol Therapy: Remeron ... or Zyprexa?? » Elroy, posted by cache-monkey on June 29, 2005, at 0:34:17
For those people living in the UK, there is an antiglucocorticoid named metyrapone that is used to treat Cushings Syndrome and other hypercortisolemic conditions. I believe metyrapone is also available in Canada. I hope someone can check on this.
Unfortunately, in the US, metyrapone is used only as a test for diagnostic purposes. It helps to differentiate the status of the adrenal glands versus the status of the HPA axis.
Ketoconazole is a cortisol synthesis inhibitor that might be of use for some people.
- Scott
Posted by Elroy on June 29, 2005, at 18:47:03
In reply to Anti-Cortisol Therapy: Remeron ... or Zyprexa?? » Elroy, posted by cache-monkey on June 29, 2005, at 0:34:17
Interesting article.
My primary reason for taking Remeron is for its cortisol-lowering effect. It was actually prescribed by my PCP / GP for that purpose rather than my psych doc (though she did agree with the prescription).
My primary problem (as far as mental / emotional disorder) consists of anxiety apparently induced by highly elevated cortisol which appears to have been induced by a malfunction of the HPA Axis. This has been born out by a daignosis of Pseudo Cushings by attending endo. Anyway, that led to the PCP's belief that possibly using Remeron will bring the cortisol levels down and permit the HPA Axis to "re-set". (I do have some degree of depression, but it came along over the last few months - this all just started over the last couple of years - and is a depression based on what's going on with my medical condtion versus a general depression)
Are you aware of any studies or trials using Zyprexa that showed a cortisol-lowering effect?
Thanks.
Elroy
X
X
X
X> Hi Elroy,
>
> I've been reading your posts on cortisol with great interest. Thanks for posting all the useful information.
>
> In some of the links you posted on Remeron as effective cortisol therapy, the authors attribute this to its 5-HT2 blockade. Remeron is known for its 5-HT2a antagonism, but less well known is that it also blocks the 5-HT2c receptors almost as hard [1]. This is a lot like Zyprexa at low doses, although with Z you also get the D-2 antagonsim. So, Zyprexa might present a reasonable altertnative in reducing cortisol levels for people who can't get over the anti-histaminic effects of Remeron.
>
> I only have personal experience with Zyprexa. So far, it seems to have mitigated a fair chunk of my free-floating anxiety that was the residual from a prolonged period of stress.
>
> Just a thought,
> cache-monkey
>
> [1] http://www.preskorn.com/columns/0003.html
>
Posted by Elroy on June 29, 2005, at 18:54:46
In reply to Anti-Cortisol Therapy: metyrapone and ketoconazole, posted by SLS on June 29, 2005, at 6:28:35
Am aware of ketoconazole but endo is highly against prescribing it due to adverse side effects.
I believe that the key will end up being the drug RU486 but (even though it's been "fast tracked" by the FDA) it's approval progress has been moving very slowly.
With RU486 the protocol is a very short-term regimen (studies I've seen have been in the four to seven day range). Cortisol lowered, HPA Axis re-set and anxiety / depression problems either resolved or (if especially resistant) now quickly respond to standard treatments.
Elroy
X
X
X> For those people living in the UK, there is an antiglucocorticoid named metyrapone that is used to treat Cushings Syndrome and other hypercortisolemic conditions. I believe metyrapone is also available in Canada. I hope someone can check on this.
>
> Unfortunately, in the US, metyrapone is used only as a test for diagnostic purposes. It helps to differentiate the status of the adrenal glands versus the status of the HPA axis.
>
> Ketoconazole is a cortisol synthesis inhibitor that might be of use for some people.
>
>
> - Scott
Posted by SLS on June 29, 2005, at 19:32:56
In reply to Re: Anti-Cortisol Therapy: metyrapone and ketocona » SLS, posted by Elroy on June 29, 2005, at 18:54:46
One of my concerns with the mifepristone 8-day protocol is that it will not have a persistent effect for someone like me (severe and chronic). I would anticipate needing several courses of treatments per year for the first several years. Even a compassionate use IND for mifepristone only allows two treatments per year.
> or (if especially resistant) now quickly respond to standard treatments.
Where did you gather this information from?
- Scott
Posted by Elroy on June 29, 2005, at 23:33:12
In reply to Re: Anti-Cortisol Therapy: metyrapone and ketocona » Elroy, posted by SLS on June 29, 2005, at 19:32:56
Kind of late now.
Will get some links (of studies) together and send them out tomorrow.
Off the top of my head, I thought I recalled reading (at least in one study) where remission rates were still showing as excellent several months later.
BTW, do you have highly elevated cortisol levels? I don't believe that the RU486 therapy is a generalized treatment protocol, but specifically for people with highly elevated cortisol (which is driving the anxiety and / or depression) that exists due to a dysfunctional HPA Axis.
Elroy
X
X
X> One of my concerns with the mifepristone 8-day protocol is that it will not have a persistent effect for someone like me (severe and chronic). I would anticipate needing several courses of treatments per year for the first several years. Even a compassionate use IND for mifepristone only allows two treatments per year.
>
> > or (if especially resistant) now quickly respond to standard treatments.
>
> Where did you gather this information from?
>
>
> - Scott
Posted by Elroy on June 30, 2005, at 21:48:39
In reply to Re: Anti-Cortisol Therapy: metyrapone and ketocona » SLS, posted by Elroy on June 29, 2005, at 23:33:12
Various links, no particular order, just from saved bookmarks.... maybe a slight chronological order....
http://www.nap.edu/books/0309049490/html/229.html
http://archfami.ama-assn.org/cgi/content/full/7/3/219
http://www.acnp.org/G4/GN401000096/CH094.html
http://www.psychosomaticmedicine.org/cgi/content/full/61/5/698
http://www.alfredsapsemd.com/91.htm
http://news.bbc.co.uk/1/hi/health/2309279.stm
http://www.psycport.com/showArticle.cfm?xmlFile=comtex_2002_08_01_bw_0000-1640-ca-stanford-medical.xml&provider=Business+Wire
http://www.psychiatrictimes.com/p040592.html
http://www.modern-psychiatry.com/many_more.htm
http://www.ncl.ac.uk/nnp/research/publication/18411
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11593077&dopt=Abstract
http://www.healthyplace.com/communities/depression/psychotic_ru486.asp
http://news-service.stanford.edu/news/2000/november8/ru486-1108.html
http://clinicaltrials.gov/show/NCT00048269 (this one endedlast year... would like to know what results were)
http://www2.eclinicalpsychiatrynews.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=aqc04032616
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11593077&dopt=Abstract
http://clinicaltrials.gov/show/NCT00048269
http://clinicaltrials.gov/ct/gui/show/NCT00043654;jsessionid=955F33A66FD69427D72FD64A1EC3325B?amp%3Border=1
(have now included bi-polar in the mix... it's my belief that intend on testing each type of disorder that has elevated cortisol levels)Elroy
X
X
X
X> Kind of late now.
>
> Will get some links (of studies) together and send them out tomorrow.
>
> Off the top of my head, I thought I recalled reading (at least in one study) where remission rates were still showing as excellent several months later.
>
> BTW, do you have highly elevated cortisol levels? I don't believe that the RU486 therapy is a generalized treatment protocol, but specifically for people with highly elevated cortisol (which is driving the anxiety and / or depression) that exists due to a dysfunctional HPA Axis.
>
> Elroy
> X
> X
> X
>
> > One of my concerns with the mifepristone 8-day protocol is that it will not have a persistent effect for someone like me (severe and chronic). I would anticipate needing several courses of treatments per year for the first several years. Even a compassionate use IND for mifepristone only allows two treatments per year.
> >
> > > or (if especially resistant) now quickly respond to standard treatments.
> >
> > Where did you gather this information from?
> >
> >
> > - Scott
>
>
Posted by SLS on July 1, 2005, at 7:26:13
In reply to Re: Anti-Cortisol Therapy: RU486 Information » Elroy, posted by Elroy on June 30, 2005, at 21:48:39
Thank you so much for taking the time to put this list together.
Be well.
- Scott
Posted by Elroy on July 1, 2005, at 16:31:24
In reply to Re: Anti-Cortisol Therapy: RU486 Information » Elroy, posted by SLS on July 1, 2005, at 7:26:13
You're welcome.
I have my next round of cortisol testing done in about three weeks. That means that I will have been on the Remeron for about six weeks when the cortisol testing is done. I am, of course, hoping that the testing is going to show that the cortisol levels have come down significantly.
Following that my hope is that the lowered cortisol will in fact allow the HPA Axis to "re-set" and allow normal cortisol secretions to resume.
And of course following that is the hope that both the severe anxiety and various physical symptoms associated with this will start going away and medications can gradually be eliminated!
We will see.
Elroy
P.S. I was started out on 15mg of Remeron and then, after two weeks moved to 30mg. Only side effect I had was extreme sedation at 15mg level and some remaining sedation SE at 30mg. I am going to talk to p doc next week about raising dosage to 45 mg or 60 mg to see if that SE then goes away.
X
X
X
> Thank you so much for taking the time to put this list together.
>
> Be well.
>
>
> - Scott
Posted by 4WD on July 1, 2005, at 21:28:36
In reply to Re: Anti-Cortisol Therapy: RU486 Information » SLS, posted by Elroy on July 1, 2005, at 16:31:24
> You're welcome.
>
> I have my next round of cortisol testing done in about three weeks. That means that I will have been on the Remeron for about six weeks when the cortisol testing is done. I am, of course, hoping that the testing is going to show that the cortisol levels have come down significantly.
>
> Following that my hope is that the lowered cortisol will in fact allow the HPA Axis to "re-set" and allow normal cortisol secretions to resume.
>
> And of course following that is the hope that both the severe anxiety and various physical symptoms associated with this will start going away and medications can gradually be eliminated!
>
> We will see.
>
> Elroy
>
> P.S. I was started out on 15mg of Remeron and then, after two weeks moved to 30mg. Only side effect I had was extreme sedation at 15mg level and some remaining sedation SE at 30mg. I am going to talk to p doc next week about raising dosage to 45 mg or 60 mg to see if that SE then goes away.
I have my test next WEdnesday where I take dexamethasone for two days then go in and get a hep lock and have blood drawn for a couple hours. I gather this is to determine if my pituitary tumor is active. I know it's also to rule out Cushings which I know already I don't have.Marsha
Posted by Elroy on July 1, 2005, at 21:49:03
In reply to Re: Anti-Cortisol Therapy: RU486 Information, posted by 4WD on July 1, 2005, at 21:28:36
Yes, this sounds like a combination DEX/CRH Test. I have had it done twice,
You indicate that you know that you don't have Cushing's? How is that?
I'm lost somewhere. I take it that you do have elevated cortisol levels. And that you do have a pituitary tumor.
This particular test is designed to test whether you are suppressing cortisol production when put thru this particular protocol, so I'm assuming that you do have elevated cortisol levels???
Of course, in all of my testing that they did, they found that I have a tumor in my left adrenal gland... and at first thought "aha!" But then more testing showed that it wasn't doing anything with the excessivee cortisol secretion, so maybe same is true with your pit tumor.
I have found - through dealing with a number of advanced specialists - that the Late Night Salivary Cortisol test is pretty much the most accurate test to rule out "real" Cushings versus Pseudo Cushings (the latter not meaning that you have "fake" Cushings, it's highly elevated cortisol either way!).
Elroy
X
X
X
>
>
> I have my test next WEdnesday where I take dexamethasone for two days then go in and get a hep lock and have blood drawn for a couple hours. I gather this is to determine if my pituitary tumor is active. I know it's also to rule out Cushings which I know already I don't have.
>
> Marsha
Posted by 4WD on July 1, 2005, at 22:28:57
In reply to Re: Anti-Cortisol Therapy: RU486 Information » 4WD, posted by Elroy on July 1, 2005, at 21:49:03
> Yes, this sounds like a combination DEX/CRH Test. I have had it done twice,
>
> You indicate that you know that you don't have Cushing's? How is that?
>
> I'm lost somewhere. I take it that you do have elevated cortisol levels. And that you do have a pituitary tumor.
>
> This particular test is designed to test whether you are suppressing cortisol production when put thru this particular protocol, so I'm assuming that you do have elevated cortisol levels???
>
> Of course, in all of my testing that they did, they found that I have a tumor in my left adrenal gland... and at first thought "aha!" But then more testing showed that it wasn't doing anything with the excessivee cortisol secretion, so maybe same is true with your pit tumor.
>
> I have found - through dealing with a number of advanced specialists - that the Late Night Salivary Cortisol test is pretty much the most accurate test to rule out "real" Cushings versus Pseudo Cushings (the latter not meaning that you have "fake" Cushings, it's highly elevated cortisol either way!).
>
> Elroy
> X
> X
> X
Yes, I have elevated cortisol levels. Ref range 20-90, my value 174. I have depression and anxiety (was actually terror for a while). The pit tumor is a microadenoma 5-6mm.I'm sure I don't have Cushings because I have no symptoms or features except for the elevated cortisol.
I don't know what it "means" if I do suppress cortisol during this procedure. Do you? Did you suppress during this test? What's the significance of suppression/nonsuppression?
I'm following all your posts re elevated cortisol because I feel, as you do, that the elevated cortisol level is in itself causing some of my symptoms. I plan to ask the endoc his recommendation for blocking or lowering cortisol levels regardless of the results of the test. I know elevated cortisol causes damage to the body over time.
I'm not real hopeful he's going to suggest supplements but I intend to start Relacore and Holy Basil after the test regardless.
Good luck with the Remeron.
Marsha
Posted by Elroy on July 2, 2005, at 22:39:18
In reply to Re: Anti-Cortisol Therapy: RU486 Information » Elroy, posted by 4WD on July 1, 2005, at 22:28:57
Please make sure that he does the appropriate tests for Cushings. It would be highly unusual to have elevated cortisol levels (basically double max levels) and a pit tumor and NOT be Cushings.
You cannot ( I repeat can NOT) go by the "normal, routine symptoms" (high obesity, moonface, etc, etc.) to determine if you have Cushings. A cousin of mine (my mother's uncle) had Cushings for years and didn't develop those tell-tale physical symptoms until like the last 18 months! And you say that you have depression and anxiety (was actually terror for a while)... well, those are also symptoms of Cushing's (BTW, Pseudo Cushings is also a form of Cushing's... instead of some tumor causing the elevated cortisol, it's youir body's own malfunctioning HPA Axis that is creating the excess cortisol secretion).
Yes, I know I have a similar situation with elevated levels (anywhere from 1.5 to six times normal max) and also have an adrenal gland tumor and am Pseudo Cushings, but I am the definite exception to the rule.
If you do NOT suppress then (if my memory serves me right), you have Cushings. If you do suppress strongly, then you "probably" don't. Yes, I suppressed (result came back as something like a 1.2 and anything under a 5 was considered a strong suppression).
I would push the doctor to also run 2 - 3 Late Night Salviary Cortisol Tests. Spread out over a week. If those come back with elevated levels then you definitely have "regular" Cushing's.
As to supplements, I would say "good luck". I went on very strong and aggressive OTC supplements of all kinds for two months and got my levels down to low 100s (118?). My labs range was 20 - 100. I stayed on those supplements for another 2 1/2 months and then stopped two weeks before the next test. I was in the high 240s. So in other words the supps (and I was doing mega doses of multiple supps, relora, holy basil, PS, etc.) couldn't even get me down into the normal range... and I shot right back up as soon as I stopped for even just two weeks.
And that's why I'm trying Remeron... and that's why I'm going to try to get an RU486 therapy protocol (if this Remeron doesn't do the trick) just as soon as one possibly could....
Elroy
P.S. Have you visited these links:
http://wideberthasmessageboard.com/forumdisplay.php?f=41
(may have to register and log in on 2nd one)
X
X
X>
> Yes, I have elevated cortisol levels. Ref range 20-90, my value 174. I have depression and anxiety (was actually terror for a while). The pit tumor is a microadenoma 5-6mm.
>
> I'm sure I don't have Cushings because I have no symptoms or features except for the elevated cortisol.
>
> I don't know what it "means" if I do suppress cortisol during this procedure. Do you? Did you suppress during this test? What's the significance of suppression/nonsuppression?
>
> I'm following all your posts re elevated cortisol because I feel, as you do, that the elevated cortisol level is in itself causing some of my symptoms. I plan to ask the endoc his recommendation for blocking or lowering cortisol levels regardless of the results of the test. I know elevated cortisol causes damage to the body over time.
>
> I'm not real hopeful he's going to suggest supplements but I intend to start Relacore and Holy Basil after the test regardless.
>
> Good luck with the Remeron.
>
> Marsha
>
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