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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by paul9 on March 31, 2009, at 23:49:50
is anyone now being treated or has anyone in the past been treated for depression with hydrocortisone either by itself or along with anti-depressants?
i've been treated for depression of years because of physical symptoms that could not be diagnosed. anti-depressants have either not been effective or have had only limited effects.
recently i discovered that all my symptoms can be explained by low adrenal function but the tests i had years ago were deemed to be "normal."my pdoc doesn't feel "comfortable" prescribing hydrocortisone. i'm wondering if it is being used by others and if it is effective.
Posted by Zana on April 1, 2009, at 12:04:24
In reply to hydrocortisone, posted by paul9 on March 31, 2009, at 23:49:50
Is this a problem for your primary care doc?
Zana
Posted by Phillipa on April 1, 2009, at 12:48:37
In reply to Re: hydrocortisone, posted by Zana on April 1, 2009, at 12:04:24
An endocrinologist can test your cortisol levels and see where you stand on the adrenals. Hydorocortisone is a very serious med. Love Phillipa an expert docs should be consulted
Posted by bleauberry on April 1, 2009, at 17:10:42
In reply to hydrocortisone, posted by paul9 on March 31, 2009, at 23:49:50
Hypoadrenalism is almost universal with amalgam illness patients and I believe it is rampant in today's fast paced lousy diet stressed world, and I believe it is highly underrecognized in the psychiatry world. I have hypoadrenalism, have studied it deeply, have taken all sorts of treatments, have hung out at forums specializing on the topic, and would be happy to share with you.
The general assumption is that depression is related to high cortisol, and that antidepressants bring those high levels back to normal. What I believe they miss is that yes, while high cortisol is in the early stages of disease, it then enters a later stage where the glands are exhausted. Symptoms of high cortisol and low cortisol are very much the same...depression and anxiety being common in both.
A female singer in my band has been on all the ssris and xanax, with not much help on her anxiety or panic attacks. One day it dawned on me, looking at how skinny she was (common in hypoadrenalism) that maybe she had low cortisol. Without even testing for it, her doctor gave her the ok to try adrenal cortex extract. This weekend for the first time ever in her life she had no anxiety or panic before a show, she said she felt free and had fun. The ground-up adrenal glands of a cow did what powerful meds couldn't. It is just low cortisol, not the neurotransmitters themselves, at fault. Cortisol orchestrates the neurotransmitters.
I had strange reactions to the common things. Herbs are basically useless. If someone wants to give you herbs, don't even bother with that road. The best first step is adrenal cortex extract. I actually felt worse on it, more depressed, more tired. For some of us, the best and only thing is cortisol itself...hydrocortisone. The typical dose to restore normal phsyiological levels is 1.25mg-20mg. Any higher than 20mg risks shutting down the adrenal glands further. You just want to replace with the bare minimum dose possible what is missing, and no more.
Benefits I felt from just 2.5mg hydrocortisone, after starting at 1.25mg for a week, were: good sleep, total elimination of the morning panic weirdness that I woke up to, and calm/peace/serenity during the day even under stress. It did not help my fatigue, but it did massively increase my endurance...instead of stopping exhausted after 15 minutes of slowly chopping firewood, I could go for 3 hours. After two weeks I had the most pronounced depression-free day I ever imagined. Nothing short of a miracle. It did what no medicine ever came close to doing.
I had to stop because of the fear it would weaken my immune system. I have Lyme disease. I think that fear is totally ridiculous and am seeking hydrocortisone again. High doses risky, yes, low doses, no. My opinion.
If you go to an Endocronologist or GP you will get a worthless test. They will test your blood cortisol one time, or give a drug to see if your glands work. Basically, are your adrenal glands alive or dead? But...no indication of whether they are functioning strong or weak.
The best test is a saliva cortisol test in which you spit into 4 different test tubes throughout a 24 hour period so as to plot your cortisol curve on a graph and see what it does throughout the daily/nightly pattern. This test is very common among alternative MDs, integrative MDs, and naturopaths. GPS probably not. They are stuck in the old school. The test is called the Adrenal Stress Index.
So do I think hydrocortisone is worth taking a look at with or without drugs? Definitely a resounding yes in my opinion. But it is very important to get the test first so you know where you are starting from. You do not want to be taking hydrocortisone if your cortisol levels are following the normal curve. You only want it if your levels are below that curve.
When you read about adrenal fatigue and you see how the symptoms fit, it is almost like a lightbulb going off in your head. You know yourself better than anyone. Call the appropriate clinician in your area to get the saliva test. Getting hydrocortisone itself isn't that easy usually because most doctors are not well educated on it. I had to go through all the herbs and extracts first...playing the game sort of...in order to get my doctor to the point where he said ok let's try it. Glad he did. It was awesome.
If your doc will consider prescribing it, but is uncomfortable, that's ok. Get the test. That way he and you will not be shooting blindly. Also, be sure to remind him these are very low doses, only physiological replacement doses, not enough to cause the risks of HC at higher doses used to treat other diseases.
> is anyone now being treated or has anyone in the past been treated for depression with hydrocortisone either by itself or along with anti-depressants?
>
> i've been treated for depression of years because of physical symptoms that could not be diagnosed. anti-depressants have either not been effective or have had only limited effects.
>
> recently i discovered that all my symptoms can be explained by low adrenal function but the tests i had years ago were deemed to be "normal."
>
> my pdoc doesn't feel "comfortable" prescribing hydrocortisone. i'm wondering if it is being used by others and if it is effective.
>
>
>
Posted by bleauberry on April 1, 2009, at 17:23:29
In reply to Re: hydrocortisone » Zana, posted by Phillipa on April 1, 2009, at 12:48:37
> An endocrinologist can test your cortisol levels and see where you stand on the adrenals. Hydorocortisone is a very serious med. Love Phillipa an expert docs should be consulted
Look, I really like Phillipa, ok? But the above comments are very much stuck in the old school.
Can an endo accurately test your cortisol? Not unless they test it 4 times during the same day and compare the results to the daily curve of normal healthy people. You could easily have adrenal fatigue, and yet have an Endo tell you your test was normal (they use a very broad range for so-called normal), not to mention that single blood test was supposed to somehow represent what your adrenals are doing 6 hours later, 10 hours later, at night, at morning, etc? Insane. Just the normal apprehension and nervousness of the appointment and drawing blood is enough to raise your cortisol levels temporarily into the normal range from low. Only to crash hard later.
Hydrocortisone is indeed a very serious med...at the wrong doses. That's how it got that reputation and misunderstanding. Yout gotta understand that for diseases treated with hydrocortisone, they use very large doses. Many dangers go along with that. It is treacherous at high doses.
For adrenal fatigue, we are talking miniscule doses in comparison to all that. We are talking about replacing what the body is missing, bringing the cortisol up to normal from low, and that's it. No more. Nothing extra. No disease treatment. No anti-inflammatory. Nothing. Nada. Just replace what's missing. That falls within 1.25mg-20mg. It is also in the medical textbooks as being common and safe at those doses.
Posted by paul9 on April 1, 2009, at 20:50:31
In reply to Re: hydrocortisone, posted by Zana on April 1, 2009, at 12:04:24
> Is this a problem for your primary care doc?
> Zana
>
no, he's my psychiatrist and has treated me for a long time.paul
Posted by Phillipa on April 1, 2009, at 21:43:13
In reply to Re: hydrocortisone followup, posted by bleauberry on April 1, 2009, at 17:23:29
If your mother died when you were l7 from hydrocortisone I really don't think you'd like it either. I've taken it when bleeding and pregnant as the doc gave it to me in a box in his office. And didn't say what it was. If I'd known wouldn't have taken it especially pregnant. That's me and my opinion only for me. I do have the right to decide what's right for me. I'm now seeing a bioidentical hormone doc as took in past but without personalized testing. Tomorrow morning I take the first drop of tincture of iodine as he feels it helps thyroid function. I've always gone the alternative route with exception of benzos. Shaklee vitamins were Great never felt better. Phillipa
Posted by paul9 on April 1, 2009, at 21:47:42
In reply to Re: hydrocortisone » paul9, posted by bleauberry on April 1, 2009, at 17:10:42
> Hypoadrenalism is almost universal with amalgam illness patients and I believe it is rampant in today's fast paced lousy diet stressed world, and I believe it is highly underrecognized in the psychiatry world. I have hypoadrenalism, have studied it deeply, have taken all sorts of treatments, have hung out at forums specializing on the topic, and would be happy to share with you.
>
> The general assumption is that depression is related to high cortisol, and that antidepressants bring those high levels back to normal. What I believe they miss is that yes, while high cortisol is in the early stages of disease, it then enters a later stage where the glands are exhausted. Symptoms of high cortisol and low cortisol are very much the same...depression and anxiety being common in both.
>
> A female singer in my band has been on all the ssris and xanax, with not much help on her anxiety or panic attacks. One day it dawned on me, looking at how skinny she was (common in hypoadrenalism) that maybe she had low cortisol. Without even testing for it, her doctor gave her the ok to try adrenal cortex extract. This weekend for the first time ever in her life she had no anxiety or panic before a show, she said she felt free and had fun. The ground-up adrenal glands of a cow did what powerful meds couldn't. It is just low cortisol, not the neurotransmitters themselves, at fault. Cortisol orchestrates the neurotransmitters.
>
> I had strange reactions to the common things. Herbs are basically useless. If someone wants to give you herbs, don't even bother with that road. The best first step is adrenal cortex extract. I actually felt worse on it, more depressed, more tired. For some of us, the best and only thing is cortisol itself...hydrocortisone. The typical dose to restore normal phsyiological levels is 1.25mg-20mg. Any higher than 20mg risks shutting down the adrenal glands further. You just want to replace with the bare minimum dose possible what is missing, and no more.
>
> Benefits I felt from just 2.5mg hydrocortisone, after starting at 1.25mg for a week, were: good sleep, total elimination of the morning panic weirdness that I woke up to, and calm/peace/serenity during the day even under stress. It did not help my fatigue, but it did massively increase my endurance...instead of stopping exhausted after 15 minutes of slowly chopping firewood, I could go for 3 hours. After two weeks I had the most pronounced depression-free day I ever imagined. Nothing short of a miracle. It did what no medicine ever came close to doing.
>
> I had to stop because of the fear it would weaken my immune system. I have Lyme disease. I think that fear is totally ridiculous and am seeking hydrocortisone again. High doses risky, yes, low doses, no. My opinion.
>
> If you go to an Endocronologist or GP you will get a worthless test. They will test your blood cortisol one time, or give a drug to see if your glands work. Basically, are your adrenal glands alive or dead? But...no indication of whether they are functioning strong or weak.
>
> The best test is a saliva cortisol test in which you spit into 4 different test tubes throughout a 24 hour period so as to plot your cortisol curve on a graph and see what it does throughout the daily/nightly pattern. This test is very common among alternative MDs, integrative MDs, and naturopaths. GPS probably not. They are stuck in the old school. The test is called the Adrenal Stress Index.
>
> So do I think hydrocortisone is worth taking a look at with or without drugs? Definitely a resounding yes in my opinion. But it is very important to get the test first so you know where you are starting from. You do not want to be taking hydrocortisone if your cortisol levels are following the normal curve. You only want it if your levels are below that curve.
>
> When you read about adrenal fatigue and you see how the symptoms fit, it is almost like a lightbulb going off in your head. You know yourself better than anyone. Call the appropriate clinician in your area to get the saliva test. Getting hydrocortisone itself isn't that easy usually because most doctors are not well educated on it. I had to go through all the herbs and extracts first...playing the game sort of...in order to get my doctor to the point where he said ok let's try it. Glad he did. It was awesome.
>
> If your doc will consider prescribing it, but is uncomfortable, that's ok. Get the test. That way he and you will not be shooting blindly. Also, be sure to remind him these are very low doses, only physiological replacement doses, not enough to cause the risks of HC at higher doses used to treat other diseases.i made the rounds to many drs in many specialties years ago and each time was told my test results were normal. i finally gave up and started seeing a psychiatrist. emotionally i can't face going through dr after dr again until i find one who is willing to treat someone for hypoadrenlism when their test results fall within the normal reference ranges. nor do i have the energy to begin a long search for an alternative dr who might treat me.
the studies i've seen where cortisol, hydrocortisone or prednisone were used to treat depression or chronic fatigue syndrome were carried out by researchers in psychiatric-related fields, not by endocrinoogists. i'd like to have a psychiatrist treat me and not have to go through a deadend series of drs in other specialities who are not are aware of or do not agree with the findings of recent research. i think most endocrinologists will not treat someone for adrenal insufficiency whose test results fall within normal ranges.
i wrote to this forum to find out if others were being treated with hydrocortisone to get an idea of whether or not this treatment is being accepted and used by psychiatrists and to find out if it was successful. also to perhaps get a lead on a dr who might treat me. i want a short road to feeling better. i've already taken the long road and i just don't have the "resources" to begin again.
paul
Posted by Phillipa on April 1, 2009, at 22:02:15
In reply to Re: hydrocortisone, posted by paul9 on April 1, 2009, at 21:47:42
Paul did the same and tested by two endos both said within normal also. Love Phillipa. It's so frustrating to go from doc to doc. I've done it too many times myself.
Posted by Garnet71 on April 1, 2009, at 22:21:58
In reply to hydrocortisone, posted by paul9 on March 31, 2009, at 23:49:50
there's a 24 hour cortisol urine test that endocronologists prescribe
Posted by Larry Hoover on April 1, 2009, at 22:46:27
In reply to Re: hydrocortisone » paul9, posted by Garnet71 on April 1, 2009, at 22:21:58
> there's a 24 hour cortisol urine test that endocronologists prescribe
The problem with that test is that it doesn't measure the diurnal variation in cortisol levels. It can't distinguish people with normal total output, but with reversed phase, or those with no diurnal cycling at all. Nor the effect of stressors during the day, which can skew the results.
I don't have faith in those who would try to interpret a daily total cortisol output, when the pattern of output is of diagnostic importance also.
Lar
Posted by bleauberry on April 2, 2009, at 4:20:01
In reply to Re: hydrocortisone followup » bleauberry, posted by Phillipa on April 1, 2009, at 21:43:13
I understsand what you are saying and agree with you, though I've never heard or read of hydrocortisone alone being a causative factor of death. Had to be other complications shw was being treated for.
You did not mention the doses she was given. You did not mention the doses you took. I think people are reading too fast and missing the point...adrenal fatigue is treated with very small low doses...not even enough to raise cortisol levels beyond normal. Normal cortisol levels don't kill people or pose risk. Cortisol levels below normal cause significant risks in terms of psychiatric and biochemical dysfunctions.
If you are doing natural hormone therapy, you might want to take a close look at adrenal cortex extract, as you said in the past your symptoms fit adrenal fatigue perfectly. A friend of mine with years and years of failures to treat her anxiety and panic is doing great with the little bit of adrenal boost she gets from it...no more anxiety, no more panic, no more stage fright, no more need for xanax. And it only took one week to get that kind of result.
> If your mother died when you were l7 from hydrocortisone I really don't think you'd like it either. I've taken it when bleeding and pregnant as the doc gave it to me in a box in his office. And didn't say what it was. If I'd known wouldn't have taken it especially pregnant. That's me and my opinion only for me. I do have the right to decide what's right for me. I'm now seeing a bioidentical hormone doc as took in past but without personalized testing. Tomorrow morning I take the first drop of tincture of iodine as he feels it helps thyroid function. I've always gone the alternative route with exception of benzos. Shaklee vitamins were Great never felt better. Phillipa
Posted by bleauberry on April 2, 2009, at 4:32:35
In reply to Re: hydrocortisone, posted by paul9 on April 1, 2009, at 21:47:42
It is so frustrating to be given inappropriate tests a condition. Without measuring the entire daily curve of cortisol, any other test is inappropriate.
Me for example. My cortisol is extremely low 18 hours in a day. But from 10pm to 6am it spikes so high it almost goes off the chart. Between 6am and 10am it is falling rapidly, passing through the normal range on its way down. You can see what dramatic differences one might get in a single cortisol test. In a 24 urine test, my results would balance out to appear in the normal range, though in fact my cortisol is extremely whacked out crazy.
Having a spike like I do is another form of adrenal fatigue. There is a time of day, at rest for me, when the adrenals make an attempt to recover. They go too far, out of control, and basically blow their wad for the rest of the day, over and over every single day. It is a relentless cycle that for me is normalized rapidly with a mere 1.25mg HC during mid morning. That somehow influences the entire feedback mechanism. With the adrenals not needing to try to catch up at night because daily levels are now normal, there is no spike. No lows due to the dose, and no spike due to the dose. It's quite fascinating actually.
One word on "normal" range. These ranges are extremely broad and apply to healthy individuals. We don't fit that. Our normal ranges are much less broad, because we are not healthy. Our ranges need to be more specific, more individualized, or the word I'm looking for is..."optimal", which is different for each person. It is kind of like in hypothyroid...someone can test in the middle or the low end of normal, and yet have severe symptoms of hypothyroid that respond well to thyroid meds.
Symptoms tell the story more than numbers.
Posted by bleauberry on April 2, 2009, at 4:41:55
In reply to Re: hydrocortisone » Garnet71, posted by Larry Hoover on April 1, 2009, at 22:46:27
This is extremely, repeat, extremely, important! The pattern of the cortisol output is as much, or more important, as the actual cortisol output. It gives a much better picture of what is going on. Thank you Lar.
> > there's a 24 hour cortisol urine test that endocronologists prescribe
>
> The problem with that test is that it doesn't measure the diurnal variation in cortisol levels. It can't distinguish people with normal total output, but with reversed phase, or those with no diurnal cycling at all. Nor the effect of stressors during the day, which can skew the results.
>
> I don't have faith in those who would try to interpret a daily total cortisol output, when the pattern of output is of diagnostic importance also.
>
> Lar
>
>
Posted by garnet71 on April 2, 2009, at 8:21:01
In reply to Re: hydrocortisone » Garnet71, posted by Larry Hoover on April 1, 2009, at 22:46:27
Thanks, Larry, what you and Blueaberry said makes a lot of sense.
I guess i just don't get it why doctors go through years of education an training, yet,, prescribe useless tests. There is either something we don't know as non-doctors...or sometimes I think doctors are trained only to treat the most common conditions in their speciality and don't read enough current research to grasp the dynamics of other conditions.
Oh I guess I could blame it on the medical industrial complex..that has worked for me in the past. lol
Posted by desolationrower on April 2, 2009, at 8:22:42
In reply to hydrocortisone, posted by paul9 on March 31, 2009, at 23:49:50
most likely insufficient adrenal output is because of atypical depression, lowered crh/acth, hypersensitve glucocorticoid receptors. normalizing catecholamines with a stimulant will normalize things long-term, and fix symptoms directly. MAOIs work too.
-d/r
Posted by desolationrower on April 2, 2009, at 8:25:18
In reply to Re: hydrocortisone » Larry Hoover, posted by garnet71 on April 2, 2009, at 8:21:01
> Thanks, Larry, what you and Blueaberry said makes a lot of sense.
>
> I guess i just don't get it why doctors go through years of education an training, yet,, prescribe useless tests. There is either something we don't know as non-doctors...or sometimes I think doctors are trained only to treat the most common conditions in their speciality and don't read enough current research to grasp the dynamics of other conditions.
>
> Oh I guess I could blame it on the medical industrial complex..that has worked for me in the past. lolmedicine is very conservative. you learn how to do things from your teachers, and then keep doing what has 'worked'. you don't do things because your theoretical model says you should. More religion than science (i mean in method, not subject).
-d/r
Posted by rotem on April 2, 2009, at 15:20:14
In reply to hydrocortisone, posted by paul9 on March 31, 2009, at 23:49:50
and low blood pressure.
Posted by Phillipa on April 2, 2009, at 19:14:19
In reply to Re: hydrocortisone followup » Phillipa, posted by bleauberry on April 2, 2009, at 4:20:01
BB no idea the doses as was just a kid when she started on it for psoriasis which covered whole body. The corisone caused Addison's disease and many crises she was hopitalized for and given ACTH. That's all I know. Love Phillipa
Posted by paul9 on April 2, 2009, at 22:18:13
In reply to easier fix, posted by desolationrower on April 2, 2009, at 8:22:42
> most likely insufficient adrenal output is because of atypical depression, lowered crh/acth, hypersensitve glucocorticoid receptors. normalizing catecholamines with a stimulant will normalize things long-term, and fix symptoms directly. MAOIs work too.
>
> -d/rmy depression is the atypical subtype and adderall was the first drug that made me feel "normal" in eons. i really had forgotten how it felt to have strength, energy, motivation, an iq above 80, to eat normally and to be fully relaxed (not having to struggle every day). unfortunately i developed tolerance which ended that episode but did lead me to start reading and finally understand the root of my symptoms. but i don't think stimulants are a long term solution. at least with adderall all it really does is elicit what is pretty much a "fight or flight response." i've read that maois are more effective treating atypical depression but when i tried them in the past they just made me feel sick as hell.
paul
Posted by DanielJ on April 3, 2009, at 9:08:19
In reply to Re: hydrocortisone » Zana, posted by Phillipa on April 1, 2009, at 12:48:37
A friend of ours has a son who is about 38 years
old. After beeing treated for a physical condition
with Hydrocortisone for a short time, he had a
psychotic break with serious symptoms like
mental confusion, hallucinations and delusions.
He was hospitalised for a week and after extended
testing, the cause of the psychosis was determined to
be the Hydrocortisone. After discontinuing the drug
for a few days his symptoms disappeared.
Posted by Larry Hoover on April 3, 2009, at 9:53:39
In reply to Re: hydrocortisone, posted by DanielJ on April 3, 2009, at 9:08:19
> A friend of ours has a son who is about 38 years
> old. After beeing treated for a physical condition
> with Hydrocortisone for a short time, he had a
> psychotic break with serious symptoms like
> mental confusion, hallucinations and delusions.
> He was hospitalised for a week and after extended
> testing, the cause of the psychosis was determined to
> be the Hydrocortisone. After discontinuing the drug
> for a few days his symptoms disappeared.I'm sorry to hear about that. It is, however, a known risk. One of the reasons for the hospitalization and testing is to determine if something else was going on. They had to rule out other causes, and that takes a little while. Meanwhile, discontinuation of the hydrocortisone, along with remission of symptoms, would provide a presumptive case for cause and effect.
Lar
Posted by bleauberry on April 3, 2009, at 16:27:30
In reply to Re: hydrocortisone, posted by DanielJ on April 3, 2009, at 9:08:19
Without knowing any more than you told, I dare say the reason he was being treated with HC was for some other reason than hypoadrenalism, and that his dose was in excess of 20mg per day?
In the horror stories of HC, nobody states what the dose was or the reason it was given.
I could be wrong in my assumption.
Even at safe low doses that are merely intended to replace what the body is not producing, it is very wise to approach HC with slow titration. By slow I mean increasing the dose no faster than once every two weeks. Even people who are diagnosed with very low cortisol and take small amounts of HC to get it into the normal range experience problems if they do it too fast.
> A friend of ours has a son who is about 38 years
> old. After beeing treated for a physical condition
> with Hydrocortisone for a short time, he had a
> psychotic break with serious symptoms like
> mental confusion, hallucinations and delusions.
> He was hospitalised for a week and after extended
> testing, the cause of the psychosis was determined to
> be the Hydrocortisone. After discontinuing the drug
> for a few days his symptoms disappeared.
This is the end of the thread.
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