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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SLS on June 6, 2015, at 4:58:51
The results of this study might translate into a helpful parameter of designing a treatment algorithm.
- Scott
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http://www.firstwordpharma.com/node/1285720?tsid=1
"Elevated Cortisol Levels Linked to Poorer Response to Fluoxetine: Presented at APA
May 21st, 2015By Louise Gagnon
TORONTO -- May 21, 2015 -- Patients with depression and have increased salivary cortisol levels fail to respond to treatment with the selective serotonin reuptake inhibitor (SSRI) fluoxetine, according to a study presented here at the 168th Annual Meeting of the American Psychiatric Association (APA).
Previous research linked elevated levels of cortisol, also referred to as the stress hormone, to resistance to antidepressant treatment, explained Raul Ventura-Junca, MD, PhD, Universidad de Chile, Santiago, Chile, on May 17.
Researchers enrolled 208 patients, 187 with normal thyroid function and 21 noneuthyroid. The diagnosis of depression and the severity of illness were determined by the Mini-International Neuropsychiatric Interview and the Hamilton depression scale (HAM-D17).
The patients with normal thyroid function were treated with fluoxetine (20 mg). Of the 166 patients who started treatment with fluoxetine, 145 continued to 3 weeks of treatment, and 122 continued to the end of 8 weeks of drug therapy.
Of the 122 patients, the 67 who responded to treatment and 48 who remitted all had significantly lower circadian basal salivary cortisol levels than nonresponders (P = .008 and .021, respectively).
We can conclude that higher cortisol levels are a predictor of resistance to fluoxetine treatment, said Dr. Ventura-Junca. If you measure circadian cortisol levels, and patients have elevated cortisol, you should not begin to treat them with either 20 or 40 mg of fluoxetine treatment. You should consider an alternative.
Salivary cortisol levels remained stable with fluoxetine treatment.
Patients who chose to discontinue treatment before the third week of the study showed reduced levels of salivary cortisol (P = .057), said Dr. Ventura-Junca, speculating that the patients were very good responders to the SSRI.
We think that these people did not abandon treatment early because of side effects of treatment but because they were already feeling better, concluded Dr. Ventura-Junca, adding that other factors are likely involved in response to fluoxetine.
Funding for the study was provided by a grant from the Chilean government.
[Presentation Title: Cortisol Levels Before and After Antidepressant Fluoxetine Treatment in Chilean Patients With Major Depressive Disorder. Abstract P3-052]"
Posted by Christ_empowered on June 6, 2015, at 9:08:56
In reply to Replay: High cortisol = poor response to Prozac, posted by SLS on June 6, 2015, at 4:58:51
doesn't remeron lower cortisol?
Posted by SLS on June 6, 2015, at 13:27:02
In reply to Re: Replay: High cortisol = poor response to Prozac, posted by Christ_empowered on June 6, 2015, at 9:08:56
> doesn't remeron lower cortisol?
I'm not sure, but that might be a good reason to investigate it clinically and compare its efficacy in high-cortisol patients. Maybe Wellbutrin, desipramine, nortriptyline, or MAOI?
- Scott
Posted by linkadge on June 7, 2015, at 12:04:17
In reply to Re: Replay: High cortisol = poor response to Prozac » Christ_empowered, posted by SLS on June 6, 2015, at 13:27:02
Yes, in general serotonergic agents do increase cortisol. I think the effect is mediated (in part) by 5-ht2 receptors. Reciprocally, cortisol increases the sensitivity of 5-ht2 receptors.
Some studies suggest a desensitization and / or normalization of cortisol over time, but others do not.
In general, agents with block 5-ht2a act as anti-cortisol agents. For instance, remeron, cyproheptadine, amitriptyline, seroquel etc have all been independently shown to decrease cortisol. In fact, cyproheptadine is a treatment for Cushings disease, characterized by hyper secretion of cortisol. Some of the antipsychotic (and perhaps augmentative) effect of atypicals is mediated by 5-ht2a.
Posted by SLS on June 7, 2015, at 12:58:03
In reply to Re: Replay: High cortisol = poor response to Prozac, posted by linkadge on June 7, 2015, at 12:04:17
> Yes, in general serotonergic agents do increase cortisol. I think the effect is mediated (in part) by 5-ht2 receptors. Reciprocally, cortisol increases the sensitivity of 5-ht2 receptors.
>
> Some studies suggest a desensitization and / or normalization of cortisol over time, but others do not.
>
> In general, agents with block 5-ht2a act as anti-cortisol agents. For instance, remeron, cyproheptadine, amitriptyline, seroquel etc have all been independently shown to decrease cortisol. In fact, cyproheptadine is a treatment for Cushings disease, characterized by hyper secretion of cortisol. Some of the antipsychotic (and perhaps augmentative) effect of atypicals is mediated by 5-ht2a.Great info. Thanks.
- Scott
Posted by miko84 on June 16, 2015, at 5:20:53
In reply to Re: Replay: High cortisol = poor response to Prozac, posted by linkadge on June 7, 2015, at 12:04:17
Yes, it's true - serotonergic antidepressants can increase activity of HPA axis via 5-HT1a, 5-HT2a/c and 5-HT3 activation. All 5-HT2a/c antagonist are good for lowering cortisol.
That's why SSRI's are not so good in depressions with high cortisol. Mirtazapine/amitriptiline/olanzapine/quetiapine and other antipsychotics are better for that.
Posted by SLS on June 16, 2015, at 6:43:13
In reply to Re: Replay: High cortisol = poor response to Prozac, posted by miko84 on June 16, 2015, at 5:20:53
> Yes, it's true - serotonergic antidepressants can increase activity of HPA axis via 5-HT1a, 5-HT2a/c and 5-HT3 activation. All 5-HT2a/c antagonist are good for lowering cortisol.
>
> That's why SSRI's are not so good in depressions with high cortisol. Mirtazapine/amitriptiline/olanzapine/quetiapine and other antipsychotics are better for that.Thanks, Miko84.
I didn't know any of that.
- Scott
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