Posted by Pfinstegg on October 22, 2002, at 21:42:10
In reply to To Pfinstegg, posted by glenn on October 22, 2002, at 11:33:36
Yes, the whole treatment question is a big puzzle. My endocrinologist does not want to rush in to using ketanozodole or mefipristone- the two he's considering, but wants to see how I do on my present self-designed cortisol-lowering regime, which consists, as I've mentioned, of tianeptine, Omega-3's, alpha-lipoic acid, phosphadatyl-serine and SAM-e. I am actually a lot better emotionally after 2 months of this, so he's interested in finding out whether what I'm already doing has lowered the cortisol any, or made me into at least a partial DST suppressor- he's doing the tests every two months to find out. One trouble with this regime- it's expensive as hell!
Having read a little more since I last posted, I am finding out about the gradual nature of this problem, which can take many years to develop. Apparently, infant or childhood stress sets the HPA axis a little high, so that subsequent stresses cause it to deliver a little more CRH and cortisol than normal. The only sign that this is happening at first is an elevated hypothalamic CRH, which is not a test that anyone ever gets! The next thing that happens is that the ACTH production by the pituitary begins to get high (no-one gets this one either); only after that does the cortisol production by the adrenals get high. Then, it has to stay high for a sustained period in order to damage the CR 2-3 receptors in the hippocampus, which are the receptors which normally take up the cortisol, returning the blood levels to normal and signalling the hypothalamus to stop producing CRH. Once you have enough damage to your hippocampal receptors to prevent cortisol uptake, you've got HPA axis dysregulation. The fact that you have high 24-hour levels, but suppress well means that you are in mid-stage in this progression; however, you do need the best possible treatment plan to prevent going on to be a non-suppressor. The few articles that I have found which actually show what reduces serum cortisol include a real collection of things: the best medications are apparently tianeptine and the tricyclics, with the SSRI's having a only a slightly positive effect on cortisol. Lithium and other mood stabilizers apparently don't affect the HPA system. rTMS and ECT sometimes have a normalizing effect, and, in one study I came across, dialectical behavior therapy actually lowered cortisol quite a lot!
Well, however we manage do it, here's to getting it down!
Pfinstegg
poster:Pfinstegg
thread:124700
URL: http://www.dr-bob.org/babble/20021019/msgs/124783.html