Posted by Pfinstegg on October 21, 2002, at 19:10:56
In reply to remeron and cortisol, posted by glenn on October 21, 2002, at 14:42:04
This is my understanding of the cortisol situation (it may well not be completely accurate): if you have an adrenal or pituitary tumor, you will probably have increased 24-hour cortisol and may or may not suppress with the DST, depending on the source and type of tumor. If you have stress-depression-based pseudo-Cushing's Syndrome, without a tumor, you can have the same range of laboratory results. So you do have to have additional tests to be diagnosed accurately. In general, when you have some kind of tumor, you have a number of progressive, obvious physical changes. I think I have an good endocrinologist who has definitely had wide experience, but he told me that he rarely gets a patient like me, who presents with PTSD and depression and a request to have cortisol investigated; he is not very used to dealing with such patients, but seems open-minded and willing to do what he can.
To go back to the relationship of HPA axis dysregulation and depression; only half of the people with MDD have elevated 24-hour urinary cortisol, and of those, only half will be non-suppressors with the DST. I guess you could speculate that in MDD, there is a progression of HPA axis dysregulation; probably it is only intermittent at first, and not easily detectable by testing, then progressing through elevated cortisol and finally elevated cortisol with non-suppression. There are articles on Medline indicating that various measures can stop or reverse this progression, including the right medications, sometimes the right neurophysiological treatments (ECT and rTMS) and the right kinds of psychotherapy and social support.
Is this your understanding,also, or is there a point I missed either in your post or in my understanding?
Pfinstegg
poster:Pfinstegg
thread:124535
URL: http://www.dr-bob.org/babble/20021019/msgs/124573.html