Posted by jerrympls on December 23, 2004, at 17:05:36
My doc is starting me on Metyrapone, a cortisol inhibitor, in adjunct to the Cymbalta I'm on. He was impressed with recent studies showing it helped with depression. However, I haven't been able to find a pharmacy that carries the medication (in the US). I did find out that the manufacturer - Novartis - has labeled it "for compassionate use" - whatever that means? Anyway, the pharmacist said I'd have to call Novartis directly to ask how to get the med. I just tried to call and they're closed - so I'll have to wait until next week. I've posted an article about the studies below.
Jerry
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Cortisol synthesis inhibitors accelerate antidepressant effectThe cortisol inhibitor metyrapone appears to be an effective adjuvant treatment for major depression, accelerating the onset of antidepressant action, study findings show.
"Alterations of the hypothalamic-pituitary-adrenal axis are the most consistent pathological endocrine findings in depression," observe Holger Jahn (University Hospital Hamburg-Eppendorf, Germany) and colleagues.
"Preclinical studies nurture the hope for new therapeutic strategies based on steroid-synthesis inhibition, but clinical data about the antidepressive efficacy of these compounds are mainly confined to small open-label trials and case reports."
To investigate further, the researchers randomly assigned 66 patients with major depression and Hamilton Rating Scale for Depression (HAM-D) scores of 18 points or higher to receive 1 g/day of metyrapone or placebo for the first 3 weeks of a 5-week course of antidepressant treatment with either nefazodone or fluvoxamine.
After 3 weeks, 23 of 33 patients receiving metyrapone had a positive treatment response, defined as a 30% reduction in HAM-D scores, compared with 13 of 30 patients taking placebo. After 5 weeks, 19 and 10 patients, respectively, were considered responders, based on a 50% reduction in HAM-D scores.
Moreover, the onset of antidepressant action, defined as the time point at which at least a 20% reduction in HAM-D scores occurred, was more rapid among the participants taking metyrapone, beginning in the first week compared with after 2 weeks for those receiving placebo.
Metyrapone was generally well tolerated, with only nausea and headaches reported significantly more often during metyrapone than placebo treatment. Adverse events tended to be mainly due to the serotonergic antidepressant therapy.
Although cortisol levels remained largely unchanged, the plasma levels of corticotropin, the cortisol precursor 11-deoxycortisol, and the neurosteroid dehydroepiandrosterone increased, confirming that metyrapone intervened with cortisol synthesis.
"Although steroid-synthesis inhibitors are not quite ready for routine clinical application, the findings of this study clearly warrant further studies aimed at identifying subgroups of depressed patients who will benefit most from this approach and surrogate markers to find the optimal dosing regimen," the researchers conclude in the Archives of General Psychiatry.
poster:jerrympls
thread:433457
URL: http://www.dr-bob.org/babble/20041223/msgs/433457.html