Posted by Elroy on September 23, 2005, at 13:05:53
In reply to Re: Remeron and Cortisol - Dexamethasone, posted by SLS on September 22, 2005, at 21:47:02
Scott,
Very interesting study - and alternative option. I have wondered the same thing with the short-term RU486 therapy - i.e., will it require periodic maintenance applications with some individuals. My prediction would be that some people will clear up with one short-term application, and that others will need several applications over a period of time. Like you said, probably of a dwindling nature as the HPA Axis strengthens.
I noted this quote: "A good clinical response was associated with a high baseline cortisol level." That would only tend to make sense, right? Whether it was dex or RU486 or Remeron, etc. The benefit is only going to work with those meds with patients who in fact have highly elevated cortisol. I think that is why some people have no response to Remeron (for example). As it's main "claim to fame" seems to be that it is one of the few "standard" psych drugs that has some record of controlling cortisol, it seems to me that the primary benefit it would have to a patient without high cortisol is that it can most surely cure insomnia (as long as you keep taking it!).
Thanks for the info....
Leroy
P.S. As some corroboration, I noted that each time my Endo had me do one of those Dex suppression tests (especially the couple that I did that were spread out over two days), I did in fact feel quite a bit beter for the day on the dex and a few days thereafter.
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X> Hi.
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> Another alternative to consider would be to employ a short course of dexamethasone: 3-4mg per day for 4 days. This might help reset the HPA axis. I am looking into this treatment for bipolar depression. I would be doing this while continuing with my current drug regime. If it works, I predict that I would need periodic maintenance treatments. Hopefully, the frequency of these treatments would decrease over time. One study suggested that this procedure was preferentially successful to those who were hypercortisolemic.
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> Just an idea.
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> - Scott
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> Acta Psychiatr Scand. 1997 Jan;95(1):58-61. Related Articles, Links
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> Dexamethasone augmentation in treatment-resistant depression.
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> Dinan TG, Lavelle E, Cooney J, Burnett F, Scott L, Dash A, Thakore J, Berti C.
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> Department of Psychological Medicine, St Bartholomew's Hospital, London, UK.
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> A total of 10 patients who fulfilled DSM-III-R criteria for major depression were recruited to the study, each of whom had failed to respond to a 6-week course of treatment with either sertraline or fluoxetine. Each subject had baseline serum cortisol measurements together with a Hamilton depression (HAMD) score. All patients were started on dexamethasone (3 mg daily) for 4 days, while remaining on their antidepressant treatment. Further Hamilton ratings were made on days 5 and 21. Six patients showed a significant improvement, whilst two showed a minimal response. A good clinical response was associated with a high baseline cortisol level.
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> PMID: 9051162 [PubMed - indexed for MEDLINE]
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poster:Elroy
thread:124535
URL: http://www.dr-bob.org/babble/20050921/msgs/558518.html