Posted by Elroy on September 23, 2005, at 17:18:14
In reply to Re: Remeron and Cortisol, posted by Tenifer on September 22, 2005, at 22:24:36
Dave,
I keep coming across so many similarities in our situations that it's spooky.
You mention that situation with getting locked in a vault at work. I too had never had any type of problem with claustraphobia until after my stress problems started at work. I had some work to do under the house at our old place (no prob, had done similar before several times) and suddenly had severe claustraphobic feelings. Likewise, had two MRIs done in 1996, no problem. But then in 1998 went to have another one (had neck surgeries from on-duty injuries in 1996 and 1998) and had extreme claustraphobia.
Oh yeah, and I keep forgetting to mention that right in the middle of all my initial stressors (the work-related stuff) that my father passed away in mid 1999! And then the family loss (and not even direct family) situation in June of 2004. But even it was like BAM!, suddenly I have this "inner unrest" and "jitteryness" that quickly (within a couple weeks) turned in to outright anxiety. And then I get all of these other physical symptoms (from the elevated cortisol which is now running rampant due to the severe anxiety busting up the HPA Axis)... but I keep analyzing back to the severe anxiety... and that's when it hit me what was happening, that I had this sudden fear of dying, of my wife dying, of things changing in an ultimate sense, of no longer existing... and with it came a concurrent fear of being elderly in a frail and broken down sense... and my very fears were increasing my anxieties which was fueling the cortisol fire which was going to insure that my fears came true!
That (probably late September by this point) was when I realized that I was going to need some serious help in getting things fixed. Not just medically, but psychologically as well. That was when I sat down with my psych doc and wanted to be put on something that would be a low-dose solution to taking the hard edge off of the anxiety (first we tried Ativan but she then decided Xanax XR would be better as far as easier to withdraw from, etc. - in fact she mentioned something about a study that showed that at doses below 4 mg a day at least 50% of users can quit cold turkey with no withdrawal). We also discussed some options for the severe insomnia (cause nothing else was going to help unless I got the severe anxiety and the insomnia under some moderate control anyway). We started with 10 mg Ambien and then even 20 mg Ambien but it has a short half-life and I would wake up - wide awake - after 4 hours, so then we went to Restoril (again, low dose at 7.5 mg). It was better, but still not full sleep (5 - 6 hours). I had also done a little bit of prior work with my initial therapist with EMDR therapy and wanted to give it a prolonged try but she was moving to Arizona and we only got a few sessions in and then she had to find me another good local one (fortunately I actually had two real good ones to choose from). So I have done about five sessions now with the second therapist - and we have yet to address the primary trauma in the form of the fear of dying, fear of aging in a non-robust fashion, etc. We have been working on clearing out a lot of older, buried traumas so that things are cleared out for when we knuckle down to addressing the main issue....
Of course it is a total package. You can't (IMHO) work strictly on the psychological problems and totally ignore the cortisol. Well, maybe you can and the cortisol levels will gradually correct themselves as the HPA Axis re-sets, but I figure that addressing both as necessary items is the better way to go. Or work on the cortisol problem / HPA Axis problem without also addressing the psychological issues!
Are you having any other physical symptoms associated with your situation? I had the following physical symptoms manifest within 4 - 6 weeks of the onset of the severe anxiety:
1. Abrupt serious hypogonadal status (libido and erectile functioning went from like a 9.5 on a 10 scale to a zero - tests showed Total Testosterone in the range of 140s with normal range being 240 - 1000 and optimum range being 700 - 1000).
2. Severe insomnia
3. Severely icy cold sensations in feet (primarily) and hands (less so).
4. Peripheral neuropathy type pains in feet (mainly) and hands (less so)
5. Periodic waves of an itchy/stinging type sensation, like a widespread rash or hives across upper torso. Will generally not be visible though at times will manifest as a visibile rash across upper chest.
6. A sensation of a burning urethra type pain (not simply when urinating like one might have with a prostate disorder, but ALL of the time), and
7. Severe tinnitus.Aside from cortisl testing, have had numerous other related tests to check out these various physical disodders. For example, neurological testing on both the tinnitus problem and the peripheral neuropathy type pains. Both checked out clear. So it's pains similar to PN but isn't PN! Also ENT doc checked clear as to any known physical cause for the tinnitus. Etc., etc., etc.
Interestingly, working on the anxiety (i.e., Xanax XR), the insomnia (i.e., Restoril), the cortisol (i.e., initially several strong anti-cortisol OTC supps and now the Remeron - and getting on TRT for the hypogonadal status - have all helped minimize these symptoms quite a bit. For example, the Xanax XR not only helped with 90% of the sever anxiety but also reduced the tinnotus to subside by about 70 - 80%. TRT tremendously helped with the loss of libido and ED problems. The insomnia is completely gone with the Remeron. Etc., etc.
Well, gotta' run as it's dinner time.
May God be with you, too....
Elroy
Some links to review:
http://www.nih.gov/news/pr/sep2002/nichd-09.htm
http://www.nature.com/npp/journal/v23/n5/full/1395567a.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9709931
http://www.annals.org/cgi/content/full/138/12/980
http://dr-john.ca/depression_article13.php
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> Yes, all of a sudden. But looking back I should have seen it coming. I had been under tons of stress since,well, for a long time. I was a paratrooper in the 82nd Airborne Division back in the late 70's, early 80s and never got used to the anxiety of jumping out of airplanes. But the anxiety was gone after the jump.
>
> Jump forward a few years and now I'm a police officer and have a constant state of tension when I'm out on patrol, punctuated by extreme moments of terror and adrenaline surges.
>
> in 1990 I started an inside job that turned into more stress than the street work. This is all due to damn computers. Anyway, this set the stage. Add to that going back to college and getting my 4.0 GPA-first in the class (but at what cost) and other stressors and the stage was set.
>
> My parents were not in good health and my father had major heart surgery. A few months later I experienced a panic attack in work when I got trapped inside a locked vestibule and couldn't get out. That was a complete surprise to me! I managed to pull myself together and found a way out. Immediately thereafter my anxiety dropped off, like its supposed to do, and I joked about it to my cooworkers when they came into work later in the day.
>
> Now jump forward a couple of more months to May 2004. I get a bad case of poison ivy and start a 6 day course of Medrol. Coincidentally, I mention to my doctor the day I saw him about the poison ivy that I've been feeling anxious lately, mostly in work. It never interfered with my sleep and always improved when I got home and later in the evening. He handed me Lexapro along with the Medrol. I didn't take it, because I didn't think it was that bad. It didn't interfere with my life in any way.
>
> Well, 2 days after completing the Medrol I literally thought I was going insane. It felt like my brain were tearing itself to pieces! It was the most horrific experience I had ever had. That was the first week in June 2004. At first I thought it was Medrol withdrawal.
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> I got a little better a couple of days after that and only had a "baloon" head - lightheaded. That came about pretty quickly when, after not having eaten for about a week, I forced myself to eat a soft pretzel. Within a few minutes I was feeling much better (wish I knew why).
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> But it didn't last, 2 weeks later I had another crash, on Monday, when back at work. I went to the doctor and he started me on Paxil which was a nightmare and made me MUCH worse. Then we added Ambien for sleep, then Desyrel for sleep, then Buspar to augment. I couldn't titrate the Paxil cause it made my anxiety worse and caused such a sharp mood swing into depression, all I could do is cry and wait for the effects to lessen.
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> We quit the Paxil and tried Effexor. No good.
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> Got off everything and actually felt better for a while - not good, but better than I had ever been on the meds. But, a couple of weeks later, my sleep went back to hell and I struggled to find something natural since the doctors had given me poison - my confidence in MD's, needless to say, is shot.
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> The only thing that helped me was St. John's Wort (Metagenics brand - 900mg day which I raised to 1125) I was able to sleep. Sometimes I would need a benadryl but I could get 5-7 hours of sleep. Stresors would always upset this fine balancing act though. I never got to full remission, things just got to a level where I could manage better.
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> The I started L-tryptophan. 6 days after starting the TRP I had one of the best nights I have had in over a year. I felt completely normal! That was Sunday night and I was really encouraged that, if I could contain the stressors in my life, that I would be on the road to recovery.
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> On Monday night, the next day, Labor Day, my father passed away. He had been in a nursing home and was slowing fading. My sister and I were at his bedside.
>
> Ever since then I have lost my grip on the tightrope and am struggling to reliably sleep. I'm back to resorting to Ambien, benadryl, vistaril, ativan, klonopin, and beer to get myself 5 hours of poor sleep. I'm having intense anxiety that is easily provoked by a song, traffic, someone talking to me, etc. I'm crying uncontrollably for no reason and am now, for the first time, experiencing some significant anger and hostility. Could this be grief? Maybe so, but with my fractured nervous system its worse than anyone living has experienced I'll bet.
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> Now, as far as cortisol goes, the interesting thing is that when this whole debacle started I had serum testing done. This was while I was on the Paxil. Instead of lowing it, the cortisol went up while taking the Paxil (no wonder it wasn't friendly to me!).
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> Note, these are all serum cortisol (AM) with a reference range of 4.0 - 22.0
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> 6/29/04 : 17.4
> 11/23/04 : 22.1
> 2/1/05 : 24.6
> 8/26/05 : 23.9 (and this was BEFORE my father's passing. I can't imagine what the corticol levels are now. :(
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> Have you ever had serum cortisol levels checked? I'm curious what my levels might translate into if converted to UFC (if thats even possible to guess).
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> I'm more than convinced that there has been a breakdown on my HPA Axis regulation. The sudden onset of these severe symptoms and their response to St. John's Wort, which helps modulate HPA function, just lend more evidence to it. The question is, how do I get it back down where it belongs and get it to stay there without taking neurotoxic meds the rest of my life?
>
> I'm about ready to give up and give some meds a try but the side effects and withdrawal effects worry me...especially the insomnia. I'm considering the following:
>
> Neurontin
> Doxepin
> Remeron
> Inderal
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> And even "beetle dung" if it will help slow me down so I can relax and sleep. ;)
>
> I have benzo's but am very reluctant to take them because of the addiction potential. And SSRI's and anything even mildly activating are not options for me. Too sensitive.
>
> Anyway, thats the redacted version of my tale. I've read alot of your posts and will try to see if I can get a UFC and a late nifghr salivary cortisol test done. I mentioned it to my holistic doc once and she said it wasn't very reproducible. I don't care. Its another piece of information; a piece of the puzzle so to speak. We'll see what she suggests tomorrow. Whatever happens, I need to get stabilized before this thing turns into an even bigger monster down the line.
>
> Great to know I'm not alone out there Elroy. Its a shame we can't chat online anytime soon. I find typing and email to be a frustrating pain in the ark. :]
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> Hope to hear from you soon and that improvement continues. May God be with you,
>
> David
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poster:Elroy
thread:124535
URL: http://www.dr-bob.org/babble/20050921/msgs/558615.html