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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on March 17, 2018, at 14:19:19
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 18:07:15
>answered everything but my question...
OK now your turn. I'm trying to answer your questions, so you should tell me :) ... What symptoms and problems are you hoping to treat by working on the HPA axis (CRF, ACTH, cortisol etc)?
I'm not asking about genetic tests or theories about neurotransmitters. I want to know, what do you feel is wrong with your mental health, that you want to make better?
Posted by Phillipa on March 17, 2018, at 17:44:25
In reply to Re: How can I block Cortisol?, posted by farshad on March 17, 2018, at 12:39:49
Hi, F, can I as really an observer ask a question? If so. And you say you have anxiety. What have you taken so far for it? Benzodizapines, atypical antipsychotics? Or Depression meds? I'm sure I'm a much older person than you are also. I will be 72 female on Tuesday and have been through periods of time where when thyroid was diagnosed by endocrinologist as Hasimotos thyroiditis that my anxiety was so high that I took per MD instructions quite high doses of benzos and nothing touched it? Since a female this was when going through Menopause. Then it basically calmed down so today although still do take benzos per Psychiatrist I take extremly low doses. Oh I'm from the USA. What country do you reside it? Thanks Phillipa
Posted by farshad on March 17, 2018, at 21:08:13
In reply to Re: How can I block Cortisol? » farshad, posted by Phillipa on March 17, 2018, at 17:44:25
thanks for all the help. Im gonna be using Metyrapone to block cortisol production.
Posted by Lamdage22 on March 18, 2018, at 5:50:21
In reply to Re: How can I block Cortisol? » farshad, posted by Phillipa on March 17, 2018, at 17:44:25
<I'm sure I'm a much older person than you are also.
I also think so. Its ok to make mistakes as long as they dont harm you. Good luck with that.
Posted by ed_uk2010 on March 18, 2018, at 6:49:10
In reply to Re: How can I block Cortisol?, posted by farshad on March 17, 2018, at 21:08:13
>Im gonna be using Metyrapone to block cortisol production.
Obtained from where? Online? I assume so.
I'm really confused about what you're trying to achieve. Cortisol is an essential hormone like insulin. It isn't something you would just casually want to block. Detailed tests would be needed.
Posted by farshad on March 18, 2018, at 10:43:00
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 6:49:10
> >Im gonna be using Metyrapone to block cortisol production.
>
> Obtained from where? Online? I assume so.
>
> I'm really confused about what you're trying to achieve. Cortisol is an essential hormone like insulin. It isn't something you would just casually want to block. Detailed tests would be needed.
>
yeah im gonna be getting it from my doctor after ive done cortisol testing.
Posted by Phillipa on March 18, 2018, at 11:33:03
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 10:43:00
So glad to hear you are seeing a doctor to test you. Will it be an endrocrinologist? Phillipa
Posted by ed_uk on March 18, 2018, at 11:52:01
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 10:43:00
>yeah im gonna be getting it from my doctor after ive done cortisol testing.
Surely that depends totally on the results of the tests, no? :)
Metyrapone is not readily available in all countries. So the choice of drugs is also location dependent.
Posted by farshad on March 18, 2018, at 11:56:42
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk on March 18, 2018, at 11:52:01
> >yeah im gonna be getting it from my doctor after ive done cortisol testing.
>
> Surely that depends totally on the results of the tests, no? :)
>
> Metyrapone is not readily available in all countries. So the choice of drugs is also location dependent.Of course it depends on the results, But im saying if it turns out I do have high cortisol problems I will ask for Metyrapone. and I checked Metyrapone exists in Sweden.
All these exist to where I live (sweden):
Mifepristone
Flucanazole
Miconazole
Ketoconazole
Spironolactone
MitotaneBut I think Metyrapone would be the best choice. Do you know about other drugs that block cortisol that maybe I can bring up with my doctor incase I do have high cortisol that might be better option?
Posted by ed_uk2010 on March 18, 2018, at 12:55:58
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 11:56:42
>But I think Metyrapone would be the best choice.
Metyrapone has a lot of side effects, it's only for Cushing's Syndrome.
If you have mild cortisol elevations associated with depression and anxiety, you might want to look at mirtazapine. It is one of the antidepressants which may help to reduce high cortisol in depressed pts.
Posted by farshad on March 18, 2018, at 13:03:46
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 12:55:58
> >But I think Metyrapone would be the best choice.
>
> Metyrapone has a lot of side effects, it's only for Cushing's Syndrome.
>
> If you have mild cortisol elevations associated with depression and anxiety, you might want to look at mirtazapine. It is one of the antidepressants which may help to reduce high cortisol in depressed pts.well if you look at the other cortisol drugs ive listed their side effects are a lot worse.
I tried mirtazapine already didnt work. Where did you see the side effecs for Metyrapone ? I dont see any listed on wikipedia.
Metyrapone has been found in early human trials to reduce recollection of emotional memories in normal volunteers. The volunteers showed significant impairment in ability to retrieve memories with negative emotional content while not impairing memories with neutral content. This has significant implication in the study of the process of emotional healing in post traumatic stress disorder.[2][3]
Posted by ed_uk2010 on March 18, 2018, at 14:01:32
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 13:03:46
>Metyrapone has been found in early human trials to reduce recollection of emotional memories in normal volunteers.
I had a look at this. It's interesting, but just a starting point for further study.
Participants were give one or two doses of metyrapone only. They were then shown a slide show. Their memories were recorded later.
Taking one or two doses like the participants in this study does not usually cause side effects except sometimes nausea. The issue is when metyrapone is used for long-term treatment. Hypoadrenalism can occur.
Posted by farshad on March 18, 2018, at 14:07:59
In reply to Re: How can I block Cortisol?, posted by ed_uk2010 on March 18, 2018, at 14:01:32
> >Metyrapone has been found in early human trials to reduce recollection of emotional memories in normal volunteers.
>
> I had a look at this. It's interesting, but just a starting point for further study.
>
> Participants were give one or two doses of metyrapone only. They were then shown a slide show. Their memories were recorded later.
>
> Taking one or two doses like the participants in this study does not usually cause side effects except sometimes nausea. The issue is when metyrapone is used for long-term treatment. Hypoadrenalism can occur.so? I rather have Hypoadrenalism then this anxiety im in 24/7.
What do you suggest then? My appointment is in 3 weeks and if I do have high cortisol. What will they do? they will give me a drug to reduce cortisol. and thats how I came up with this list.Metyrapone has a very short half life like 1 hour. So I would need to dose it several times a day every 4 hours. its also very expensive I think.
Posted by ed_uk2010 on March 18, 2018, at 14:28:06
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 14:07:59
>so? I rather have Hypoadrenalism then this anxiety im in 24/7.
I'm not trying to downplay your symptoms. I understand how awful it can be. Hypoadrenalism is serious though.
What medication are you actually taking at the moment, and what symptoms do you have? You mentioned selegiline, pramipexole, armodafinil and bupropion. None of these drugs are usually helpful for anxiety.
>What do you suggest then? My appointment is in 3 weeks and if I do have high cortisol. What will they do?
>they will give me a drug to reduce cortisol.Probably not. Anti-cortisol drugs are normally only used for severe cortisol elevations (eg. caused by certain types of tumour). Less severe elevations associated with anxiety and depression and normally treated by targeting the anxiety and depression.
>Metyrapone has a very short half life like 1 hour. So I would need to dose it several times a day every 4 hours. its also very expensive I think.
The total dose is spread out across the day, yes. I'm unsure of the cost in Sweden. In the UK, it costs about £400 for a pack of 100 x 250mg caps.
Posted by farshad on March 18, 2018, at 14:37:45
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 14:28:06
> >so? I rather have Hypoadrenalism then this anxiety im in 24/7.
>
> I'm not trying to downplay your symptoms. I understand how awful it can be. Hypoadrenalism is serious though.
>
> What medication are you actually taking at the moment, and what symptoms do you have? You mentioned selegiline, pramipexole, armodafinil and bupropion. None of these drugs are usually helpful for anxiety.
>
> >What do you suggest then? My appointment is in 3 weeks and if I do have high cortisol. What will they do?
> >they will give me a drug to reduce cortisol.
>
> Probably not. Anti-cortisol drugs are normally only used for severe cortisol elevations (eg. caused by certain types of tumour). Less severe elevations associated with anxiety and depression and normally treated by targeting the anxiety and depression.
>
> >Metyrapone has a very short half life like 1 hour. So I would need to dose it several times a day every 4 hours. its also very expensive I think.
>
> The total dose is spread out across the day, yes. I'm unsure of the cost in Sweden. In the UK, it costs about £400 for a pack of 100 x 250mg caps.
>
>
In sweden anything that exceeds 200 euros you just have to pay it once and you get the medication free for the whole year.like I said im just taking the 4 dopamine drugs for my severe depression and it worked best for me. Nothing for anxiety. I have tried various drugs for anxiety none of which have worked. Thats why I really believe my anxiety it has to do with cortisol. specificaly excess CRF1 activation.
So what should I ask for them to check when im doing this cortisol test? Cortisol,ACTH,CRF1/CRF2 thats it?
Posted by farshad on March 18, 2018, at 14:39:04
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 14:37:45
> > >so? I rather have Hypoadrenalism then this anxiety im in 24/7.
> >
> > I'm not trying to downplay your symptoms. I understand how awful it can be. Hypoadrenalism is serious though.
> >
> > What medication are you actually taking at the moment, and what symptoms do you have? You mentioned selegiline, pramipexole, armodafinil and bupropion. None of these drugs are usually helpful for anxiety.
> >
> > >What do you suggest then? My appointment is in 3 weeks and if I do have high cortisol. What will they do?
> > >they will give me a drug to reduce cortisol.
> >
> > Probably not. Anti-cortisol drugs are normally only used for severe cortisol elevations (eg. caused by certain types of tumour). Less severe elevations associated with anxiety and depression and normally treated by targeting the anxiety and depression.
> >
> > >Metyrapone has a very short half life like 1 hour. So I would need to dose it several times a day every 4 hours. its also very expensive I think.
> >
> > The total dose is spread out across the day, yes. I'm unsure of the cost in Sweden. In the UK, it costs about £400 for a pack of 100 x 250mg caps.
> >
> >
> In sweden anything that exceeds 200 euros you just have to pay it once and you get the medication free for the whole year.
>
> like I said im just taking the 4 dopamine drugs for my severe depression and it worked best for me. Nothing for anxiety. I have tried various drugs for anxiety none of which have worked. Thats why I really believe my anxiety it has to do with cortisol. specificaly excess CRF1 activation.
>
> So what should I ask for them to check when im doing this cortisol test? Cortisol,ACTH,CRF1/CRF2 thats it?
also why do u not believe I have a mutation in my CRF1 gene ? I showed u the 2 SNPS I had .
>
Posted by ed_uk2010 on March 18, 2018, at 14:57:07
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 14:39:04
>also why do u not believe I have a mutation in my CRF1 gene?
I don't not believe you! :)
What I'm saying is that a particular mutation doesn't prove that you have severe high cortisol as the cause of your problems - the type that would be treated with a cortisol blocking drug. You can only prove that by specifically testing for high cortisol.
The body has ways of balancing things out (homeostasis). If your CRF was abnormal, something else could have changed to balance that. This is why you can only diagnose a problem due to elevated cortisol by doing special tests for it.
Posted by ed_uk2010 on March 18, 2018, at 15:13:10
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 14:37:45
Hi Farshad,
>In Sweden anything that exceeds 200 euros you just have to pay it once and you get the medication free for the whole year.
Ah I see. Do you pay the full price or part of it? I'm guessing part of it. Prescriptions are very cheap in the England, but people still complain about paying (mainly because they don't know how much people have to pay elsewhere)! We have plenty of other expensive things to balance it out though :/
>like I said im just taking the 4 dopamine drugs for my severe depression and it worked best for me. Nothing for anxiety.
That's really good that your depression has improved. Do these meds make your anxiety worse or just the same? What does your anxiety feel like and what have you tried for it?
>So what should I ask for them to check when im doing this cortisol test? Cortisol,ACTH,CRF1/CRF2 thats it?
Most likely, your doctor will follow the protocol recommended by the local pathology department. If high cortisol is suspected, you should always have a careful physical examination at the hospital or clinic. Routine blood tests would be taken (urea & electrolytes, full blood count, fasting glucose etc). Then, you would have one or two of the tests listed below as a starting point:
1. A 24 hour urine collection and analysis for cortisol content (this test is often done twice),
2. A late night saliva test for cortisol concentration,
3. An overnight dexamethasone suppression test with morning analysis of blood cortisol level.
These are the first tests. If they were normal, that would probably be all. If they were abnormal, they would look into it in more detail.
Posted by farshad on March 18, 2018, at 15:15:18
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 14:57:07
> >also why do u not believe I have a mutation in my CRF1 gene?
>
> I don't not believe you! :)
>
> What I'm saying is that a particular mutation doesn't prove that you have severe high cortisol as the cause of your problems - the type that would be treated with a cortisol blocking drug. You can only prove that by specifically testing for high cortisol.
>
> The body has ways of balancing things out (homeostasis). If your CRF was abnormal, something else could have changed to balance that. This is why you can only diagnose a problem due to elevated cortisol by doing special tests for it.
>
>
>if the body had a way of balancing things then I wouldnt have this anxiety. People wouldnt have schizoprenia due too much dopamine etc.. so no I dont believe the body can always go into homeostasis. I will test for high cortisol first but I figured since its a long time to my appointment might aswell chat about it maybe I can learn some stuff and then when I meet my doctor bring it up to her.
Posted by farshad on March 18, 2018, at 15:18:11
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 15:13:10
> Hi Farshad,
>
> >In Sweden anything that exceeds 200 euros you just have to pay it once and you get the medication free for the whole year.
>
> Ah I see. Do you pay the full price or part of it? I'm guessing part of it. Prescriptions are very cheap in the England, but people still complain about paying (mainly because they don't know how much people have to pay elsewhere)! We have plenty of other expensive things to balance it out though :/
>
> >like I said im just taking the 4 dopamine drugs for my severe depression and it worked best for me. Nothing for anxiety.
>
> That's really good that your depression has improved. Do these meds make your anxiety worse or just the same? What does your anxiety feel like and what have you tried for it?
>
> >So what should I ask for them to check when im doing this cortisol test? Cortisol,ACTH,CRF1/CRF2 thats it?
>
> Most likely, your doctor will follow the protocol recommended by the local pathology department. If high cortisol is suspected, you should always have a careful physical examination at the hospital or clinic. Routine blood tests would be taken (urea & electrolytes, full blood count, fasting glucose etc). Then, you would have one or two of the tests listed below as a starting point:
>
> 1. A 24 hour urine collection and analysis for cortisol content (this test is often done twice),
>
> 2. A late night saliva test for cortisol concentration,
>
> 3. An overnight dexamethasone suppression test with morning analysis of blood cortisol level.
>
> These are the first tests. If they were normal, that would probably be all. If they were abnormal, they would look into it in more detail.no these dopamine drugs dont make my anxiety worse I think it makes it better just a tiny bit tho.
I have tried SNRI,SSRI,MAOI,Buspar and some others I dont remember
Posted by ed_uk2010 on March 18, 2018, at 15:52:02
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 15:15:18
>I dont believe the body can always go into homeostasis.
Now that is true, but you don't know until you test because anxiety has so many causes.
>I can learn some stuff and then when I meet my doctor bring it up to her.
It's definitely good to educate yourself. The most important realisation is the limitation of your own knowledge though. Even the best neuroscientists only have a limited understanding of anxiety. You have to keep an open mind.
Posted by ed_uk2010 on March 18, 2018, at 15:55:38
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 15:18:11
>I have tried SNRI, SSRI, MAOI, Buspar and some others I dont remember,
What is your anxiety like? Describe it.
Also, which MAOI did you try?
How does your anxiety respond to benzodiazepines?
Are you diagnosed with depression and anxiety? Maybe something else like bipolar?
You will always tend to get bad suggestions if you don't say much about your problems :/
Posted by farshad on March 18, 2018, at 16:01:26
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 15:55:38
> >I have tried SNRI, SSRI, MAOI, Buspar and some others I dont remember,
>
> What is your anxiety like? Describe it.
>
> Also, which MAOI did you try?
>
> How does your anxiety respond to benzodiazepines?
>
> Are you diagnosed with depression and anxiety? Maybe something else like bipolar?
>
> You will always tend to get bad suggestions if you don't say much about your problems :/
>
>Nardil did nothing for me just side effects.
My anxiety is that just anxiety, I also have OCD . Both which are related to high cortisol.
Its like im in a constant anxious state and every second as I type this I feel anxiety even tho I have no reason to. I have gotten used to this feeling but my head is so hot. I believe its due to too much CRF1 activation and there are CRF1 receptors in the amygdala . Which lead to an overactive amygdala. Tried 2 benzos , klonopin which had no effect at all then I also tried Valium which worked meh. No I have no diagnosists .
Im 100% its cortisol related.
Posted by ed_uk2010 on March 18, 2018, at 16:07:13
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 16:01:26
>Its like im in a constant anxious state and every second as I type this I feel anxiety even tho I have no reason to.
When you tried SSRIs for your anxiety, how long did you take them for?
>No I have no diagnosis.
What sort of doctor do you see? A psychiatrist? A general practitioner/family doctor?
Posted by farshad on March 18, 2018, at 16:11:05
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 16:07:13
> >Its like im in a constant anxious state and every second as I type this I feel anxiety even tho I have no reason to.
>
> When you tried SSRIs for your anxiety, how long did you take them for?
>
> >No I have no diagnosis.
>
> What sort of doctor do you see? A psychiatrist? A general practitioner/family doctor?
>tried ssri for months. seein a family doctor.
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