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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by ed_uk2010 on March 18, 2018, at 16:17:35
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 16:11:05
So why aren't you seeing a specialist/psychiatrist?
Posted by farshad on March 18, 2018, at 16:23:09
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 16:17:35
> So why aren't you seeing a specialist/psychiatrist?
they refuse to help me and say I should just go the therapy route since no meds work for me.
Posted by ed_uk2010 on March 18, 2018, at 16:33:27
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 16:23:09
> > So why aren't you seeing a specialist/psychiatrist?
So, meds like pramipexole, did you buy online?
Posted by farshad on March 18, 2018, at 16:41:55
In reply to Re: How can I block Cortisol?, posted by ed_uk2010 on March 18, 2018, at 16:33:27
> > > So why aren't you seeing a specialist/psychiatrist?
>
> So, meds like pramipexole, did you buy online?
>yeah I get them all online besides wellbutrin which I get from my doctor .
Posted by ed_uk2010 on March 18, 2018, at 16:46:34
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 16:41:55
So have you been referred to someone for the endocrine tests?
Posted by farshad on March 18, 2018, at 16:47:48
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 16:46:34
> So have you been referred to someone for the endocrine tests?
>family doctor which I get my wellbutrin from
Posted by SLS on March 19, 2018, at 8:43:45
In reply to Re: How can I block Cortisol?, posted by ed_uk2010 on March 18, 2018, at 16:33:27
For what it's worth, I tried mifepristone for 8 consecutive days. It did not help with depression at all. However, by the eighth day, I felt washed-out and unwell. The protocol at the time called for treatment of a short duration so as not to not cause adrenal exhaustion. Although I do not have psychotic depression, I thought that it was worth a try.
- Scott
Posted by farshad on March 19, 2018, at 14:13:05
In reply to Re: How can I block Cortisol?, posted by SLS on March 19, 2018, at 8:43:45
has anyone seen this study ? its from 1998 . I think they are suggesting there could be CRF1 mutations but unrelated to cushings disease>
I quote from the study ...No mutations affecting the CRF1-R protein have been found in all tumors analyzed. However, we found a significant overexpression of the CRF1-R messenger RNA in ACTH-secreting pituitary adenomas vs. inactive adenomas and normal pituitaries. We conclude that mutations of the CRF1-R are unlikely to be involved in Cushing's disease. We suggest that the overexpression of the CRF1-R messenger RNA may be related to a disturbed receptor regulation in ACTH-secreting pituitary adenomas...
https://www.ncbi.nlm.nih.gov/pubmed/9745449
English is my 3rd language so maybe someone can explain this that understands it better_
Posted by farshad on March 19, 2018, at 14:16:15
In reply to Re: How can I block Cortisol?, posted by farshad on March 19, 2018, at 14:13:05
> has anyone seen this study ? its from 1998 . I think they are suggesting there could be CRF1 mutations but unrelated to cushings disease>
>
> I quote from the study ...No mutations affecting the CRF1-R protein have been found in all tumors analyzed. However, we found a significant overexpression of the CRF1-R messenger RNA in ACTH-secreting pituitary adenomas vs. inactive adenomas and normal pituitaries. We conclude that mutations of the CRF1-R are unlikely to be involved in Cushing's disease. We suggest that the overexpression of the CRF1-R messenger RNA may be related to a disturbed receptor regulation in ACTH-secreting pituitary adenomas...
>
> https://www.ncbi.nlm.nih.gov/pubmed/9745449
>
> English is my 3rd language so maybe someone can explain this that understands it better_I found 2 possible mutations that I have related to ACTH>
PDE8B https://www.selfdecode.com/gene/pde8b/#advanced-summary
ACE (Angiotensin I converting enzyme) https://www.selfdecode.com/gene/ace/
Posted by farshad on March 19, 2018, at 14:20:38
In reply to Re: How can I block Cortisol?, posted by farshad on March 19, 2018, at 14:16:15
> > has anyone seen this study ? its from 1998 . I think they are suggesting there could be CRF1 mutations but unrelated to cushings disease>
> >
> > I quote from the study ...No mutations affecting the CRF1-R protein have been found in all tumors analyzed. However, we found a significant overexpression of the CRF1-R messenger RNA in ACTH-secreting pituitary adenomas vs. inactive adenomas and normal pituitaries. We conclude that mutations of the CRF1-R are unlikely to be involved in Cushing's disease. We suggest that the overexpression of the CRF1-R messenger RNA may be related to a disturbed receptor regulation in ACTH-secreting pituitary adenomas...
> >
> > https://www.ncbi.nlm.nih.gov/pubmed/9745449
> >
> > English is my 3rd language so maybe someone can explain this that understands it better_
>
> I found 2 possible mutations that I have related to ACTH>
>
> PDE8B https://www.selfdecode.com/gene/pde8b/#advanced-summary
>
> ACE (Angiotensin I converting enzyme) https://www.selfdecode.com/gene/ace/--------------
One mutation in human PDE8B (His350Pro), from a patient with severe adrenal hyperplasia, impaired PDE8B catalytic activity, and its expression in Hela cells resulted in increased cAMP-signaling, suggesting a role for cAMP in development of adrenal hyprerplasia. Such PDE8B mutations may not directly cause adrenal hyperplasia, however, since PDE8B KO mice do not develop adrenal tumors (Tsai and Beavo 2011). Inactivating PDE11A gene mutations are also associated with the development of adrenal hyperplasia and Cushing syndrome (Libe et al. 2008), and with Carney complex (CNC). CNC is caused by germline mutations in the alpha regulatory subunit of PKA (PRKARIA) and is associated with endocrine tumors, including nodular adrenal hyperplasia and adrenal and testicular tumors (Levy et al. 2011;Libe et al. 2011). PDE11A mutations may also play a role in susceptibility to prostate cancer (Faucz et al. 2011) and testicular germ cell tumors (TGCT) (Horvath et al. 2009).
------------https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275405/
https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia
Posted by farshad on March 19, 2018, at 14:29:45
In reply to Re: How can I block Cortisol?, posted by farshad on March 19, 2018, at 14:20:38
> > > has anyone seen this study ? its from 1998 . I think they are suggesting there could be CRF1 mutations but unrelated to cushings disease>
> > >
> > > I quote from the study ...No mutations affecting the CRF1-R protein have been found in all tumors analyzed. However, we found a significant overexpression of the CRF1-R messenger RNA in ACTH-secreting pituitary adenomas vs. inactive adenomas and normal pituitaries. We conclude that mutations of the CRF1-R are unlikely to be involved in Cushing's disease. We suggest that the overexpression of the CRF1-R messenger RNA may be related to a disturbed receptor regulation in ACTH-secreting pituitary adenomas...
> > >
> > > https://www.ncbi.nlm.nih.gov/pubmed/9745449
> > >
> > > English is my 3rd language so maybe someone can explain this that understands it better_
> >
> > I found 2 possible mutations that I have related to ACTH>
> >
> > PDE8B https://www.selfdecode.com/gene/pde8b/#advanced-summary
> >
> > ACE (Angiotensin I converting enzyme) https://www.selfdecode.com/gene/ace/
>
> --------------
> One mutation in human PDE8B (His350Pro), from a patient with severe adrenal hyperplasia, impaired PDE8B catalytic activity, and its expression in Hela cells resulted in increased cAMP-signaling, suggesting a role for cAMP in development of adrenal hyprerplasia. Such PDE8B mutations may not directly cause adrenal hyperplasia, however, since PDE8B KO mice do not develop adrenal tumors (Tsai and Beavo 2011). Inactivating PDE11A gene mutations are also associated with the development of adrenal hyperplasia and Cushing syndrome (Libe et al. 2008), and with Carney complex (CNC). CNC is caused by germline mutations in the alpha regulatory subunit of PKA (PRKARIA) and is associated with endocrine tumors, including nodular adrenal hyperplasia and adrenal and testicular tumors (Levy et al. 2011;Libe et al. 2011). PDE11A mutations may also play a role in susceptibility to prostate cancer (Faucz et al. 2011) and testicular germ cell tumors (TGCT) (Horvath et al. 2009).
> ------------
>
> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4275405/
>
>
> https://en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia
>https://en.wikipedia.org/wiki/Angiotensin (Angiotensin I converting enzyme)
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