![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by glenn on April 8, 2003, at 11:40:48
Seeing as the issue of cortisol has reared its head again I just thought I would post my view that those of us with high or low cortisol get a raw deal.
It seems to me that we get shoved into a category which is not necessarily very accurate, ie depression, anxiety, chronic fatigue and then prescribed medications which do not really get to the nub of the problem chemically speaking.
I appreciate there is not yet a specific medication for cortisol problems and that ads, benzos etc may do something for some of our symptoms but we are always at risk it seems to me of being labelled a neurotic, trd or some other unhelpful label.
How many of you have had a doc suggest you have your cortisol levels checked, then if you have a problem ( after having ruled out cushings and addisons of course) were told that you have hypercortisolaemia or some similar name?
I don't think it is necessarily just a form of depression or anxiety, sure there are similarities but then again there are with lyme disease, anaemia etc, but you get properly directed treatment for them (hopefully)
Just look at all the hassle people with cfs had trying to get their condition recognised, and gulf war veterans!
This might change with ru-486 and the crf antagonists but it seems to me that as it has been recognised by some researchers that cortisol can be a cause and not just an effect of an illness it ought to have its own place and treatment stratagem.Please fee free to comment
Glenn
Posted by mattdds on April 8, 2003, at 19:05:58
In reply to IMHO Cortisol Club members get a raw deal!, posted by glenn on April 8, 2003, at 11:40:48
Hi,
I too was told that I had hypercortisolemia about a year and a half ago when I was in my worst stage. I was also a DST "non-suppressor".
Frankly, I am pretty skeptical that anyone's root problem is primary hypersecretion of cortisol. It seems MUCH more likely that high cortisol is occurring "downstream", therefore representing more of a biological marker for someone with severe anxiety / depression rather than the root cause of it all.
Also, unless they are being used to rule out Cushing's Syndrome from primary hypercortisolemia (from a pituitary adenoma or an adenoma or hypertrophy of the adrenal cortex), I really think cortisol and DST tests are worthless (and wasteful) from a clinical standpoint. It just gives an already stressed out person another thing to worry about. I actually spoke to an endocrinologist about this and she told me she thought that psychiatrists who try to determine how to treat depression based on serum cortisol or DST tests were "quacks". This being because knowing that one has high cortisol does not give any useful clinical information! It does not predict who will respond to a certain drug, or therapy, etc. So why do them and why worry about it? Sure, it is an interesting observation, but clinically, it is totally useless!
I see all these people on here worrying (and therefore increasing cortisol!) about their hypercortisolemia. Their worry creates distess and only exacerbates the problem. Do you see how this could become a self fulfilling prophecy? Oh no! I will never recover because I have the dreaded hypercortisolemia! I worried many nights about this, especially after reading about the hippocampal shrinkage business. Looking back, it was a waste of time to worry about this.
I'm sure there are countless brain chemicals that are out of whack during depression, but to say any one is the "cause" is not likely.
Don't mean to sound unsupportive, because, hey, I'm in the club too. I just think that we may be worrying about nothing, or at least missing the bigger picture, which involves a whole lot more than cortisol!
Thanks,
Matt
Posted by Pfinstegg on April 8, 2003, at 20:32:25
In reply to IMHO, Don't sweat the hypercortisolemia!, posted by mattdds on April 8, 2003, at 19:05:58
I do think that the basic abnormality in mood disorders is some kind of dysregulation of the HPA axis. But endocrinologists and psychopharmacologists both dislike feeling pressure to investigate this area clinically because they do not have a treatment to offer at the present time. The things we do have- all the AD's which exist now- are designed to make up for deficiencies in neurotransmitters in the interneuronal spaces which are caused by damage to hippocampal neurons by cortisol, glutamate and other mineralocorticoids- they are treating the end-results of a cascade of hormones, which is essential for life, but has become abnormal in degree in the mood disorders.
I think it is correct to focus on changes in CRF secretion in the hypothalamus as the starting point in this cascade of changes, which runs through the pituitary, then the adrenals and ends up by damaging the hippocampus in particular. Once the hippocampus is not secreting or taking up normal amounts of serotonin, norepinehrine or dopamine, the best psychopharmacologists can do at present is increase the concentrations of these substances in the intercellular spaces of the hippocampus by one or more of the AD's.
What I have really liked about these intermittent, but ongoing, discussions on PB, is that people here are focussing on what the basic abnormality in mood disorders really is. We all know that we don't yet have a treatment which can modulate CRF secretion, but there have been a number of valuable suggestions about things to do which may be somewhat neuroprotective of the hippocampus, and a few about things which may tend to reset the HPA axis a bit more towards normal. I find it valuable to know what the latest research is, and where it is leading, even though there isn't yet a really good treatment for me out there. If nothing else, I will know where to stand in line for a CRF modifier when one comes on the scene!
Pfinstegg
Posted by Ron Hill on April 8, 2003, at 21:53:28
In reply to Re: IMHO, Don't sweat the hypercortisolemia! » mattdds, posted by Pfinstegg on April 8, 2003, at 20:32:25
Pfinstegg,
We are truly fortunate to have a medical doctor of your stature willing to take time out of your busy day to provide such educational, thought provoking, and well written posts. Thank you Ms. Pfinstegg, M.D.
-- Ron
Posted by jerrympls on April 8, 2003, at 22:25:10
In reply to Re: IMHO, Don't sweat the hypercortisolemia!, posted by Ron Hill on April 8, 2003, at 21:53:28
My endo dr. has never mentioned "hypercortisolemia" - this is the first I've heard the term. However, I think my endo dr. passed the test when he told me exactly what some of you have already posted - that "there is currently no specific treatment for abnormalities in the cortisol/HPA axis." he's been willing to try certain replacement therapies with me because of my severe treatment-resistant depression and because I had a complete remission of my depression last summer when I was put on methylprednisolone (I think I spelled that correctly) during a bout of pneumonia.
He says "Let's try this and test levels again and if it helps and it's not going to hurt yo uin the long run, then great...."
so..we'll see.
Jerry
Posted by Pfinstegg on April 8, 2003, at 23:38:41
In reply to Re: IMHO, Don't sweat the hypercortisolemia!, posted by Ron Hill on April 8, 2003, at 21:53:28
Thank you, Ron- I do appreciate your warm comments. As you have probably gathered by now, as a person with quite severe PTSD, I feel I am gaining at least as much as I am able to offer by participating in this board. Most of what I've been able to learn has come from ideas and references originating right here. I think I have an excellent psychopharmacologist, but I can tell you that these ideas did not come from him!
Pfinstegg
Posted by glenn on April 9, 2003, at 4:37:31
In reply to Re: IMHO, Don't sweat the hypercortisolemia! » Ron Hill, posted by Pfinstegg on April 8, 2003, at 23:38:41
I am more impressed with jerrys endocrinologist than matts I have to say.
If an endocrinologist has carried out a study differentiating between those with high cortisol levels and those having normal or lowered levels and trying treatment based on this which failed, then fair enough, they may have the right to call others quacks.
If not then to beleive them seems to be putting your fate in the hands of someone very keen to dismiss others who are at least trying to further the treatment of a difficult illness.
I presume they are in part referring to Owen Wolkowicz, you might like to look up his work before you go along with a blanket condemnation of him!
I also wonder whether it might be that the sweating you refer to is in fact a causal factor in the cortisol levels rising in the first place,
yes of course further worrying will exacerbate this, but you do not seem to have come up with an alternative method for dealing with the high or low cortisol, ignoring it maybe!When a study is carried out which treats those who have abnormal cortisol levels with those methods known to counteract this ( be they pharmaceutical, natural supplemntal or herbal)
and this is proven to be a failure, then I will admit defeat on this.
One final point , I am rather fed up of having been treated by " downstream" methods such as ads,
if they do not work then it seems you are the problem! not the treatment method or the lack of knowledge on the medics part.
I take comfort in the australian guy who 20 years or so ago suggested that most ulcers were the result of helicobacter infestation. He was roudly condemned by the majority of docs who said that what you really needed to do was stress management, change your personality from type a to type b and swallow your zantac you naughty boy!Nowadays the prescription is almost always for metronidazole ( after a test for h/p of course)maybe with some zantac or similar med to strart with.
Now where have all those type a and b docs gone? haven't seen many recently?
Posted by mattdds on April 9, 2003, at 13:04:46
In reply to Re: IMHO, Don't sweat the hypercortisolemia!, posted by glenn on April 9, 2003, at 4:37:31
Hi Everyone,
I certainly didn't mean to sound unsupportive, I was just stating the opinion that has impressed me about this cortisol problem.
Obviously, there is something awry with the HPA axis in depression and anxiety. My argument was never that "it is all in your head" or anything like that. Obviously, there are true biological disturbances going on here.
However, the HPA axis does not exist in a vacuum. It is definitely not some autonomous organ that simply squirts out evil chemicals as it pleases. It receives inputs from many higher cortical centers. Most neurophysiologists subscribe to the so-called "James-Lange" theory of fear and anxiety conditioning. This theory holds that higher cortical areas (the parts from which conscious-level negative thoughts would arise) are the inputs that activate the HPA axis. Why would it have been evolutionarily advantageous to have a randomly firing HPA axis? I think eons of evolution have this organ more fine tuned than we think, much like the renal osmotic regulatory systems that we all possess.
The other (much less accepted) theory of HPA and ANS hyperarousal is the Cannon-Bard theory, which holds that sympathetic discharge preceeds cortical (higher awareness) perception of fear. But to me, this makes no sense whatsoever! Again, what primordial conditions would have favored animals with randomly-firing HPA axes?
To me the former theory makes much more sense from an evolutionary standpoint. First the potential threat information is gathered from the environment, and filtered through neural networks. If the belief systems (which arise from neural networks) calculate that a threat is present, then the animal's ANS and HPA axis would become activated. So the more things that we perceive to be threatening, based on our individual threat beliefs, the more the HPA axis is aroused.
So, the "stream", so to speak, in my opinion begins at the higher cortical centers, where beliefs originate. This seems pretty common sense to me. Many people (myself included) perceive so many things to be threatening (e.g. exams, projects at work, social situations, and so on), that their HPA axis is in a constant state of arousal! This becomes a vicious cycle, where the HPA axis becomes increasingly sensitive to any threat stimuli. It is a sick, viscious cycle!
I feel this is why my extreme (2 psychiatrists diagnosed me as TRD, as I failed EVERY class of antidepressants) depression responded so well to cognitive behavioral therapy. Because I, over the period of a year, have begun to "rewire" all those threat related beliefs, so I no longer perceive them to be harmful. This took a great deal of work! Slowly, I imagine, my HPA is beginning to calm down. This is certainly my subjective experience, as I FEEL much calmer and much less depressed. I would imagine that I would have by now converted to a DST supressor, and that my 24hr cortisols would be normal, corresponding with how I now feel. However, who knows? I haven't cared to check them, but it might be interesting.
So it is in this sense that I feel most pharmacological treatments (including the much awaited CRF antagonists in the pipeline) are "downstream" treatments. This is not to say they are not worthwhile and not helpful! They may quite possibly be quite helpful, perhaps miraculously so. Only time will tell. I am hoping they will be. I am for anything that helps, be it psychotherapy, ECT, pharmacology or otherwise. But I think without good psychotherapy, these treatments will be insufficient for many, and may be ignoring the underlying cause (negatively skewed perceptions of the world, at the cortical level...or beliefs). But again, this is all just my own speculation, and certainly open to criticism.
Please feel free to comment! I am not married to any of these ideas. Sorry it takes me so long to make a point, but I feel these are complicated problems.
Thanks again for the great discussion!
Matt
Posted by Peter S. on April 9, 2003, at 15:58:44
In reply to My hypothesis of the origin of HPA axis dysreg. , posted by mattdds on April 9, 2003, at 13:04:46
Hi Matt,
I think you've made some great points. I think the chemical stress handling systems in the brain/body and cognitive belief systems are closely entwined. However from my own personal experience, I have found psychotherapy (including years of cognitive behavioral therapy) to be only mildly effective. I must admit to feeling somewhat angry and betrayed after pumping so much money, effort, and time into something and getting very little benefit. When psychotherapy doesn't work there is always a psychological explanation like "resistance" or deep seated cognitive "schemas". This is an excuse to spend additional years in therapy and provide the therapist with a good living. Do you sense any bitterness?
Anyway I have to say that psychotherapy has definitely been of benefit to me. However I know that it has not addressed the fundamental issue. Anti-depressants have been the only things that have worked for me on a deep level. I wish it weren't so- I'm no fan of the pharmaceutical industry.
Anyway, that's my 2 cents. Would love to hear other opinions.
Peter
> Hi Everyone,
>
> I certainly didn't mean to sound unsupportive, I was just stating the opinion that has impressed me about this cortisol problem.
>
> Obviously, there is something awry with the HPA axis in depression and anxiety. My argument was never that "it is all in your head" or anything like that. Obviously, there are true biological disturbances going on here.
>
> However, the HPA axis does not exist in a vacuum. It is definitely not some autonomous organ that simply squirts out evil chemicals as it pleases. It receives inputs from many higher cortical centers. Most neurophysiologists subscribe to the so-called "James-Lange" theory of fear and anxiety conditioning. This theory holds that higher cortical areas (the parts from which conscious-level negative thoughts would arise) are the inputs that activate the HPA axis. Why would it have been evolutionarily advantageous to have a randomly firing HPA axis? I think eons of evolution have this organ more fine tuned than we think, much like the renal osmotic regulatory systems that we all possess.
>
> The other (much less accepted) theory of HPA and ANS hyperarousal is the Cannon-Bard theory, which holds that sympathetic discharge preceeds cortical (higher awareness) perception of fear. But to me, this makes no sense whatsoever! Again, what primordial conditions would have favored animals with randomly-firing HPA axes?
>
> To me the former theory makes much more sense from an evolutionary standpoint. First the potential threat information is gathered from the environment, and filtered through neural networks. If the belief systems (which arise from neural networks) calculate that a threat is present, then the animal's ANS and HPA axis would become activated. So the more things that we perceive to be threatening, based on our individual threat beliefs, the more the HPA axis is aroused.
>
> So, the "stream", so to speak, in my opinion begins at the higher cortical centers, where beliefs originate. This seems pretty common sense to me. Many people (myself included) perceive so many things to be threatening (e.g. exams, projects at work, social situations, and so on), that their HPA axis is in a constant state of arousal! This becomes a vicious cycle, where the HPA axis becomes increasingly sensitive to any threat stimuli. It is a sick, viscious cycle!
>
> I feel this is why my extreme (2 psychiatrists diagnosed me as TRD, as I failed EVERY class of antidepressants) depression responded so well to cognitive behavioral therapy. Because I, over the period of a year, have begun to "rewire" all those threat related beliefs, so I no longer perceive them to be harmful. This took a great deal of work! Slowly, I imagine, my HPA is beginning to calm down. This is certainly my subjective experience, as I FEEL much calmer and much less depressed. I would imagine that I would have by now converted to a DST supressor, and that my 24hr cortisols would be normal, corresponding with how I now feel. However, who knows? I haven't cared to check them, but it might be interesting.
>
> So it is in this sense that I feel most pharmacological treatments (including the much awaited CRF antagonists in the pipeline) are "downstream" treatments. This is not to say they are not worthwhile and not helpful! They may quite possibly be quite helpful, perhaps miraculously so. Only time will tell. I am hoping they will be. I am for anything that helps, be it psychotherapy, ECT, pharmacology or otherwise. But I think without good psychotherapy, these treatments will be insufficient for many, and may be ignoring the underlying cause (negatively skewed perceptions of the world, at the cortical level...or beliefs). But again, this is all just my own speculation, and certainly open to criticism.
>
> Please feel free to comment! I am not married to any of these ideas. Sorry it takes me so long to make a point, but I feel these are complicated problems.
>
> Thanks again for the great discussion!
>
> Matt
>
>
>
>
Posted by glenn on April 9, 2003, at 17:26:18
In reply to My hypothesis of the origin of HPA axis dysreg. , posted by mattdds on April 9, 2003, at 13:04:46
Great response Matt! ermm give me a few days to digest it and I'll get back to you lol
Glenn
Posted by mattdds on April 9, 2003, at 20:21:02
In reply to Re: My hypothesis of the origin of HPA axis dysreg. , posted by glenn on April 9, 2003, at 17:26:18
Peter,
Sorry to hear CBT didn't work for you. I can certainly understand how you would become bitter with psychotherapy, even with CBT!
I still hold the position that drugs can indeed be useful! Don't get me wrong. Perhaps even if it is "downstream", antidepressants or other psychotherapeutics can help to break the viscious cycle of worry, and the corresponding changes in the brain, whatever they may be. For example, the benzodiazepines were / are VERY useful for me, and they felt somemewhat "curative". I do hope that the CRF antagonists pan out as many of us are hoping, but I have serious doubts that this will be the silver bullet. For that matter, I really doubt that ANY one neurotransmitter will turn out to be the culprit.
Finally, even though I am obviously a CBT enthusiast, I don't think it is a panacea, and I do think (and strongly hope) that more advanced methods of changing deeply rooted self defeating beliefs / psychic kinks will eventually be developed. Perhaps it will be some sort of virtual reality program that "rewires" our brain through some sort of crazy A/V interface. Who knows? I just sometimes wish I were born about 400 years later, just to see what the future holds! So really, it is not CBT per se that I am so enthusiastic about. It is the idea of being able to manipulate neural networks in the brain so they interpret incoming data (i.e. LIFE) in a more productive and positive manner.
In sum, I view the brain (and therefore the mind that arises from it) as more of an electrical network, rather than a sack of chemicals. I feel that trying to target discreet chemicals represents a sort of "shotgun" approach, and that a cure, if it exists will more likely involve a "reprogramming" of sorts, much like a computer with faulty software. Obviously, we don't have the mechanism of delivery for this sort of approach, but CBT, to me, represents a primordial, tedious, and sometimes frustrating effort to rewire our brains. But I still definitely feel the possible benefits outweigh any difficulties, especially since you have nothing to lose! I wish there were an easier way to do this, but we're not there yet.
And hey, for right now, I appreciate the "shotguns" that we have, but feel that CBT, although crude, is more on track.
Again, comments (negative/positive) are welcome! Perhaps I am just totally whacked out here? Or does anyone else feel the same?
Thanks,
Matt
Posted by mattdds on April 9, 2003, at 20:46:08
In reply to CBT - a CRUDE way of rewiring your brain » glenn, posted by mattdds on April 9, 2003, at 20:21:02
Whoops,
The above message was for Peter, but I hope anyone who reads it feels free to comment on it.
Thanks,
Matt
Posted by Pfinstegg on April 10, 2003, at 7:50:14
In reply to OOPS - Above message was meant to be for Peter, posted by mattdds on April 9, 2003, at 20:46:08
That was an excellent post- I'm so glad you wrote it! We have all been talking about what goes wrong with the HPA axis, but not about what MAKES that occur. I have seen at least three other posters here comment on how much their anxiety and fear reactions, expecially, have diminished with CBT; all three were extremely enthusiastic about it, but also commented on how hard, continuous and tedious the work was- as you did.
I think some therapists working with PTSD feel that the original thought and stress reactions to trauma may originate in the left hemisphere, where they would be relatively accessible to conscious thinking, and modification by CBT. This would likely be true of later childhood and adult trauma. But there are also therapists who think that earlier childhood traumas are not very accessible to modification by words or thoughts, because the hemisphere used during the first three years of life is principally the right one. In this situation, non-verbal methods of treatment may be more powerful modulators of feeling states- for example, art therapy, EMDT, sensory integration therapy, and forms of psychotherapy which involve regression. Starting with these treatment modalities allows the brain to attach words to the traumatic memories- and then thought and feeling modification, as used in CBT, have a chance of being more useful.
To connect my own experience to this, I was able to get into remission from a long-term depression with TMS, plus fish oil, lots of all the vitamins, especially the Bs, exercise and meditation. However, I was aware of continuing hypervigilance, extreme startle reactions, and other signs of a nervous system set way too "high", and I felt that I needed to do something further to try to prevent relapse.
Because my principle trauma was the absence of my mother during the first four years of my life, I decided to see a psychoanalyst who specializes in early childhood PTSD and attachment disorders. He utilizes an art therapist as a co-therapist, and encourages benign regressions in which feeling-states are more important than words- although gradually, we do put things into words as best we can. In the two months that I have been doing this, I have noticed a tremendous calming-down inside me. I did return to being a DST suppressor after having TMS, but feel that this therapy is giving me the best chance of staying that way, and of, basically, helping my HPA axis function in a more normal manner. Of course, I don't know for sure- it just feels that way!Pfinstegg
Posted by Ritch on April 10, 2003, at 13:47:42
In reply to Re: CBT, psychotherapy and resetting the axis » mattdds, posted by Pfinstegg on April 10, 2003, at 7:50:14
....I think some therapists working with PTSD feel that the original thought and stress reactions to trauma may originate in the left hemisphere, where they would be relatively accessible to conscious thinking, and modification by CBT. This would likely be true of later childhood and adult trauma. But there are also therapists who think that earlier childhood traumas are not very accessible to modification by words or thoughts, because the hemisphere used during the first three years of life is principally the right one. In this situation, non-verbal methods of treatment may be more powerful modulators of feeling states- for example, art therapy, EMDT, sensory integration therapy, and forms of psychotherapy which involve regression. Starting with these treatment modalities allows the brain to attach words to the traumatic memories- and then thought and feeling modification, as used in CBT, have a chance of being more useful.....
Pfinstegg, I realize this is somewhat of a tangent, but you have given me some interesting ideas about the *causes* of the cortisol-stress-reaction thing and resultant HPA-axis dysregulation. Would it be accurate to say that MOST of the jobs that people work at in modern times more consistently use the left-hemisphere instead of the right? And this is continuining to become more and more the case? What if your job is *reprogramming* your brain circuits in a manner that is making you ill, because it is forcing you to use the left hemisphere (i.e.), more than your brain has been "designed" to? This might result in abnormal brain chemistry due to environmental re-programming. Perhaps a significant minority of folks with HPA-axis dysregulation and resultant depression/anxiety (which respond to "right-brained" therapies) would benefit from a career change (IOW, getting away from experiences that are causing them harm)? I've noticed that medications that tend to increase ruminative thoughts make me feel worse, and meds that seem to accentuate music or smell make me feel better.
Another weird thing I have noticed while working. A computer workstation I am very familiar with got moved to a different location and orientation. I had difficulty for several days doing the same tasks on the same machine just because it was in a different part of the room and oriented in a different way.
Posted by pelorojo on April 10, 2003, at 17:34:21
In reply to Re: CBT, psychotherapy and resetting the axis » mattdds, posted by Pfinstegg on April 10, 2003, at 7:50:14
Hi there Pfinstegg -
I thought this was very insightful and it caught my interest as I also have PTSD from early childhood (though mine continued through to adulthood). I have an "avoidant" attachment style and right now have depression (more of the atypical variety, with anhedonia) sitting on top of the PTSD and "avoidant" pieces. Forgive my ignorance, but what is the "TMS" you mention below (and DST suppressor)? Also, how did you find a therapist that specialized in these areas? How much "bang for the buck" did you get with the art therapy?Thanks so much for anything you can add.
> That was an excellent post- I'm so glad you wrote it! We have all been talking about what goes wrong with the HPA axis, but not about what MAKES that occur. I have seen at least three other posters here comment on how much their anxiety and fear reactions, expecially, have diminished with CBT; all three were extremely enthusiastic about it, but also commented on how hard, continuous and tedious the work was- as you did.
>
> I think some therapists working with PTSD feel that the original thought and stress reactions to trauma may originate in the left hemisphere, where they would be relatively accessible to conscious thinking, and modification by CBT. This would likely be true of later childhood and adult trauma. But there are also therapists who think that earlier childhood traumas are not very accessible to modification by words or thoughts, because the hemisphere used during the first three years of life is principally the right one. In this situation, non-verbal methods of treatment may be more powerful modulators of feeling states- for example, art therapy, EMDT, sensory integration therapy, and forms of psychotherapy which involve regression. Starting with these treatment modalities allows the brain to attach words to the traumatic memories- and then thought and feeling modification, as used in CBT, have a chance of being more useful.
>
> To connect my own experience to this, I was able to get into remission from a long-term depression with TMS, plus fish oil, lots of all the vitamins, especially the Bs, exercise and meditation. However, I was aware of continuing hypervigilance, extreme startle reactions, and other signs of a nervous system set way too "high", and I felt that I needed to do something further to try to prevent relapse.
> Because my principle trauma was the absence of my mother during the first four years of my life, I decided to see a psychoanalyst who specializes in early childhood PTSD and attachment disorders. He utilizes an art therapist as a co-therapist, and encourages benign regressions in which feeling-states are more important than words- although gradually, we do put things into words as best we can. In the two months that I have been doing this, I have noticed a tremendous calming-down inside me. I did return to being a DST suppressor after having TMS, but feel that this therapy is giving me the best chance of staying that way, and of, basically, helping my HPA axis function in a more normal manner. Of course, I don't know for sure- it just feels that way!
>
> Pfinstegg
Posted by Pfinstegg on April 11, 2003, at 11:08:07
In reply to Re: CBT, psychotherapy and resetting the axis » Pfinstegg, posted by Ritch on April 10, 2003, at 13:47:42
Hi Ritch.. I don't think you are alone in thinking that your work is utiliizing your left hemisphere- pretty much all the work that we all do requires a lot of left hemisphere work, and not much input from the right, unless, of course, one is an artist, architect, dancer, musician, etc- those lucky people get to use both hemispheres most of the time.
I do think that people working with computers may particularly feel a lack of emotion, spontaneity,connectedness to others and physical relaxation. It is hard, lonely, very detailed work. Short of changing careers, I suppose the best thing to do is to fill in your free hours with activities which allow the other parts of you to be fully engaged- music, dance, art, warm relationships with others, and sports where you get in closer touch with your own body. But I should say that all of us in today's world are challenged in our efforts to try to live full and balanced lives, using as much as we can of what we have inside of us. Time seems to be the biggest roadblock!
Pfinstegg
Posted by Pfinstegg on April 11, 2003, at 11:38:35
In reply to Re: CBT, psychotherapy and resetting the axis » Pfinstegg, posted by pelorojo on April 10, 2003, at 17:34:21
Hi Pelorojo.. Because I had gotten severely depressed and anxious, as a sequel to the childhood trauma, I had a course of Transcranial Magnetic Stimulation- a newer form of shock therapy utilizing electromagnetic waves. One of the physiological markers of the depression I had was that I did not suppress my cortisol output after a challenge dose of dexamethasone- the DST non-suppression.
Finding the right therapist took some searching. I began with a local Psychoanalytic Institute(I live in a large city), and asked for an analyst specifically trained in treating attachment disorders. I was pleasantly surprised to find that psychoanalysis has changed a great deal in the last 10-15 years- away from Freudian ideas and towards a very interactive style. The treatment I am having is face-to face, with a great deal of the work involving talking about what is happening, in thoughts and feelings, between the analyst and me from moment to moment. It is still very new to me, but I think it is having a powerful effect in resolving the feeling I had of being irreparably damaged by the trauma which occurred in childhood.
As to the art therapy, I go to that just occasionally.But when I do go, I am amazed at the powerful memories and feelings which are evoked; it always seems to have the effect of focussing and deepening the psychotherapy.
All of this is very hard on one's budget, but I feel that what I am getting is beyond price.
Posted by Ritch on April 11, 2003, at 11:56:13
In reply to Re: CBT, psychotherapy and resetting the axis » Ritch, posted by Pfinstegg on April 11, 2003, at 11:08:07
> Hi Ritch.. I don't think you are alone in thinking that your work is utiliizing your left hemisphere- pretty much all the work that we all do requires a lot of left hemisphere work, and not much input from the right, unless, of course, one is an artist, architect, dancer, musician, etc- those lucky people get to use both hemispheres most of the time.
>
> I do think that people working with computers may particularly feel a lack of emotion, spontaneity,connectedness to others and physical relaxation. It is hard, lonely, very detailed work. Short of changing careers, I suppose the best thing to do is to fill in your free hours with activities which allow the other parts of you to be fully engaged- music, dance, art, warm relationships with others, and sports where you get in closer touch with your own body. But I should say that all of us in today's world are challenged in our efforts to try to live full and balanced lives, using as much as we can of what we have inside of us. Time seems to be the biggest roadblock!
>
> Pfinstegg
Thanks for responding! When I was working my way through college I did a lot of construction work to make extra money and I felt SOOO much clearer-headed and generally cheerful. Entrance into the cubicle world made me feel depersonalized, disoriented. Getting off work was like emerging from a dark theatre in daytime from a bad movie. I slowly became accustomed to that feeling and I don't even notice those effects now. Meds are fine tuned better than ever, but I really wonder if I wasn't "doing negative CBT" at my job if it would make a big difference. Hmmm. Maybe this is what the "simplicity movement" is all about ....
Posted by pelorojo on April 11, 2003, at 11:59:59
In reply to Re: CBT, psychotherapy and resetting the axis » pelorojo , posted by Pfinstegg on April 11, 2003, at 11:38:35
Posted by worrier on April 15, 2003, at 20:50:09
In reply to My hypothesis of the origin of HPA axis dysreg. , posted by mattdds on April 9, 2003, at 13:04:46
> Hi Everyone,
>
> I certainly didn't mean to sound unsupportive, I was just stating the opinion that has impressed me about this cortisol problem.
>
> Obviously, there is something awry with the HPA axis in depression and anxiety. My argument was never that "it is all in your head" or anything like that. Obviously, there are true biological disturbances going on here.
>
> However, the HPA axis does not exist in a vacuum. It is definitely not some autonomous organ that simply squirts out evil chemicals as it pleases. It receives inputs from many higher cortical centers. Most neurophysiologists subscribe to the so-called "James-Lange" theory of fear and anxiety conditioning. This theory holds that higher cortical areas (the parts from which conscious-level negative thoughts would arise) are the inputs that activate the HPA axis. Why would it have been evolutionarily advantageous to have a randomly firing HPA axis? I think eons of evolution have this organ more fine tuned than we think, much like the renal osmotic regulatory systems that we all possess.
>
> The other (much less accepted) theory of HPA and ANS hyperarousal is the Cannon-Bard theory, which holds that sympathetic discharge preceeds cortical (higher awareness) perception of fear. But to me, this makes no sense whatsoever! Again, what primordial conditions would have favored animals with randomly-firing HPA axes?
>
> To me the former theory makes much more sense from an evolutionary standpoint. First the potential threat information is gathered from the environment, and filtered through neural networks. If the belief systems (which arise from neural networks) calculate that a threat is present, then the animal's ANS and HPA axis would become activated. So the more things that we perceive to be threatening, based on our individual threat beliefs, the more the HPA axis is aroused.
>
> So, the "stream", so to speak, in my opinion begins at the higher cortical centers, where beliefs originate. This seems pretty common sense to me. Many people (myself included) perceive so many things to be threatening (e.g. exams, projects at work, social situations, and so on), that their HPA axis is in a constant state of arousal! This becomes a vicious cycle, where the HPA axis becomes increasingly sensitive to any threat stimuli. It is a sick, viscious cycle!
>
> I feel this is why my extreme (2 psychiatrists diagnosed me as TRD, as I failed EVERY class of antidepressants) depression responded so well to cognitive behavioral therapy. Because I, over the period of a year, have begun to "rewire" all those threat related beliefs, so I no longer perceive them to be harmful. This took a great deal of work! Slowly, I imagine, my HPA is beginning to calm down. This is certainly my subjective experience, as I FEEL much calmer and much less depressed. I would imagine that I would have by now converted to a DST supressor, and that my 24hr cortisols would be normal, corresponding with how I now feel. However, who knows? I haven't cared to check them, but it might be interesting.
>
> So it is in this sense that I feel most pharmacological treatments (including the much awaited CRF antagonists in the pipeline) are "downstream" treatments. This is not to say they are not worthwhile and not helpful! They may quite possibly be quite helpful, perhaps miraculously so. Only time will tell. I am hoping they will be. I am for anything that helps, be it psychotherapy, ECT, pharmacology or otherwise. But I think without good psychotherapy, these treatments will be insufficient for many, and may be ignoring the underlying cause (negatively skewed perceptions of the world, at the cortical level...or beliefs). But again, this is all just my own speculation, and certainly open to criticism.
>
> Please feel free to comment! I am not married to any of these ideas. Sorry it takes me so long to make a point, but I feel these are complicated problems.
>
> Thanks again for the great discussion!
>
> Matt
>
>
>
>
>Just want to throw in a little comment on your theory...while I agree that from an evolutionary view point the random activity of the HPA axis doesn't seem to make much sense, remember that not all traits that are expressed are adaptive. They may be highly maladaptive, but linked to another trait that is adaptive and thus continue to be expressed in some individuals. I myself feel that for me, at least most of the time, I experience the physical symptoms first and interpret them as anxiety, which probably increases the physical symptoms which increases the anxiety and 'round and 'round we go. My cortisol levels, both blood and 24hr urine are quite high and when my doc rechecked they were even higher which I could have predicted based on how I felt (physically, nothing had changed in my mood or environment). Have an appointment with an endocrinologist next week...we'll see what she thinks. Guess I'm really just playing devils advocate and possibly looking for an easy way out of my problem (its just my malfunctioning HPA axis, give me a pill to fix it.... but the point remains that just because something doesn't seem to make evolutionary sense on the surface doesn't mean it can't exist.(eg. the gene for sickle-cell anemia). Worrier.
This is the end of the thread.
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